Evaluation of rejection causes based from preanalytic origin in our emergency laboratory

Abstract

ÖZAmaç: Laboratuvardaki toplam hataların büyük çoğunluğunu preanalitik evre hataları oluşturur (%46-68). Bu çalışmanın amacı, acil laboratuvarımızdaki bazı test gruplarına ilişkin reddedilen örneklerin oranlarını ve nedenlerini araştırmaktı. Yöntem: Çalışma Kasım 2014 ve Nisan 2015 tarihleri arasında reddedilen örnekler üzerine planlandı ve acil laboratuvarındaki 6 test grubu (klinik kimya, ilaç düzeyi, kardiyak belirteçler, koagülasyon, eritrosit sedimantasyon hızı, tam idrar tetkiki) dâhil edildi. Numunelerin toplam sayısı ve reddedilen örnekler, hastane bilgi sisteminden retrospektif olarak elde edildi. Hatalar test grubuna, örnek tipine ve ret nedenlerine göre sınıflandırıldı. Bulgular: Altı aylık dönemde acil laboratuvarımıza toplam 144387 numune geldiği belirlendi. Numunelerin %1,14'ü preanalitik hatalar nedeniyle reddedildi. Yanlış kodlama en sık ret nedeni olarak bulundu (%22,9). Fazla kodlama, hemoliz ve yetersiz numune ret oranları ise sırasıyla %20,2, %17, %12,5 olarak belirlendi. Sonuç: Çalışmamızda preanalitik hataların en sık nedeni test istem hataları idi. Tıbbi sekreterlerin eğitimi bu sorunu çözüme kavuşturulabilir.Anahtar kelimeler: Preanalitik değişkenler, numunelerin reddedilmesi, laboratuvar hataları, klinik laboratuvar ABSTRACT Objective: Preanalytical phase errors constitute the majority of the total number of errors in the laboratory (46-68%). The aim of this study was to investigate the causes and rates of rejected samples in certain test groups in our emergecy laboratory. Methods: This study was designed on the samples rejected between November 2014 and April 2015 and six test groups examined in emergecy laboratory (clinical chemistry, drug level, cardiac markers, coagulation, erythrocyte sedimentation rate, complete urinalysis) were included in the study. The total number of specimens and rejected samples were obtained from the Hospital Information System retrospectively. Laboratory errors were classified by test groups, specimen types and causes of specimen rejection. Results: The study was planned on 144887 blood samples sent to our emergency laboratory within six months between November 2014 and April 2015 and 1.14% of them were rejected because of preanalytical errors. Erroneous coding was found as the most common cause of rejection (22.9%). Rejection rates for extraneous coding, hemolysis and insufficient volume were found to be 20.2%, 17% and 12.5%, respectively. Conclusions: In our study, test request errors were the most common causes of preanalytical errors. Education of medical secretaries can solve this problem.

The Effects of Education and Training Given to Phlebotomists for Reducing Preanalytical Errors

“…After the training, a significant enhancement observed in the rates of these two errors, but no improvement/decrease seen in other ones. In the study performed by Aksit et al (20) in our hospital, it has been reported that the most common cause of preanalytical errors was the test request errors and the training of medical secretaries could solve this problem. The main reasons for ‘test request errors’ which was found to have been the most reject rate in our study were observed such as: the codes of the parameters used in our hospital’s emergency laboratory had diversity, test requests coming from services and intensive care units during out of working hours were being putting in process by the secretaries working in emergency services, appointment of medical secretaries in emergency laboratories who were employed in different departments, who were newly employed or who did not have a HIS training.…”

Laboratuvarlar Tarafından Reddedilen Hasta Numunelerinin Kök Neden Analizi: 21 Adım Uygulaması Örneği

“…In studies conducted in Turkey, there are studies in which the sample rejection rate ranges from 1 to 1.30% (17,18,30,31). There are also studies where the rejection rate is between 0.3% and 0.7% (32)(33)(34)(35)(36).…”

“…In the study, it was observed that the vacuum system, which draws blood to a sufficient level, is not common, especially in services. It is known that the risk of hemolysis also increases, as the risk of blood entering the injector hitting the wall of the tube with pressure increases due to the absence of a vacuum system (17). In this context, the identified improvement activities are presented in Table 1.…”

“…Inappropriate sample rejection is an important step for patient safety in the laboratory (15) and is a very common condition (16). Data obtained from rejected samples is a quality indicator of the preanalytical process (17). At this point, for accurate and reliable results, it is necessary to analyze retrospectively, to identify errors, to identify and implement corrective preventive actions, and to constantly evaluate the effectiveness of the measures taken (18).…”