Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)

Abstract

Abstract:It is now undeniable that laboratory testing is vital for the diagnosis, prognostication and therapeutic monitoring of human disease. Despite the many advances made for achieving a high degree of quality and safety in the analytical part of diagnostic testing, many hurdles in the total testing process remain, especially in the preanalytical phase ranging from test ordering to obtaining and managing the biological specimens. The Working Group for the Preanalytical Phase (WG-PRE) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has planned many activities aimed at mitigating the vulnerability of the preanalytical phase, including the organization of three European meetings in the past 7 years. Hence, this collective article follows the previous three opinion papers that were published by the EFLM WG-PRE on the same topic, and brings together the summaries of the presentations that will be given at the 4th EFLM-BD meeting "Improving quality in the preanalytical phase through innovation" in Amsterdam, 24-25 March, 2017.

Impact of Educational Activities in Reducing Pre-Analytical Laboratory Errors: A quality initiative

“…Maintenance of the blood/additive ratio is extremely important and insufficient blood quantities can contribute to wastage and errors, necessitating repeat sampling and at times resulting in unnecessary delays in instituting therapy. 6 The appointment of specialist nurse phlebotomists at SQUH would not only help in reducing preanalytical laboratory errors, but would also reduce the current burden on nursing staff working in special areas like intensive care units, day care facilities and delivery wards, as well as encourage job creation within the healthcare system in Oman. One limitation of the current study was that no proper objective method was used to quantatively assess non-conforming samples.…”

“…Recently, the European Federation of Clinical Chemistry and Laboratory Medicine highlighted the importance of such measures by initiating a special working group to provide official guidelines and recommendations regarding preanalytical activities and enable continuous education for laboratory professionals and other healthcare operators. 6 It is the responsibility of each laboratory provider to assess the impact of such errors and institute corrective measures as part of their quality improvement procedures in order to ensure credible diagnostic results. These corrective measures should be aimed at eliminating common causes of nonconforming samples to prevent their occurrence and include advances in information technology, appropriate and timely quality control measures and continuous education for healthcare personnel.…”

“…These corrective measures should be aimed at eliminating common causes of nonconforming samples to prevent their occurrence and include advances in information technology, appropriate and timely quality control measures and continuous education for healthcare personnel. 6,7 Educating nursing staff on blood sample handling and processing procedures has been recognised as a vitally important step in reducing pre-analytical errors. 7 At the Sultan Qaboos University Hospital (SQUH), a tertiary care centre and one of the main referral hospitals in Muscat, Oman, blood samples are collected almost exclusively by nurses.…”

The EFLM strategy for harmonization of the preanalytical phase

“…This has been developed through the participation of WG-PRE members in many national and international meetings about harmonization and standardization in laboratory medicine, and also through the organization of an international, joint EFLM-Becton Dickinson meeting every 2 years. The first meeting was organized in Parma (Italy) in 2011 (~300 participants) [40], the second in Zagreb (Croatia) in 2013 (~500 participants) [41], the third in Porto (Portugal) in 2015 (~600 participants) [42], the fourth (as yet) being organized in Amsterdam (The Netherlands) in 2017 (over 600 participants) [43] and the next one scheduled in Munich (Germany), in Spring 2019. The full programs of these meetings are available in a dedicated website [44].…”

Harmonization in laboratory medicine: more than clinical chemistry?

“…The use of harmonized standard operating procedures (SOP), assuring multiple identifiers, as well as automated systems for patient/sample identification and information technology facilities, should obviate the risks of patient misidentification and "wrong blood in tube", true nightmares for any clinical laboratory [21]. Major advancements have been achieved in standardizing patient preparation, sample collection and handling procedures, thanks also to the efforts of working groups, in particular, the WG-PRE of the EFLM [22][23][24][25][26][27]. Finally, further work to optimize and standardize sample transportation procedures [28,29], and to harmonize criteria for evaluating the quality of biological samples and accepting/rejecting them has been largely promoted and reported, also by means of automated workstations and serum indexes [30,31].…”