Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

Abstract

IntroductionThe aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia.Materials and methodsThis paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100).ResultsIn investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96).ConclusionFirst two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.

Joint EFLM-COLABIOCLI recommendation for venous blood sampling

“…Given the risk associated with the use of reusable tourniquets and the quality of available evidence, we have graded this recommendation as 1A. Unfortunately, disposable tourniquets are not widely used, especially in some developing or non-developed countries [53]. Hospital management should be made aware of the risk associated with the use of reusable tourniquets and potential benefit of the use of disposable tourniquets for the safety of the patients and healthcare staff.…”

Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project

“…Laboratories in the UK and Ireland would reject 40% of results above the cut-off point automatically [29]. Nikolac et al [30] showed that 136 out of 159 laboratories (86%) would reject a potassium result in a sample with hemolysis of 0.5 g/L, while in our study, 72% of laboratories would reject a potassium test result in a sample with hemolysis of 1 g/L. The different actions taken by laboratories may indicate that they might apply less stringent quality criteria for some analytes to prevent rejection of test results, and therefore to a larger extent rely on local performance studies or apply cut-off points based on clinical needs [23,[31][32][33].…”

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)

“…One such initiative was recently described in a study summarizing results from six rounds of preanalytical EQA during 2014-2016 in 175 Croatian laboratories, which showed that major critical spots during phlebotomy in Croatia were the lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes. The data may obviously differ from country to country, pointing to the need for more engagement of national professional associations in this area to assess the local specificities and requirements [56].…”