High preanalytical non-compliance and samples rejection rate in clinical biochemistry laboratory are decreased by nurse staff training in phlebotomy and sample handling
DOI:
https://doi.org/10.30574/gscbps.2020.13.3.0400Keywords:
Preanalytical phase, Sample non-compliances, Staff training in phlebotomyAbstract
Background: Preanalytical phase of biomedical analysis remains an important source of diagnostic errors that deserves special attention. This study aims to evaluate the training in phlebotomy and sample handling impact on the preanalytical non-compliances.
Material and Methods: we performed a prospective study before and after staff training in phlebotomy and sample handling by systematically recording all clinical samples non-compliances. First, we assessed and describe the non-compliance baseline rate from January to December 2017 in the clinical biochemistry laboratory of Hôpital Sominé DOLO de Mopti. After two sessions of one week staff training in January 2018, we performed the same study from January to December 2018. We compared the proportions of non-compliances between the two assessments. Data were collected on the case report forms, captured in Excel and analyzed by R software for (Mac) OS X version 4.0.3. Pearson Ch2 or Fisher exact tests were used for the comparison of proportions. The statistical significance was set at p < 5%.
Results: a total of 27,810 venous blood samples were received during the study period; 48% was for biochemistry, 41% for immuno-serology, 9% for blood cell count and 2% for coagulation tests. There were 3,826 instances of preanalytical non-compliances (13.76%) identified that led to sample rejection. Out of the 11 types of non-compliances investigated, 5 (45.4%) accounted for nearly 91% of the problems: insufficient sample volume (28.9%), hemolyzed samples (20.5%), inappropriate collection time (17.8%), sample clot (12.9%), and inappropriate sample collection tube (10.8%). We observed a significant difference in rates of non-compliance between inpatients and outpatients samples (44.4% vs 7.3%; p < 0.001). The proportion of non-compliance have significatively decreased after the two training sessions of hospital staff in phlebotomy and sample handling 3,826/27,810 (13.8%) vs 3,009/32,476 (9.3%); p < 0.001.
Conclusion: we report a significantly higher rate of non-compliance in inpatients. Hospital staff training in phlebotomy and sample handling reduce the proportion of preanalytical non-compliance and thereby improve patient management and safety.
Metrics
References
Kevin Olsen . The first 110 years of laboratory automation: technologies, applications, and the creative scientist. Lab Autom. Dec 2012; 17(6): 469-80.
Plebani M. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Biochem Rev. 2012; 33: 85–88.
Plebani M, Sciacovelli L, Aita A. Harmonisation of pre-analytical quality errors. Biochem Med. 2014; 24: 105–113.
Giuseppe Lippi, Janne Cadamuro. Novel Opportunities for Improving the Quality of Preanalytical Phase. A Glimpse to the Future? J Med Biochem. 28 Oct 2017; 36(4): 293-300.
International Organization for Standardization. ISO 15189:2012: Medical laboratories: particular requirements for quality and competence. Geneva, Switzerland: International Organization for Standardization. 2012.
Laura Sciacovelli, Giuseppe Lippi, Zorica Sumarac, Isabel Garcia Del Pino Castro, Agnes Ivanov, Vincent De Guire, Cihan Coskun. Working Group “Laboratory Errors and Patient Safety” of IFCC. Pre-analytical quality indicators in laboratory medicine: Performance of laboratories participating in the IFCC working group "Laboratory Errors and Patient Safety" project. Clin Chim Acta. Oct 2019; 497: 35-40.
Sintayehu Ambachew, Kasaw Adane, Abebaw Worede, Tadele Melak, Daniel Asmelash, Shewaneh Damtie, Habtamu Wondifraw. Errors in the Total Testing Process in the Clinical Chemistry Laboratory at the University of Gondar Hospital, Northwest Ethiopia. Ethiop J Health Sci. Mar 2018; 28(2): 235-244.
Ma Jesús Alsina, Virtudes Alvarez, Núria Barba, Sandra Bullich, Mariano Cortés, Irene Escoda, Cecília Martínez-Brú. Preanalytical quality control program - an overview of results (2001-2005 summary). Clin Chem Lab Med. 2008; 46(6): 849-54.
Alexandre C Guimarães, Marilei Wolfart, Maria L L Brisolara, Caroline Dani. Causes of rejection of blood samples handled in the clinical laboratory of a University Hospital in Porto Alegre. Clin Biochem. Jan 2012; 45(1-2): 123-6.
Güzin Aykal, Mustafa Keşapli, Özgür Aydin, Hatice Esen, Ayşenur Yeğin, Faruk Güngör, Necat Yilmaz. Pre-Test and Post-Test Applications to Shape the Education of Phlebotomists in A Quality Management Program: An Experience in a Training Hospital. Biochem. Sep 2016; 35(3): 347-353.
Lourens A Jacobsz, Annalise E Zemlin, Mark J Roos, Rajiv T Erasmus. Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town. Clin Chem Lab Med. Oct 2011 14; 49(12): 2047-50.
Zeliha Gunnur Dikmen, Asli Pinar, Filiz Akbiyik. Specimen rejection in laboratory medicine: Necessary for patient safety? Biochem Med (Zagreb). 15 Oct 2015; 25(3): 377-85.
Giuseppe Lippi, Antonella Bassi, Giorgio Brocco, Martina Montagnana, Gian Luca Salvagno, Gian Cesare Guidi. Preanalytic error tracking in a laboratory medicine department: results of a 1-year experience. Clin Chem. Jul 2006; 52(7): 1442-3.
Maria Salinas, Maite López-Garrigós, Emilio Flores, Ana Santo-Quiles , Mercedes Gutierrez, Javier Lugo, Rosa Lillo. Ten years of preanalytical monitoring and control: Synthetic Balanced Score Card Indicator. Biochem Med (Zagreb). 2015; 25(1): 49-56.
Ana-Maria Simundic, Nora Nikolac, Ines Vukasovic, Nada Vrkic. The prevalence of preanalytical errors in a Croatian ISO 15189 accredited laboratory. lin Chem Lab Med. Jul 2010; 48(7): 1009-14.
Cheryl M Coffin, Marilyn S Hamilton, Theodore J Pysher, Philip Bach, Edward Ashwood and al. Pediatric laboratory medicine: current challenges and future opportunities. Am J Clin Pathol. May 2002; 117(5): 683-90.
Cai Q, Zhou Y, Yang D. Nurses' knowledge on phlebotomy in tertiary hospitals in China: a cross-sectional multicentric survey. Biochem Med (Zagreb). 15 Feb 2018; 28(1): 010703.
Fatma Demet Arslan, Inanc Karakoyun, Banu Isbilen Basok, Merve Zeytinli Aksit, Esma Celik, Kemal Dogan, Can Duman. The Effects of Education and Training Given to Phlebotomists for Reducing Preanalytical Errors. J Med Biochem.1 Apr 2018; 37(2): 172-180.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.