Golniški simpozij 2011 Zbornik povzetkov

Patient safety – the preanalytical
impact on quality of laboratory reports
Pika Meøko Brguljan
University Clinic for Respiratory Diseases and Allergy Golnik, Clinical Chemistry Department, Golnik,
Slovenia
Patient safety, the freedom from accidental or unnecessary harm due to adverse events occurring in
any healthcare setting, directly affects the quality of care. The Institute of Medicine (IOM) report, To err
is human, dramatically increased level of concern about adverse events and patient safety in healthcare,
including errors in laboratory medicine (1). Even a low incidence of laboratory mistakes among
the billions of tests performed every day worldwide could have important public health and patient
safety implications. While the IOM report presented few data on errors in laboratory medicine, it has
wide-reaching implications for all disciplines. The IOM report, Crossing the quality chasm (2), stressed
the concept of patient-centered care and the fact that complex systems are characterized by specialization
and interdependency. The evidence reported can be translated into a better understanding of
the importance of the total testing process (TTP) – preanalytical, analytical and postanalytical, as the
right framework for patient safety in laboratory medicine. The TTP consists of a series on interrelated
processes, each involving a series of a process step, every one of which can result in an error (3).
In the last years, in our laboratory many strategies are used to reduce errors, such as improved laboratory
technology, internal quality control procedures, external quality assurance programs, educational
programs, licensing of laboratory professionals, certification of laboratory (as the part of our
clinic’s ISO 9001:2000 and DNV accreditation certificates). Laboratory also fulfil the Slovenian regulatory
requirements in laboratory medicine and gain the working license in the year 2009. In the
past, the preanalytical phase has been often overlooked as a source of errors, evidence from recent
studies shows that a large percentage of laboratory errors occur in the preanalytical steps (4). In the
laboratory several steps have already been taken to increase awareness and establish a governance
of the preanalytical aspect of laboratory processes. Standardization and monitoring of the most common
preanalytical errors have been implemented in the every-day work in the laboratory. Quality indicators
and the error monitoring system of the preanalytical phase are tools that can be used to
supervise the activity carried out in the laboratory and activities in relation to the clinical laboratory.
Till the data are collected and corrective actions, such as education of staff on preanalytical issues,
have been taken, a big improvement in fulfilment of the quality specifications have been detected.
The interdisciplinary approach to manage the quality of the preanalytical phase is a good approach
to avoid and reduce laboratory errors in TTP. In the future our aim is to integrate more effective error
tracking and quality indicator reporting system to our laboratory informaton system (LIS). Continuous
actions for all involved in the processes and move from error reporting to risk managament is of extreme
importance for patient safety.
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