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Transcript of Laboratory Errors
Handling of the sample and sample information before any testing begins
Collection, test requisition (from the dr), transportation, specimen drop-off, specimen distribution
: Improperly obtaining the specimen (e.g. miss-timing a 24 hour urine)
: Improperly transporting and storing the specimen (e.g. not storing a campy plate at 42C)
: Improperly labeling and distributing the specimen (e.g. labeling a urine as a CSF)
Testing the sample using a universally acceptable method
Cell differentials, clinitest, platelet assay, blood type compatibility testing, liver enzyme tests, microbial testing etc.
Can have extreme consequences
Errors may not be easily caught
: manually put results into computer without a double check
Over 40 yrs errors were decreased by 1/20th
Acurate/precise technologies like
: Not following the procedure correctly from miss-reading or remembering it incorrectly (e.g. pipetting 50 uL instead of 5.0)
: Exhibiting improper identification or technique when processing a sample (e.g. calling myeloblast a monocyte
: Testing the wrong patient (e.g. pipetting patient serum A into the test tube for patient B)
: Improperly verifying that instrument run testing is correct (e.g. allowing an impossibly high glucose to be charted)
: Improperly recording the results into the computer (e.g. typing m
crocytosis instead of m
Critical Reporting error
: Failing to call the doctor when a critical value is flagged (e.g. glucose of 420 not called)
: The doctor improperly interprets the report due to formatting or other causes (e.g. form lists nitr
tes instead of nitr
Handling of the sample and sample information after testing is completed
Transferring results into the computer, reporting of critical values, doctor interpreting the results
Know the three main categories of lab errors and how often they occur
Examples of each error type
Know about consequences of the errors
Be able to recognize which error is being committed and exactly why it is wrong
" An act that through ignorance, deficiency, or accident departs from or fails to achieve what should be done
Lab errors cost
$17 billion-$29 billion
Three kinds of Errors:
In which stage of sample processing
do you think that most errors occur?
Some errors are more consequential than others
Most errors occur during this stage, but many of those errors are caught in later stages
labeled as a CSF
: observation of
looks nothing like a CSF
Case Study Question
A doctor suspected a patient had a parasitic infection and ordered an ova and parasite test. The patient filled the three non sterile containers with stool before he went to bed. After it sat in his bathroom overnight he dropped the samples off at the hospital which were taken to the lab to be tested.
What is the pre-analytical error?
Error with sample collection
: parasitic stool sample needs three samples from
three separate days
: non-sterile container and waiting time
A tech is performing a cell differential. She focuses the microscope on 50x and begins. When performing the differential she is interrupted by a coworker, but later returns to the microscope to report its results. She types into the computer 6 monocytes, 1 eosinophil, 32 lymphocytes and 52 segs.
What is the error?
: She did not count
6+1+32+52 = 91
91 =/= 100
: individual cell counts
Can be extremely serious
Errors can no longer be caught before getting to the patient, last step
A lab tech is sitting at the command center in chemistry and notices a critical glucose flagged of 38 mg/dL. The tech calls the nurse in charge of that patient who reads back the result. The nurse's shift is ending so she puts into the inter-shift communication log that the patient is hyperglycemic and leaves work for the evening.
Where is the error?
: the patient is
hypoglycemic not hyperglycemic
The are many different types of lab errors that can be committed falling with in the three categories
Can be avoided by decreasing ignorance, deficiencies and accidents
Error has decreased over the years
should be considered for consequences and dealt immediately
• Hammerling, J. (2012). A review of medical errors in laboratory diagnostics and where we are today.MedScape Multispecialty, 2(43), 41-44. Retrieved from http://www.medscape.com/viewarticle/758467_7
• Plebani, M. (2006). Errors in clinical laboratories or errors in laboratory medicine?. Clinical Chemistry Laboratory Medicine, 6(44), 750-759. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16729864
• Plumhoff, E., Masoner, D., & Dale, J. (2008). Preanalytic laboratory errors: Identification and prevention. The Mayo Clinic Communique, 4(1), Retrieved from http://www.mayomedicallaboratories.com/articles/communique/2008/12.html
• Clipart Images retrieved from http://www.wikicommons.com
• Microscopic Images retrieved from http://www.nikonsmallworld.com