Lab Errors
Lab Errors
Lab Errors
Clinical Biochemistry
Laboratory errors
Collected and prepared by:
ESAM ALFAGIEH
4th year of medical technology
2013-2014
Laboratory errors
What are lab errors?
Can we stop them?
How do we stop them?
REPORTING
ORDERING
Error
s
INTERPRETING
Lab Errors
Laboratory errors may be defined as any
65%
20%
15%
Pre-analytical phase
o Test Ordering.
o Sample collection.
o Sample transport to the lab.
o Sample processing or preparation for
testing.
Test Ordering
Unsuitable tests.
Patient Preparation.
Handwriting.
Patient misidentification.
Orders Test on incorrect Patient.
Written Orders are not Correctly
Patient Preparation
Fasting
Postprandial
Before or After Medication Dosage
At specific time in a hormonal cycle
(Patient not obey the instructions)
Sample collection
- Phlebotomy errors
- Site selection
- Choice of Collection Area:
- Hematoma.
- Indwelling IV.
- Tube selection
Sample collection
- Phlebotomy errors
- Tourniquet Application
(No > 1 Minute).
- Allow for Complete Drying of Alcohol.
- Selection of Correct Needle Size
(18 to 23 Gauge May Be Used).
- Complete Fill of Tubes
(Over or under filling).
(Hemolysis).
Protect from Light if Necessary Amber
Tubes.
Efficiently as Possible
- Light exposure
testing
- Delivery to Departments
- Temporary Specimen Storage
- Specimen Separation
- Centrifuging
Other pre-analytical
Variables
Controllable variables
Non controllable variables
Controllable variables
- Diet
- Life style (smoking, alcohol ingestion, drug
administration)
- Drugs
- Physiological variables (prolonged bed rest,
exercise)
influences)
- Obesity
- Pregnancy
- Stress
:Post-analytical
- Reporting.
- Typing errors.
Pre-analytical Issues
Associated with Specimen
Processing
Hemolysis
Allow complete clot formation to occur
Centrifuge promptly
- speed (high speed lead to hemolysis)
Hemolysis
The presence of hemolysis
Causes of Hemolysis
Prolonged tourniquet application
Incomplete alcohol drying following site
preparation.
Rupture of red cells when collected with
small bore needle
Tissue trauma during collection.
Causes of Hemolysis
Vigorous shaking of collection tubes.
Freezing of red blood cells during storage
or transportation.
Exposure of cells to excessive heat during
storage or transportation.
Hemolysis
Glucose, Bilirubin.
Suggested quality
indicators for
preanalytical phase
Standard operating procedures (SOP)
rejection.
Miss-concept
Lab staff alone are responsible for
lab errors.
WRONG !!!
Labs, Physicians and Patients are
All RESPONSIBLE.