Olof Wallin

Preanalytical venous blood sampling practices demand improvement — A survey of test-request management, test-tube labelling and information search procedures ☆

BACKGROUND Most errors in laboratory medicine are preanalytical in nature. In the present study, we aimed to survey preanalytical steps in venous blood sampling, prior to actual sample collection. These steps included test-request management and test-tube labelling, as well as information search procedures. METHODS Venous blood sampling staff (n=314, response rate 94%) in hospital wards and laboratories completed a questionnaire related to clinical chemistry testing. RESULTS Instructions for test-request management and test-tube labelling were not always followed. For example, only 66% of the ward staff reported always checking the test-request if someone else completed it, compared to 90% of the laboratory staff (p=0.003). As few as 16% of the ward staff reported desirable practices regarding test-tube labelling, compared to 100% of the laboratory staff (p<0.001). Furthermore, 18% of the ward staff reported always using online manuals (the only source of updated information), compared to 63% of the laboratory staff (p<0.001). CONCLUSIONS Our results indicate a substantial risk of preanalytical error in test-request management, test-tube labelling, and information search practices, particularly in the wards. Our findings thus underscore the importance of quality control in venous blood sampling, in order to increase patient safety in modern health care.

Preanalytical effects of pneumatic tube transport on routine haematology, coagulation parameters, platelet function and global coagulation

Abstract Background: Pneumatic tube transport of blood samples reduces turnaround times and labour. However, the preanalytical effects on new clinical chemistry parameters and instruments are not fully known. The aim of this study was to evaluate the effect of pneumatic tube transport on haematology and coagulation parameters, including platelet function with PFA-100®, and global coagulation with a thromboelastograph. Methods: Paired venous blood samples from healthy volunteers were obtained before and after 1 week of treatment with acetylsalicylic acid. One sample was transported by pneumatic tube transport, while the other remained in the laboratory. Results: No preanalytical effect of pneumatic tube transport could be seen for most haematology and coagulation parameters, as well as analysis with PFA-100®. For the thromboelastographic analysis, time to clot formation was shorter (–16%, p=0.037) in the transported samples. Treatment with acetylsalicylic acid had no effect on the majority of the test results. Conclusions: Pneumatic tube transport does not introduce preanalytical errors when transporting samples for analysis of routine haematology, coagulation parameters and platelet function with the PFA-100®. We recommend manual transport of samples for analysis with thromboelastographic techniques. Clin Chem Lab Med 2008;46:1443–9.

Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling.

Abstract Background: Most errors in laboratory medicine occur in the preanalytical phase and are the result of human mistakes. This study investigated information search procedures, test request management and test tube labelling in primary healthcare compared to the same procedures amongst clinical laboratory staff. Methods: A questionnaire was completed by 317 venous blood sampling staff in 70 primary healthcare centres and in two clinical laboratories (response rate = 94%). Results: Correct procedures were not always followed. Only 60% of the primary healthcare staff reported that they always sought information in the updated, online laboratory manual. Only 12% reported that they always labelled the test tubes prior to drawing blood samples. No major differences between primary healthcare centres and clinical laboratories were found, except for test tube labelling, whereby the laboratory staff reported better practices. Re-education and access to documented routines were not clearly associated with better practices. Conclusions: The preanalytical procedure in the surveyed primary healthcare centres was associated with a risk of errors which could affect patient safety. To improve patient safety in laboratory testing, all healthcare providers should survey their preanalytical procedures and improve the total testing process with a systems perspective. Clin Chem Lab Med 2009;47:195–201.

Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories

UNLABELLED Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories BACKGROUND   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory. AIMS   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories. METHODS   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing. RESULTS   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff. CONCLUSIONS   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards.

Is the test result correct? A questionnaire study of blood collection practices in primary health care

RATIONALE, AIMS AND OBJECTIVES Venous blood tests are important for clinical decision making. Most errors in blood testing are due to human errors before the blood samples reach the laboratory. The present study was designed to investigate venous blood sampling (VBS) practices in primary health care centres (PHCs) compared with clinical laboratory staff. METHOD A cross-sectional survey of 70 PHCs and two clinical laboratories is conducted. All staff responsible for VBS (317 respondents, response rate 94%) completed a questionnaire on VBS practices. RESULTS Instructions for VBS were not followed in the surveyed PHCs. For example, only 54% reported that they always identified the patient by using name/Swedish identification number and only 5% reported that they always used photo-ID, the two preferred means for patient identification. Only 12% reported that they always released venous stasis as soon as possible. Fewer PHC staff than clinical laboratory staff reported correct VBS practices. For example, 54% of the PHC staff reported that they always identified the patient by name and Swedish identification number, as compared with 95% of the clinical laboratory staff (P < 0.001). Documented VBS routines and re-education in VBS were not clearly associated with reported correct VBS practices. CONCLUSIONS In the surveyed PHCs, there are clinically important risks for misidentification of patients and erroneous test results, with consequences for the diagnosis and treatment of patients. Quality interventions, aimed at improving VBS practices, are needed to ensure patient safety.

Patient‐centred care – preanalytical factors demand attention: A questionnaire study of venous blood sampling and specimen handling

Objective. Most mistakes in laboratory medicine are the result of human error occurring before the blood sample reaches the laboratory. This survey of preanalytical procedures was designed to identify sources of error and potential targets for quality improvement strategies. Material and methods. The staff in a highly specialized surgical ward at a university hospital completed a questionnaire addressing the collection and handling of venous blood samples in plastic vacuum test‐tubes for general clinical chemistry testing. Results. The results suggest that venous blood sampling instructions are not always followed. When uncertain about how a sample should be collected, the majority of respondents rely on potentially poor sources of information, such as out‐of‐date printed instructions or the advice of a colleague, rather than consult up‐to‐date electronic instructions. Furthermore, they do not always report errors and the referrals are not always handled according to sampling instructions. The respondents were highly motivated, however, and had a strong interest in receiving further education in, and assuming increased responsibility for, venous blood sampling procedures in the ward. Conclusions. We believe that the introduction of standardized routines and regular staff training, combined with an exchange of the existing paper‐based referral management system with an electronic system for managing referrals, could increase safety in the preanalytical process, with positive effects on patient safety. Given the importance of venous blood samples in patient care, a more extensive study covering other hospital wards and primary health‐care centres is needed.

Incident reporting practices in the preanalytical phase : low reported frequencies in the primary health care setting

Abstract Objective: Incident reporting is commonly used to improve patient safety. The preanalytical phase of laboratory testing contains several manual error-prone tasks where mistakes can affect patient outcomes. However, the practical use of incident reports in this area has not been previously investigated in the primary health care setting, where the majority of the patients come in contact with health care. Material and methods: All staff responsible for venous blood sampling in 70 primary health care centres and in two hospital clinical laboratories (317 respondents, response rate 94%) completed a questionnaire. Results: Of the primary health care staff, 69% reported that they had never filed an incident report regarding venous blood sampling. Barriers for not filing incident reports often/always included lack of time (44%) and a complicated reporting procedure (27%). A higher proportion of staff with re-education (43%) had filed at least one incident report as compared to those without re-education (20%, p < 0.001). No differences in incident reporting practices were found between primary health care and hospital clinical laboratory staff. Conclusions: The investigated incident reporting system is likely to underreport incidents in the preanalytical phase. Therefore, the ability to discover preventable system vulnerabilities needs refinement.