Pre-Analytical Errors: A Major Issue in Laboratory Medicine
The literature review was done to gather the information about the most common source of error in the medical laboratory. Majority of errors comes from the pre-analytical phase that considered the basis for all laboratory works. Pre-pre-analytic and true pre-analytic are two types of the pre-analytical phase (Plebani, 2012). Test selection, patient identification, sample collection, preparation and handling are part of the pre-pre-analytical process while storing, pipetting and centrifugation sample are actual pre-analytical process (Hawkins, 2012; Plebani, 2012). Missing any steps in the previous processes will cause errors related ...view middle of the document...
A delay in blood samples was tested in one of the literature review and the result indicates a significant change in the procoagulant functions (Lacroix et al., 2011). In addition, the error related to long agitation for the blood sample was examined and the result was inaccurate because of this factor (Lacroix et al., 2011). Even though this study focused on the lag in time, it did not specify what type of test got affected due to the delay of the sample.
Some microbiological samples must be sent in a transporter medium to keep the sample wet such as a throat swab. Other samples require specific tube or sterile container to avoid contamination. For instance, sodium citrate is required for measuring the coagulation factors (Fayaloro et al., 2011). Physicians, nurses and medical technicians are responsible for these types of errors.
Physicians also are encountering for the pre-analytical errors such as ordering test request that is not relevant to the patient condition (Sharma, 2009). For instance, physician ordered vitamin D test for patients presented with headache. Sending unrelated test request may delay the diagnosis of the patient condition and the treatment become difficult within the time. Additionally,
Since the error in this phase will result in wrong diagnosis, the patient will have the wrong medication. Moreover, the pre-analytical errors considered challenges to the MLS because nurse, physician and medical technician are the responsible for these errors.
Most of the retrieved articles did not provide enough examples that might help in the illustration for the pre-analytical errors. Furthermore, the researchers did not correlate the errors with the whole computer system in the hospital. For instance, internal system in the hospital might shut down due to technical issues which then will provide incompatible patient information. This point is considered a limitation for the article.
From pre-analytical phase, the patient specimen is handed to the laboratory scientist who will process the samples and issues the result to the doctor. Thus, the laboratory scientist has to pay close attention to the patient information on the label and the test that has been ordered by the doctor. By ignoring this confirmation step, the laboratory scientist will put the patient life in danger because the result does not correlate with the patient’s condition (Layfield et al, 2010).
Moreover, Pre-analytical errors might imply a weakness in the laboratory protocol (Plebani et al., 2010). Consequently, the errors in this phase will have undesired consequences that will put the laboratory at risk (Fayaloro et al., 2012). Therefore, the patient will feel uncomfortable with his laboratory results because of the preliminary errors that occurred before processing the specimen (Plebani et al., 2010). That particularly means the patients did not know the actual source of error but they assume that the laboratory is in charge of this error.
Lacking of trust...