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Incident reporting practices in the preanalytical phase: low reported frequencies in the primary health care setting
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
2009 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 69, no 7, 731-735 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2009. Vol. 69, no 7, 731-735 p.
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-21254DOI: 10.3109/00365510903007018PubMedID: 19929714OAI: oai:DiVA.org:umu-21254DiVA: diva2:211192
Projects
blood specimen collection, medical errors, phlebotomy, quality of health care, questionnaires
Available from: 2009-04-09 Created: 2009-04-09 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Sources of preanalytical error in primary health care: implications for patient safety
Open this publication in new window or tab >>Sources of preanalytical error in primary health care: implications for patient safety
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Venous blood tests constitute an important part in the diagnosis and treatment of patients. However, test results are often viewed as objective values rather than the end result of a complex process. This has clinical importance since most errors arise before the sample reaches the laboratory. Such preanalytical errors affect patient safety and are often due to human mistakes in the collection and handling of the sample. The preanalytical performance of venous blood testing in primary health care, where the majority of the patients contact with care occurs, has not previously been reported.

Aims To investigate venous blood sampling practices and the prevalence of haemolysed blood samples in primary health care.

Methods A questionnaire investigated the collection and handling of venous blood samples in primary health care centres in two county councils and in two hospital clinical laboratories. Haemolysis index was used to evaluate the prevalence of haemolysed blood samples sent from primary health care centres, nursing homes and a hospital emergency department.

Results and discussion The results indicate that recommended preanalytical procedures were not always followed in the surveyed primary health care centres. For example, only 54% reported to always use name and Swedish identification number, and 5% to use photo-ID, the two recommended means for patient identification. Only 12% reported to always label the test tubes prior to blood collection. This increases the possibility of sample mix-up. As few as 6% reported to always allow the patient to rest at least 15 minutes before blood collection, desirable for a correct test result. Only 31% reported to have filed an incident report regarding venous blood sampling, indicating underreporting of incidents in the preanalytical phase.

Major differences in the prevalence of haemolysed blood samples were found. For example, samples collected in the primary health care centre with the highest prevalence of haemolysed samples were six times (95% CI 4.0 to 9.2) more often haemolysed compared to the centre with the lowest prevalence. The significant variation in haemolysed samples is likely to reflect varying preanalytical conditions.

Conclusions This thesis indicates that the preanalytical procedure in primary health care is associated with an increased risk of errors with consequences for patient safety and care. Monitoring of haemolysis index could be a valuable tool for estimating preanalytical sample quality. Further studies and interventions aimed at the preanalytical phase in primary health care are clearly needed.

Place, publisher, year, edition, pages
Umeå: Institutionen för medicinsk biovetenskap, 2009. 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1250
Keyword
blood specimen collection, haemolysis, medical errors, phlebotomy, preanalytical, primary health care, quality indicators, quality of health care, questionnaires, specimen handling
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-21256 (URN)978-91-7264-741-1 (ISBN)
Public defence
2009-05-08, Sal 135, Byggnad 9A, Bv, Norrlands Universitetssjukhus, 901 85 Umeå, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-20 Created: 2009-04-09 Last updated: 2012-11-02Bibliographically approved

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