Design and implementation of a clinical laboratory information system in a low-resource setting

Background: Reducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of the sources of laboratory errors.Objectives: This article describes the development process for a clinical laboratory information system (LIS) that leverages informatics interventions to address problems in the laboratory testing process at a hospital in a low-resource setting.Methods: We designed interventions using informatics methods for previously identified problems in the laboratory testing process at a clinical laboratory in a low-resource setting. First, we reviewed a pre-existing LIS functionality assessment toolkit and consulted with laboratory personnel. This provided requirements that were developed into a LIS with interventions designed to address the problems that had been identified. We piloted the LIS at the Kamuzu Central Hospital in Lilongwe, Malawi.Results: We implemented a series of informatics interventions in the form of a LIS to address sources of laboratory errors and support the entire laboratory testing process. Custom hardware was built to support the ordering of laboratory tests and review of laboratory test results.Conclusion: Our experience highlights the potential of using informatics interventions to address systemic problems in the laboratory testing process in low-resource settings. Implementing these interventions may require innovation of new hardware to address various contextual issues. We strongly encourage thorough testing of such innovations to reduce the risk of failure when implemented

Mandatory HIV testing as a prerequisite for surgical procedures: Perspectives on rights and ethics

Background. Undergoing mandatory HIV testing as a criterion for a surgical or invasive procedure is illegal in Nigeria, and unethical. This includes requesting an HIV test without the consent of the client, and the disclosure of the test results.Objectives. To assess the practice of mandatory HIV testing among health practitioners, andtoexamine HIV testing without consent, and the disclosure of test results to the patient.Methods. This was a cross-sectional survey of both medical doctors and nurses with surgical skills. We used convenience sampling to selectrespondents from Jos University Teaching Hospital, Nigeria and Federal Teaching Hospital, Gombe, Nigeria. A total of 99 respondents filled and returned a questionnaire. Statistical Package for the Social Sciences version 20 was used to manage the data, and the results were presented using descriptive statistics.Results. Over one-third (34.3%) of the respondents reported that they would insist on seeing an HIV test result before performing a surgical or invasive procedure; meanwhile, 4 (4%) of the respondents had refused to render surgical or invasive intervention to HIV clients, while (3%) admitted having refused surgical procedures to patients who refused to take an HIV test. The majority of the respondents (79; 79.8%)reported that the basic equipment and consumables needed for universal precautions were either not available or grossly inadequate.Conclusion. Requests for patients to take an HIV test before surgical procedures are frequent; however, only a few respondents had ever refused to provide a surgical intervention on the basis of a patient's HIV-positive status. Equipment and consumables necessary for universal precautions were either not available or grossly inadequate in the surveyed hospitals

Using Portfolios to Assess Professional Competence and Development in Medical Laboratory Sciences

Background:Portfolios have been recommended for the assessment of professional development. To stimulate engagement and assess professional development during laboratory training; portfolio assessment was proposed for the final year BMLS and DMLT programmes in Kampala International University. Work Done The students undergoing clinical laboratory training in teaching hospitals; and engaged in routine laboratory services under supervision of qualified Medical Laboratory Scientists; composed a portfolio detailing their daily experiences; work done; and lessons learned. Their supervisors and facilitators provided daily feedback and endorsed their entries. The portfolios were examined at the end of training by faculty staff and external examiner through oral presentation and interviews. Rating rubric considered quality of presentation; portfolio content; demonstration of progressive development; and ability to make professional judgment. Students' and assessors' acceptance of this instrument was determined with questionnaire. Results 72of the students and assessors accepted the method. Many students reported that it improved commitment to training; encouraged reflection; and allowed for frequent feedback. Many believed that it was a rational assessment; but it was time consuming. 88of the participants would welcome it as a supplement to the standard tests.Conclusions:The portfolio assessment was well accepted; rational; and provided a valid assessment of student engagement and progression during professional training.Take Home Message The inclusion of portfolio assessment in Medical Laboratory Sciences Education provided valid assessment of students' engagement in training and professional development over time