ABSTRACT
To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Cross-sectional descriptive study. Combined Military Hospital Kohat, Pakistan from 1[st] January to 30[th] June 2012. For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety
ABSTRACT
The routine prophylactic administration of an uterotonic agent is an integral part of active management of the third stage of labor, helping to prevent postpartum haemorrhage [PPH]. The two most widely used uterotonic agents are: ergometrine-oxytocin [Syntometrine _] [a combination of oxytocin, 5 international units [iu] and ergometrine, 0.5 mg] and oxytocin, [Syntocinon _] 10 international units [iu]. To compare the efficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the managementof third stage of labor. Experimental study. Department of obstetrics and gynaecology Combined Military Hospital Peshawar. Over one year period from March 2005 to March 2006. A total 200 women having singleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simple random sampling using random number tables, 100 patients received 2 ml Syntometrine, [a combination of oxytocin, 5iu and ergometrine meleate 0.5mg] intramuscularly and 100 patients received 10iu of intravenous syntocinon at the delivery of anterior shoulder of the fetus. The use of intravenous oxytocin,, was associated with a reduction in postpartum blood loss [P<0.001] but there was no difference in the risk of post partum hemorrhage, in the need for repeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for blood transfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The use of syntometrine was associated with a higher risk of hypertension [RR 2.39,95% Cl 1.00-5.70] other side effects were mild in nature with no differences between the two groups. There are no important clinical differences in the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum blood loss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low