Pre-analytical errors in a peripheral hospital laboratory

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