Intensive educational efforts combined with external quality assessment improve the preanalytical phase in general practitioner offices and nursing homes.

BACKGROUND: Errors in the preanalytical phase in clinical laboratories affect patient safety. The aim of this study was to evaluate the effect of intensive educational efforts together with external quality assessment (EQA) of the preanalytical phase from 2013 to 2015 to improve patient identification in primary health care in Norway. In addition, routines for venous and capillary blood sampling were investigated. METHODS: A preanalytical EQA was circulated in 2013 by the Norwegian Quality Improvement of Laboratory Examinations (Noklus) to general practitioner offices and nursing homes (n=2000) to obtain information about important issues to focus on before launching an intensive educational program with courses, posters and visits in 2013-2015. Preanalytical EQA surveys were further circulated in 2014 and 2015. RESULTS: The response rate varied between 42% and 55%. The percentages of participants asking for the patients' name and the Norwegian identification number increased from about 8% in 2013 to about 35% in 2015. The increase was similar for those participating in only one EQA survey and for those who participated in EQA surveys both in 2013 and 2015. Guidelines for venous and capillary blood sampling were not always followed. CONCLUSIONS: Educational efforts more than the preanalytical EQA influenced the actions and resulted in an increase in the percentages of participants that followed the guidelines for patient identification. Some aspects of blood sampling routines need improvement.

[Dip-slides for culturing urine in general practice]. / Urindyppekultur i allmennpraksis.

BACKGROUND: A consensus meeting at the Norwegian Institute of Public Health decided to change the limits for significant bacteriuria (used in microbiology laboratories) from 104 to 103 colony-forming units per ml. Such a low threshold value is difficult to read on dip-slides; NOKLUS (Norwegian quality improvement of laboratories in primary care) therefore wished to review the use of dip-slides in general practice. MATERIAL AND METHODS: The article is based on literature retrieved through a non-systematic search in PubMed and on the authors' experience and research in the field. RESULTS: Escherichia coli (E coli) is the most common agent in both lower and upper urinary tract infections, and in asymptomatic bacteriuria in pregnant women. In most infections, and particularly in upper urinary tract infections, bacterial concentrations are at least 104 colony-forming units per ml of urine in monocultures. Dip-slides should be the preferred transport medium when transport takes more than two days (because the number of colonies is not affected), otherwise urine samples with boric acid as a preservative are preferred. INTERPRETATION: Dip-slides with E coli-agar may provide important information on complicated (especially upper) urinary tract infections and when examining pregnant women for asymptomatic bacteriuria. Dip-slides should not be used in uncomplicated cystitis. Medical practices using dip-slides must achieve and maintain sufficient expertise, and participate in an external quality assurance system. Proper sampling and handling of urine is even more important than before because of the lower threshold for significant bacteriuria.

[Quality assessment of urine dip-slides in primary care]. / Vurdering av urindyppekultur i primaerhelsetjenesten.

BACKGROUND: In Norway, approximately 35% of surgery laboratories use dip-slides to assess bacteriuria. From 2000 to 2004 the Norwegian centre for quality assurance in primary health care (NOKLUS) has evaluated how office laboratories assess urine dip-slides. MATERIAL AND METHODS: Once a year participants receive inoculated and incubated dip-slides to read and report to NOKLUS. Target values are determined from assessments in four large microbiological laboratories. RESULTS: Knowledge of reading dip-slides is insufficient. Only 40% of the participants in the quality assessment program evaluate whether growth is gram-negative or gram-positive, or take into account whether the growth is mono-bacterial or mixed. Many participants send the dip-slide to microbiological laboratories for evaluation whenever growth is significant, also when the growth is mixed. INTERPRETATION: The programme shows that Norwegian office laboratories do not use all the information they can get from the dip-slide. There is a need for guidelines on this topic in general practice.