Dr Preeti Kabra, Chief Of Lab, Neuberg Diagnostics emphasises that as a laboratory head, when I think of patient safety, I consider the entire testing pathway – right from test registration, sample collection, sample analysis and test reporting. These are categorised as pre-analytical, analytical and post-analytical processes in laboratory terms
According to World Health Organization, patient safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Though there is a notion that patient safety may not be so critical in terms of laboratory medicine, each discipline where ever patient’s sample is involved has to be considered critical in terms of safety.
As a laboratory head, when I think of patient safety, I consider the entire testing pathway – right from test registration, sample collection, sample analysis and test reporting. These are categorised as pre-analytical, analytical and post-analytical processes in laboratory terms.
Each of these processes involves a risk where patient safety might get affected and as laboratory professionals, it’s our duty to ensure we are providing accurate and timely results to the patient by analysing correct patient sample.
When we look at the pre-analytical processes, test requisition form mis-match, unlabelled sample and mislabeled sample are the most frequent types of errors which may affect patient safety. Correct patient identification is an important part of patient safety. In a lab set up it is important to ensure that we get the blood collection tubes checked by patient/relatives for correct barcodes before collection of samples. This is one of the key initiatives which gives confidence to patients as well as the lab professionals analysing the sample.
Any small doubt about any issue with sample integrity calls for a re–collection rather than giving out results on a compromised sample.
When we come to the Analytical part – Proper equipment maintenance, proper reagent inventory, appropriate quality Control procedures, adequately trained and experienced professionals play an important role in giving accurate results within a defined and acceptable Turn-around time. Any deviation in above processes may affect patient safety depending on the seriousness of the error.
During the Post-analytical part – We need to make sure the test result reported from the equipment goes out on the test reports, along with correct units and remarks as per age and gender and test requested for the correctly identified patient. All results need to be seen in toto rather than separately as per various departments in the lab and here the role of pathologists and microbiologists cannot be undermined. Communication of critical alerts on time is an important aspect of patient safety.
As the laboratory medicine has evolved significantly from semi-automated equipment to high through-put fully automated analysers, flow cytometers, next generation sequencing procedures, the error rates have been reduced but not totally eliminated. Accredited laboratories are required to implement risk management in their laboratories and I feel that this should be made mandatory for all the laboratories.
Risk management requires that the laboratory shall evaluate the impact of work processes and potential failures on examination results as they affect patient safety, and shall modify processes to reduce or eliminate the identified risks and document decisions and actions taken.
Although implicit in the International Standard for medical laboratories accreditation, the International Organization for Standardization (ISO) 15189:2007, the concept of risk became explicit and patient-centered only in the 2012 revision. Risk Management is now considered as the process of identifying process improvement opportunities and helps laboratory professionals monitor and review their processes in terms of patient safety.
Proper training and creating awareness in laboratory professionals about thinking and handling every sample as his /her own will play a great role in patient safety.
Lastly- Effective communication with the patient and the referring clinician goes a long way to ensure the laboratories are doing the best in providing safe healthcare to everyone. Laboratories cannot and should not work independently. Improving patient experience and effective clinician engagement are the key areas through which laboratories can help provide safe healthcare.
The role of all laboratory professionals including phlebotomist, customer care executive, technician as well as laboratory doctors is critical to delivering safe healthcare practices.