ABSTRACT
In the last few years much progress has been made in raising the awareness of laboratory medicine professionals a bout the effectiveness of quality indicators (QIs) in monitoring,and improving upon,performances in the extra-analytical phases of the total testing process (TTP).An effective system for management of QIs includes the implementation of an internal assessment system and participation in inter-laboratory comparison.A well-designed internal assessment system allows the identification of critical activities and their systematic monitoring.Active participation in inter-laboratory comparison provides information on the performance level of one laboratory with respect to that of other participating laboratories.In order to guarantee the use of appropriate QIs and facilitate their implementation,many laboratories have adopted the Model of Quality Indicators (MQI) proposed by Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of IFCC,since 2008,which is the result of international consensus and continuous experimentation,and updating to meet new,con stantly emerging needs.Data from participating laboratories are collected monthly and reports describing the statistical results and evaluating laboratory data,utilizing the Six Sigma metric,issued regularly.Although the results demonstrate that the processes need to be improved upon,overall the comparison with data collected in 2014 shows a general stability of quality levels and that an improvement has been achieved over time for some activities.The continuous monitoring of QI dataallows identification all possible improvements,thus highlighting the value of participation in the inter-laboratory program proposed by WGLEPS.The active participation of numerous laboratories will guarantee an ever more significant State-of-the-Art,promote the reduction of errors and improve quality of the TTP,especially the extra-analytical quality,thus guaranteeing patient safety.
ABSTRACT
A trombose é uma doença caracterizada por eventos de hipercoagulabilidade. A terapêutica anticoagulante oral com antagonistas da vitamina K (AVKs) é amplamente indicada para prevenção e/ou controle de distúrbios da coagulação. O manuseio de administração dos AVKs é difícil devido à complexidade da definição da dose. Em geral, o monitoramento de indivíduos submetidos à terapêutica com AVK é realizado pela determinação do tempo de protrombina, em que se avalia o grau de anticoagulação através do coeficiente internacional normatizado. Invariavelmente, o fluxo do processamento laboratorial, que compreende as fases pré-analítica, analítica e pós-analítica, é importante para a fidedignidade dos resultados, repercutindo na conduta médica de forma determinante. O objetivo deste estudo foi a realização de uma revisão da literatura científica descritiva utilizando bases de dados eletrônicos para busca de materiais científicos, como Google Scholar, MEDLINE, LILACS, PubMed, SciELO e Science Direct. Abordamos alguns aspectos relacionados ao fluxo analítico da monitoração laboratorial em um laboratório de análises clínicas. Em conclusão, é necessária uma apropriada condução das fases analíticas para que seja possível o sucesso terapêutico com uso dos AVKs (AU)
Thrombosis is a disease characterized by hypercoagulable events. Oral anticoagulant therapy with vitamin K antagonists (VKAs) is widely indicated for prevention and/or control of coagulation disorders. The administration of VKAs is difficult because of the complexity of dose setting. In general, individuals submitted to VKA therapy are monitored by prothrombin time, in which the degree of anticoagulation is assessed by the international normalized ratio. Invariably, the flow of laboratory processing, which comprises pre-analytical, analytical, and post-analytical phases, is of importance to the trustworthiness of results, with significant consequences to the medical practice. The purpose of this study was to carry out a review of the scientific literature using electronic databases to search for scientific materials, such as Google Scholar, MEDLINE, LILACS, PubMed, SciELO, and Science Direct. We discuss some aspects related to the analytical flow of laboratory monitoring in a clinical laboratory. In conclusion, appropriate management of the analytical phases is necessary so that therapeutic success using VKAs is possible (AU)