RESUMEN
The monitoring of quality indicators, combined with a detailed risk analysis, validates the process of automated blood culture. Here we report the methodology of 5 years monitoring for 5 indicators at the Biology Department of Foch Hospital: volume sampled, proportion of contaminants, proportion of positive blood cultures in each instrument and drawer, epidemiological indicator and proportion of false-positive instrument signals. The results obtained were outside the expected target for the volume sampled and were acceptable for the other indicators. The analysis of these results leads us to discuss the evolution of quality indicators and more particularly the implementation of corrective measures, their periodicity, their relevance as well as the need to refine their results to carry out targeted actions.
Asunto(s)
Cultivo de Sangre/normas , Cultivo de Sangre/tendencias , Control de Calidad , Indicadores de Calidad de la Atención de Salud , Acreditación , Automatización de Laboratorios/normas , Cultivo de Sangre/métodos , Contaminación de Equipos , Reacciones Falso Positivas , Humanos , Fase Preanalítica/normas , Fase Preanalítica/tendencias , Valor Predictivo de las Pruebas , Mejoramiento de la Calidad/normas , Mejoramiento de la Calidad/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Sepsis/sangre , Sepsis/diagnóstico , Estudios Seroepidemiológicos , Esterilización/métodos , Esterilización/normasRESUMEN
Background Quality indicators (QIs) and risk management are important tools for a quality management system designed to reduce errors in a laboratory. This study aimed to show the effectiveness of QI-based risk management for the continual improvement of pre-analytical processes in the Kayseri Public Health Laboratory (KPHL) which serves family physicians and collects samples from peripheral sampling units. Methods QIs of pre-analytical process were used for risk assessment with the failure modes and effects analysis (FMEA) method. Percentages and risk priority numbers (RPNs) of QIs were quantified. QI percentages were compared to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) performance specifications and RPNs were compared to risk level scale, and corrective actions planned if needed. The effectiveness of risk treatment actions was re-evaluated with the new percentages and with RPNs of predefined QIs. Results RPNs related to four QIs required corrective action according to the risk evaluation scale. After risk treatment, the continual improvement was achieved for performance and risk level of "transcription errors", for risk levels of "misidentified samples" and "not properly stored samples" and for the performance of "hemolyzed samples". "Not properly stored samples" had the highest risk score because of sample storage and centrifugation problems of peripheral sampling units which are not under the responsibility of the KPHL. Conclusions Public health laboratories may have different risk priorities for pre-analytical process. Risk management based on predefined QIs can decrease the risk levels and increase QI performance as evidence-based examples for continual improvement of the pre-analytical process.
Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Fase Preanalítica/métodos , Indicadores de Calidad de la Atención de Salud/normas , Recolección de Muestras de Sangre/métodos , Recolección de Muestras de Sangre/normas , Técnicas de Laboratorio Clínico/tendencias , Humanos , Laboratorios/normas , Estudios Longitudinales , Errores Médicos/tendencias , Seguridad del Paciente/normas , Fase Preanalítica/tendencias , Salud Pública/métodos , Medición de Riesgo/métodos , Gestión de Riesgos/métodos , Manejo de Especímenes , TurquíaAsunto(s)
Bioquímica , Servicios de Laboratorio Clínico , Fase Preanalítica , Sociedades Médicas/organización & administración , Equilibrio Ácido-Base/fisiología , Bioquímica/métodos , Bioquímica/organización & administración , Bioquímica/tendencias , Análisis de los Gases de la Sangre/métodos , Análisis de los Gases de la Sangre/normas , Análisis de los Gases de la Sangre/tendencias , Servicios de Laboratorio Clínico/organización & administración , Servicios de Laboratorio Clínico/tendencias , Hospitales , Humanos , Enfermedades Pulmonares/clasificación , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/fisiopatología , Paris , Fase Preanalítica/métodos , Fase Preanalítica/normas , Fase Preanalítica/tendencias , Mejoramiento de la Calidad , Pruebas de Función Respiratoria/métodos , Pruebas de Función Respiratoria/tendencias , Sociedades Médicas/normasRESUMEN
El objetivo del trabajo consistió en evaluar el estado de armonización de la etapa preanalítica de la orina de 24 horas (orina-24h). Se realizó una encuesta anónima sobre la etapa preanalítica de la orina-24h a bioquímicos de Argentina. Respondieron 92 profesionales. Del análisis de las respuestas surge que el 95% de los bioquímicos facilita a los pacientes instrucciones escritas para la recolección; 11% incluye instrucciones con información visual gráfica además de escrita; 37% registra hora de inicio y finalización de la recolección; 59% recomienda que durante la misma la muestra se mantenga refrigerada; 73% suministra al paciente el recipiente para la recolección; 47% proporciona el envase con conservante, si corresponde; 100% solicita al paciente llevar al laboratorio la totalidad de la orina juntada; 4% solicita al paciente medir y anotar la diuresis y entregar al laboratorio una alícuota de la orina-24h; 78% realiza una o más acciones para evaluar la correcta recolección. Los criterios de rechazo seleccionados en orden decreciente fueron: pérdida de micciones, incumplimiento del tiempo de recolección, según la diuresis, según la eliminación diaria de creatinina y recipiente no apto. Esta encuesta evidenció que existen aspectos de la etapa preanalítica de la orina- 24h que requieren de mejora y armonización entre los laboratorios.
The objective of the present work was to evaluate the harmonization state of the pre-analytical phase of 24-hour urine. To this aim, an anonymous survey on the pre-analytical phase of 24-hour urine (Moreno-Carbonell, et. al) was carried out by biochemists from Argentina. A total of 92 professionals responded to the the survey. As a result, 95% provide patients with written instructions for collection; 11% include visual graphic instructions; 37% record starting and finishing time of collection; 59% recommend sample refrigeration during collection time; 73% supply the container; 47% provide the container with a preservative, if necessary; 100% ask the patient to take the complete 24-hour volume to the laboratory; 4% indicate to measure and record sample volume and to take an aliquot of it; and 78% perform one or more actions to evaluate the proper collection procedure. The rejection criteria selected in decreasing order were: loss of micturition, non-compliance with collection time, according to the volume and daily creatinine excretion, and improper container. To conclude with, this survey showed that there are aspects of the pre-analytical phase of 24-h urine that need improvement and harmonization between laboratories.
O objetivo do trabalho foi avaliar o estado de harmonização da fase pré-analítica da urina de 24 horas (urina-24h). Foi realizado um levantamento anônimo sobre a fase pré-analítica da urina-24h a bioquímicos da Argentina. Responderam 92 profissionais. Da análise das respostas surge que 95% fornecem aos pacientes instruções escritas para a coleta; 11% inclui instruções com informação visual gráfica além de escrita; 37% registra hora de início e finalização da coleta; 59% recomenda que durante a coleta a urina seja mantida refrigerada; 73% fornece o recipiente para a coleta; 47% fornece o recipiente com um conservante, se necessário; 100% solicita ao paciente que leve o volume completo de 24 horas ao laboratório; 4% indica ao paciente medir e registrar a diurese e entregar ao laboratório uma alíquota da urina-24h; 78% realiza uma ou mais ações para avaliar o procedimento apropriado de coleta. Os critérios de rejeição selecionados em ordem decrescente foram: perda das micções, descumprimento do tempo de coleta, de acordo com a diurese, conforme a eliminação diária de creatinina, e recipiente inadequado. Esta pesquisa mostrou que há aspectos da fase pré-analítica da urina de 24h que precisam ser melhorados e harmonizados entre os laboratórios.
