Acreditación de laboratorios clínicos: ¿un asunto pendiente? / Accreditation of clinical laboratories: a pending issue?

Los procesos de acreditación en los laboratorios se han convertido en algo cotidiano y conocido en nuestros días. No obstante, el grado de implantación de estos procedimientos de calidad no es tan alto como sería deseable. La complejidad del periodo preanalítico en concreto, requiere de un sistema de garantía de calidad siendo necesarias medidas capaces de acometer estrategias que fomenten la implantación de sistemas de calidad en las Unidades de Laboratorio Clínico. De hecho, la fase preanalítica es un periodo complejo y multidisciplinar sobre el que recae el mayor número de errores reportados en la literatura. Por ello, implementar este tipo de medidas mejoraría el cumplimiento de los procesos asistenciales relacionados, colaborando en una mejora continua de la seguridad clínica, la calidad asistencial y la costoeficiencia del sistema sanitario. (AU)

Compliance with the clinical laboratory quality protocol in public primary healthcare centres.

The clinical and economic relevance of the clinical laboratories procedures in Andalusia (Spain) have led the Regional Department of Health to focus attention on their improvement. A unified laboratory protocol was implemented that consisted of the unification of criteria in the handling and processing of samples, and report of results. The objective of this study is to describe the degree of compliance with the clinical laboratory protocol in the preanalytical phase, which includes the analytical request and up to the delivery in the laboratory, as well as the influencing factors. Cross-sectional descriptive study with a sample of 214 healthcare professionals involved in the preanalytical phase of laboratory procedures in primary care. A self-reported questionnaire with 11 items was used for data collection. Each item was assessed separately with a scale from 0 to 10. A 5 points score was considered as the cutoff point. Descriptive analysis was conducted and Mann-Whitney U test was used to determine differences between subgroups. Internal consistency of the questionnaire was considered. The best rated item was verifying the correspondence between the request form and identity of the patient. Each item scored from 3 to 10, and the mean for each item ranged from 6.40 (standard deviation = 3.06) to 8.57 (standard deviation = 2.00). Values above or equal to 8 were obtained, for 63.6% of them. Statistically significant differences between accredited and nonaccredited centres were found. Differences were not noteworthy regarding centres with a teaching activity or those without it. All the items were measured separately. The compliance with the protocol was adequate among primary healthcare professionals, who have a strategic position in the sample collection and its transport during the preanalytical phase. Being so, standardisation should be a priority to reduce errors and improve clinical safety and results.

Preanalytical errors in emergency department samples: Investigating error sources.

BACKGROUND: The presence of preanalytical errors is a recurring fact in all areas of healthcare that send samples to laboratories. Increasing the knowledge of possible sources of error in the preanalytical phase has been the objective of this group during the last 10 years. METHODS: In this study, descriptive research has been carried out using professionals' opinions obtained by means of the Strengths, Weaknesses, Opportunities, and Threats method in a focus group. RESULTS: The opinions expressed within the focus group have emphasised the importance of patients' safety and willingness for the introduction of a computerized analytical module. The most commented weakness in both hospitals was the transport of samples through the pneumatic tube. Improving the duration of workers' contracts, especially in the laboratory, and creating a circuit for professional's localization during the work shift to facilitate potential error solving are some opportunities for the future. CONCLUSIONS: Different approaches have been developed depending on the healthcare scenario. For this, establishing a flow of information between the different professionals allows identifying identical aspects through a priori, different points of view. The line to follow is to improve the safety of the patient and also to give professionals an opportunity to express themselves.

Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples.

BACKGROUND: To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). METHODS: The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. RESULTS: The real impact associated with educational intervention in LAB1 was an increase of &OV0556;16,961.378, and the expected impact was an increase &OV0556;78,745.27 (difference of &OV0556;61,783.9). In LAB2, the real impact in the same period amounted to &OV0556;260,195.37, and the expected impact was &OV0556;193,905.83 (difference of -&OV0556;66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. CONCLUSIONS: Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.

Transcultural Adaptation and Piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" Questionnaire.

Preanalytical errors account for up to 70% of the total potentially detectable errors in the laboratory. The main problems detected are related with procedures associated with Primary Care nursing practices that are directly involved in the preanalytical phase. The objective of this study is to carry out a transcultural adaptation and piloting of the "Regarding Blood-Sampling Practices at Primary Health Care Centres" questionnaire as regards blood sampling in Primary Care. For this, a cross-sectional descriptive study has been developed within the Primary Care area of the Andalusian Public Health System. The venous blood sampling questionnaire was translated into and adapted to Spanish by qualified professionals and expert translators. The questionnaires were then delivered to all staff nurses from the health districts involved. The total sample consisted of 224 primary care nursing professionals. The factors that showed statistically significant relationships were identification and sample collection, management with information search, storage and labelling of samples, and reporting of errors. A lack of global relationship between factors makes it impossible to find a global quality factor in the sampling process. The process of translation, adaptation, and piloting of the questionnaire from its original version to the Spanish one has proven to be understandable by professionals in its entirety and to offer data similar to the original version.

Plan de cuidados en las necesidades psicoemocionales de los supervivientes de cáncer / Care plan in the psychoemotional needs of cancer survivors

El cáncer es un evidente problema de salud mundial. Es una enfermedad social: padecerla afecta tanto a la mortalidad como a los costes asociados a la morbilidad. La supervivencia de estos pacientes está aumentando, por lo que se está produciendo una transición hacia la cronicidad de la enfermedad. En el presente artículo se describe la situación actual de estos pacientes a nivel nacional e internacional, las características de este colectivo de pacientes, sus necesidades y expectativas, consecuencias derivadas de los tratamientos, afectaciones sociales y psicológicas. Finalmente, se propone un plan de cuidados, con sus criterios de evaluación e intervenciones, para este tipo de pacientes

Cancer is an evident health worlwide problem. It is a social disease: suffering cancer involves both costs related with morbidity and mortality. The increased surveillance of these patients produces a transition to chronic disease, changing their needings, expectations and treatment derived consequences, together with social and psychological affections. Finally, we propose a specific care plan, with outcomes and interventions for this kind of patients

Utilization of a healthcare failure mode and effects analysis to identify error sources in the preanalytical phase in two tertiary hospital laboratories.

INTRODUCTION: The presence of errors in the preanalytical phase is a thoroughly studied problem. A strategy to increase their source detection might be the use of the Healthcare Failure Mode and Effects Analysis (HFMEA). The aim of this study is improving the capacity of identifying sources of error during the preanalytical period in samples provided by primary care clinics (PCC) with the use of the HFMEA as a tool in the laboratories of two tertiary hospitals. MATERIALS AND METHODS: A HFMEA was carried out in each laboratory, by means of the creation of groups of experts with similar characteristics (doctors and nurses from PCC and laboratory, support staff, and laboratory technicians). The Risk Priority Number (RPN) was calculated. RESULTS: Items with elevated RPN were presented in both centers. The highest RPN were in LAB1: "two request notes for a patient" and "the segregation of oncology urgent samples" (both with 384), while in LAB2 was "the lack of information in patients with oral glucose overload test" (RPN 576). Considering the different steps in the preanalytical phase, LAB1 paid attention in sampling, samples reception and the programming in the Laboratory Information System, while LAB2 paid attention in the request form, the appointment system, sampling procedures, transport and reception. CONCLUSION: The laboratories prioritized the problems differently. However, both centers offer solutions to these possible sources of error. We proposed improvement actions that can be resolved easily, with a low cost for the system, mainly to schedule a specific formative programme and a deep revision of the existing protocols.

Adherencia al tratamiento anticoagulante con apixabán y rivaroxabán en un entorno real / Adherence to anticoagulant treatment with apixaban and rivaroxaban in a real environment

El cumplimiento terapéutico en el tratamiento con anticoagulantes directos (AD) es de difícil comprobación, al no existir, como en el tratamiento con antivitaminas K (AVK), controles periódicos. El objetivo del estudio es explorar la adherencia estimada en dos AD (uno con una toma diaria, y otro con dos). Se realizó un estudio de cohortes retrospectivo en pacientes con fibrilación auricular no valvular en tratamiento con apixabán (A) o rivarixabán (R) para la prevención del ictus. Los datos se obtuvieron del registro sueco de prescripciones. La adherencia estimada se calculó dividiendo el número de dosis diarias desde la prescripción más cercana, tres meses tras la primera dispensación farmacológica. Se incluyeron 123 pacientes en tratamiento con A y 227 pacientes en tratamiento con R, con un seguimiento de un año. No había diferencias sociodemográficas entre los grupos, aunque en los pacientes tratados con R había un mayor porcentaje de tratamiento previo con AVK (29,2 vs. 31,4%, p=0,025). Los autores concluyen que ambos formatos de dosis (cada 12 y cada 24 h) poseen una adherencia estimada elevada. A los tres meses, se observó que la adherencia estimada en A=97% y R=96%, p=0,43, mostrando una buena adherencia tanto en el A como en R en pacientes con fibrilación auricular no valvular en un sistema con una buena estructura de seguimiento por parte de Enfermería (AU)

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Anticoagulantes directos y Enfermería: un abordaje desde la seguridad clínica / Direct anticoagulants and nursing: an approach from patient's safety

En los últimos años ha aparecido una nueva línea de tratamiento para la prevención del ictus en la fibrilación auricular no valvular, los denominados anticoagulantes directos o nuevos anticoagulantes. El adecuado manejo y seguimiento de estos pacientes resulta imprescindible para minimizar sus efectos secundarios y garantizar la seguridad del paciente. En este artículo, se ofrece una descripción de estos fármacos, analizando sus características, funcionamiento e interacciones junto con las intervenciones enfermeras más habituales, así como una reflexión sobre las implicaciones para la práctica

In recent years, a new line of treatment for the prevention of stroke in non-valvular atrial fibrillation, the so-called direct anticoagulants or new anticoagulants has appeared. The proper management and follow-up of these patients is essential to minimize their side effects and ensure patient safety. In this article, a description of these drugs is given, analyzing their characteristics, functioning and interactions together with the most habitual nursing interventions, as well as a reflection on the implications for the practice

Direct anticoagulants and nursing: an approach from patient's safety. / Anticoagulantes directos y Enfermería: un abordaje desde la seguridad clínica.

In recent years, a new line of treatment for the prevention of stroke in non-valvular atrial fibrillation, the so-called direct anticoagulants or new anticoagulants has appeared. The proper management and follow-up of these patients is essential to minimize their side effects and ensure patient safety. In this article, a description of these drugs is given, analyzing their characteristics, functioning and interactions together with the most habitual nursing interventions, as well as a reflection on the implications for the practice.