Errores en la identificación del paciente y en muestras biológicas en el proceso analítico: ¿es posible la mejora de la seguridad de los pacientes? / Patient identificacion errors and biological samples in the analytical process: Is it possible to improve patient safety?

Introducción. Los errores en la identificación del paciente representan uno de los problemas con mayor índice de factor de riesgo en provocar un evento adverso en el paciente. Objetivo. Detectar y analizar las causas de los errores de identificación de paciente y sus muestras biológicas en las solicitudes analíticas (EIPMB) procedentes de Urgencias e implantar estrategias de mejora. Material y métodos. Diseño del proceso y protocolo a seguir por todos los profesionales implicados en el proceso de petición y realización de pruebas analíticas. Evaluación y seguimiento de indicadores de EIPMB antes y después de la implantación de dichas medidas de mejora (años 2010 a 2014). Resultados. Durante el período del estudio se detectan un total de 316 EIPMB en un total de 483.254 solicitudes del Servicio de Urgencias que representan una media de 6,80/10.000. El error de identificación de paciente fue el más frecuente en todos los semestres, con una diferencia significativa con p < 0,0001. Conclusiones. Las estrategias de mejora aplicadas demostraron ser eficaces en la detección de los EIPMB, así como en su prevención. No obstante, se debe seguir trabajando en esta estrategia, fomentando la cultura de seguridad de todos los profesionales implicados e intentando alcanzar el objetivo de que el 100% de las solicitudes analíticas, así como las muestras, estén identificadas correctamente (AU)

Background. Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. Objective. To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. Material and methods. A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). Results. A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (P < .0001). Conclusions. The improvement strategies applied showed to be effective in detecting PIEAR, as well as the prevention of such errors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified (AU)

[Patient identification errors and biological samples in the analytical process: Is it possible to improve patient safety?]. / Errores en la identificación del paciente y en muestras biológicas en el proceso analítico: ¿es posible la mejora de la seguridad de los pacientes?

BACKGROUND: Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. OBJECTIVE: To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. MATERIAL AND METHODS: A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). RESULTS: A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (P<.0001). CONCLUSIONS: The improvement strategies applied showed to be effective in detecting PIEAR, as well as the prevention of such errors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified.

Immunomagnetic quantification of circulating tumoral cells in patients with prostate cancer: clinical and pathological correlation.

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied. RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% < or = 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presence or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metastases [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)] , these differences were not significant. CONCLUSIONS: Immunomagnetic analysis permits CTCs to be enumerated in peripheral blood and could be a possible way to correctly stage and make a reasonable prognosis of metastatic disease.

Cuantificación inmunogenética de células tumorales circulantes en pacientes con cáncer de próstata: correlación clínica y patológica / Immunomagnetic quantification of circulating tumoral cells in patients with prostate cáncer: clinical and pathological correlation

OBJETIVOS: Detección y cuantificación de células tumorales prostáticas circulantes (CTC) en sangre periférica de pacientes con cáncer de próstata (CP) y estudiar la relación de las CTCs con los parámetrosclínico-patológicos.MÉTODOS: Estudio prospectivo con tres brazos: 26 pacientes (p) con CP localizado (CPL); 24p con CP metastático(CPM) y 30 controles voluntarios sanos. Se extrajouna única muestra de 7,5 mL de sangre periférica y se aislaron las CTC según un método inmunomagnéticobasado en el sistema CellSearch (Veridex). Las CTCs fueron identificadas como células nucleadas negativas para el CD45 (leucocitos) y positivas para las citoqueratinas(8, 18 y 19). Se estudiaron las relaciones del número de CTCs con los niveles de PSA, Gleason y clasificación TNM.RESULTADOS: Sólo el 10% de controles sanos tenían 1 CTC/7,5 mL, ninguno de los pacientes con CP localizadotuvo más de 3 CTC (88% ≤ 2 CTC) y aquellos con CPM presentaban niveles de CTCs significativamente más altos [m: 29 (1-178)] comparados con los otros dos grupos (P: 0.000). Se demostró una correlación positiva entre el número de CTC y cifras de PSA, con el tamaño del tumor y con la presencia o no de adenopatías.El grado Gleason fue el único parámetro que no mostró correlación con los niveles de CTC y aunque el número de CTC fue mayor en aquellos con metástasis viscerales [m: 297 (0-416)] comparado con los que tenían metástasis óseas [m: 68 (9,5-168)] estas diferenciasno fueron significativas.CONCLUSIONES: El análisis inmunomagnético nos permite cuantificar las CTC en sangre periférica y podríapresentar una posibilidad para lograr una estadificacióncorrecta y estimar un pronóstico adecuado de la enfermedad metastática(AU)

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied.RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% ≤ 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presen-ce or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metasta-ses [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)], these differences were not significant(AU)