Preanalitik süreçte kan alma hatalarının incelenmesi

Abstract

Amaç: İnsan faktörünün aktif rol oynadığı numune toplama hataları, kan alan kişinin kişisel özellikleri ve deneyimine bağlıdır. Bu çalışmada, hastanemizde yatan hastalar ile ayaktan hastaların kan örneklerindeki preanalitik hata oranlarının karşılaştırılması ve kan toplama hatalarının incelenmesi amaçlanmıştır.

Gereç ve Yöntemler: Preanalitik hatalar, Laboratuvar Bilgi Sistemi’ndeki 10 aylık periyoda ait reddedilen numune kayıtlarının incelenmesiyle belirlendi. Bu numuneler, çalışma gruplarına ve preanalitik hata gruplarına ayrıldı. Kan alma ünitesinde çalışan her bir hemşirenin günlük numune alma sayısı hesaplandı.

Bulgular: Reddedilen total numune oranı yatan hastalarda %1,23 ve ayaktan hastalarda %0,2 (P = 0.000)’ydi. Kan alma ünitesinde çalışan bir hemşirenin günlük aldığı kan numunesi sayısı, yaklaşık olarak 200’dü. Pıhtılı numune ve yetersiz hacim en sık numune ret sebepleri olarak bulundu.

Sonuçlar: Preanalitik hataların çoğu, flebotomistlerin ve hemşirelerin uygun şekilde eğitilmeleri ile azaltılabilir. Hastanede çalışmaya yeni başlayan hemşirelerin eğitim programına uygulamalı kan alma eğitimi dahil edilebilir. Preanalitik hataların azalması hasta güvenliğine katkıda bulunacaktır. 

Keywords

• Kan örneği toplama,eğitim,deneyim,hemşire,preanalitik hatalar

Investigation of blood collection errors in the preanalytical process

Abstract

Aim: Sample collection errors, in which the human factor plays an active role, depend on the experience and personal characteristics of the blood-drawing person. This study aimed to investigate blood collection errors and to compare the rates of pre-analytical errors in blood samples of outpatients and inpatients in our hospital.

Material and Methods: Pre-analytical errors were determined by examining rejected samples from the Laboratory Information System records for a period of 10 months. The samples were separated into working groups and pre-analytical error groups. The daily number of sampling procedures was calculated for each nurse working in the blood collection unit.

Results: The total rate of rejected samples was 0.2% in outpatients and 1.23% in inpatients (P = 0.000). Nurses working in the blood collection unit drew about 200 blood samples each per day. Clotted samples and insufficient volume were the most often found causes for rejection of samples.

Conclusion: Most preanalytical errors can be reduced by appropriate training of phlebotomists and nurses. Practical blood draw training can be included in the training program of nurses new starting to work in hospital. The reduction of preanalytical errors will contribute to patient safety. 

Keywords

• Blood sample collection,education,experience,nurse,pre-analytical errors

References

1. 1. Bölenius K, Brulin C, Graneheim UH. Personnel’s experiences of phlebotomy practices after participating in an educational intervention programme. Nursing Res Pract 2014; 2014: 538704. doi:10.1155/2014/538704.
2. 2. Makitalo O, Liikanen E. Improving quality at the preanalytical phase of blood sampling: Literature Review. Int J Biomed Lab Sci 2013; 2: 7-16.
3. 3. Daglıoglu G. Klinik laboratuvarlarda kalite yönetimi: Altı Sigma protokolünün uygulanması. 2009. Available from: library.cu.edu.tr/tezler/7283.pdf. Accessed on June 19,2014.
4. 4. Chawla R, Goswami B, Tayal D, Mallika V. Identification of the types of preanalytical errors in the clinical chemistry laboratory: 1-Year study at G.B. Pant hospital. Lab Med 2010; 41:89-92.
5. 5. Plebani M. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Biochem Rev 2012; 33: 85-8.
6. 6. Salinas M, López-Garrigós M, Flores E, Santo-Quiles A, Gutierrez M, Lugo J, et al. Ten years of preanalytical monitoring and control: Synthetic balanced score card indicator. Biochem Med 2015; 25: 49-56.
7. 7. Cuhadar S. Preanalytical variables and factors that interfere with the biochemical parameters: a review. OA Biotechn 2013; 2: 1-7.
8. 8. Ernst DJ. Preanalytical errors that occur after specimen collection. 2007. Available from:http://duiform.weebly.com/uploads/1/2/0/1/12016444/blood_preanalytical_errors_after_collection.pdf. Accessed on March 13,2015.

9. 9. Simundic AM, Cornes MP, Grankvist K, et al. Colour coding for blood collection tube closures-a call for harmonization. Clin Chem Lab Med 2015; 53: 371-6.
10. 10. Guder WG, Naraynan S. (eds) Pre-Examination Procedures in Laboratory Diagnostics. Preanalytical aspects and their Impact on the quality of medical laboratory tests. Berlin, Boston; Walter de Gruyter GmbH; 2015.
11. 11. Lippi G, Chance JJ, Church S, et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011; 49: 1113-26.
12. 12. Sinici Lay I, Pınar A, Akbıyık F. Classification of reasons for rejection of biological specimens based on pre-preanalytical processes to identify quality indicators at a university hospital clinical laboratory in Turkey. Clin Biochem 2014; 47: 1002-5.
13. 13. Abdollahi A, Saffar H, Saffar H. Types and frequency of errors during different phases of testing at a clinical medical laboratory of a teaching hospital in Tehran, Iran. North Am J Med Sci 2014; 6: 224-8.
14. 14. Melkie M, Girma A, Tsalla T. The practice of venous blood collection among laboratory and non-laboratory professionals working in Ethiopian Government Hospitals: a comparative study. BMC Health Services Res 2014; 14: 88.
15. 15. Atay A, Demir L, Cuhadar S, et al. Clinical biochemistry laboratory rejection rates due to various types of preanalytical errors. Biochem Med 2014; 24: 376–82.
16. 16. Simundic AM. EFLM WG-PA European survey on pflebotomy practices. Available form:http://www.labquality.fi/@Bin/2827774/AnaMaria+Simundic_+Managing+the+Qualiy+of+Preanalytical+Phase_Labquality+days_2015.pdf. Accessed on April 01,2016.
17. 17. Yüksel H, Kaplan İ, Toprak G, et al. A questionnaire study among nurses: awareness of blood and urine sample collection procedures. Clin Chem Lab Med 2014; 52: e159-e161.
18. 18. Wallin O. Preanalytical errors in hospitals. Implications for quality improvement of blood sample collection. Thesis, Department of Medical Biosciences, Clinical Chemistry Department of Nursing Umeå University, Umeå, Sweden; 2008.
19. 19. Dorotić A, Antončić D, Biljak DR, Nedić D, Beletić A. Hemolysis from a nurses’ standpoint – survey from four Croatian hospitals. Biochem Med 2015; 25: 393-400.
20. 20. Lillo R, Salinas M, Lopez-Garrigos M, et al. Reducing preanalytical laboratory sample errors through educational and technological interventions. Clin Lab 2012; 58: 911-7.
21. 21. Da Rin G. Pre-analytical workstations: A tool for reducing laboratory errors. Clin Chim Acta 2009; 404: 68-74.