KLİNİK LABORATUVARDA KAN ÖRNEKLERİNDEKİ RET ORANLARININ DEĞERLENDİRİLMESİ

Yıl 2025, Cilt: 26 Sayı: 1, 1 - 4, 27.01.2025

Müjgan Ercan , Ayşe Ertekin , Özge Fenercioğlu , Mehmet Özcan , Rumeysa Duman , Berika Şahim , Esra Tunç , İsmet Enis Çeri , Gürkan Aydın , Mehmet Ali Alkan , Yasemin Engin

https://doi.org/10.18229/kocatepetip.1367222

Öz

AMAÇ: Kalite göstergeleri (KG), hata oranlarını azaltarak ve hasta güvenliğini koruyarak laboratuvar hizmetlerinin kalitesini iyileştirmek için kullanılan temel araçlardır. Çalışmamızda, acil servisten gelen ve reddedilen kan numunelerinin sayı ve oranları incelenerek IFCC’ nin (Uluslararası Klinik Kimya ve Laboratuvar Tıbbı Federasyonu) “Laboratuvar Hataları ve Hasta Güvenliği” Çalışma Grubu’nun (WG-LEPS) rapor ettiği kalite indekslerine göre karşılaştırılması amaçlandı.
GEREÇ VE YÖNTEM: Acil servisten Klinik Biyokimya Laboratuvarı'na gelen kan numunelerinin sayılarını değerlendirmek için, 2022 yılına ait veriler Laboratuvar Bilgi Sistemi’nden (LBS) geriye dönük olarak alındı. Analiz öncesi aşamada, laboratuvara gelen kan örneklerinin sayıları, reddedilme nedenlerine göre gruplandırılarak aylık ve yıllık yüzdeleri hesaplandı. IFCC WG-LEPS’nin üç hedef kriterlerini içeren ölçütler (%25’lik yüksek performans, %50’lik orta dereceli performans ve %75’lik düşük performans) kapsamında değerlendirildi.
BULGULAR: Toplam numune ret oranı % 2,3 olarak hesaplanmıştır. Reddedilme nedenlerine göre “hemolizli numune”, “uygun olmayan numune kabı”, “uygun olmayan numune miktarı” ve “pıhtılı numune”’ lerin % KG değerleri sırasıyla 0,72, 0,03, 0,77 ve 0,80 olarak belirlendi.
SONUÇ: Laboratuvarımızın “hemolizli numune” ve “uygun olmayan numune kabı’’ için % KG’sinin düşük performansa sahip olduğu gösterildi. “Pıhtılı numune” ve “uygun olmayan numune miktarı” için % KG’lerinin kabul edilemez aralıkta olduğu tespit edildi. Sonuç olarak, numune alımı ve transferi konularındaki eğitimlerin sıklığı artırılarak, sürecin kalitesinin artırılacağı düşüncesindeyiz.

Anahtar Kelimeler

Kalite göstergeleri , Analiz öncesi aşama , Hemoliz.

EVALUATION OF BLOOD SAMPLE REJECTION RATES IN CLINICAL LABORATORY

Öz

OBJECTIVE: Quality indicators (QI) are basic tools used to improve the quality of laboratory services by reducing error rates and protecting patient safety. In our study, it was aimed to examine the numbers and rates of rejected blood samples received from the emergency department and compare them according to the quality specifications reported by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) "Laboratory Errors and Patient Safety" Working Group (WG-LEPS).
MATERIAL AND METHODS: In order to evaluate the numbers of blood samples reaching the Clinical Biochemistry Laboratory from the Emergency Department, the data were obtained retrospectively from the Laboratory Information System (LIS) for 2022. In the preanalytical phases, the numbers of blood samples received to the laboratory were grouped according to the reasons for rejection, and their monthly and annual percentages were calculated. It was evaluated within the criteria of the IFCC WG-LEPS, which includes the three target criteria (25% high performance, 50% medium performance, and 75% low performance).
RESULTS: The total sample rejection rate was calculated as 2.3 %. According to the numbers of rejection reasons, the QI percentages for the “hemolyzed sample”, “inappropriate sample container”, “inappropriate sample amount ” and “clotted samples” were determined as 0.72, 0.03, 0.77 and 0.80, respectively.
CONCLUSIONS: It was determined that our laboratory had poor QI values for “hemolyzed sample” and “inappropriate sample container”. The QI percentages for "clot sample" and "inappropriate sample amount" were found to be in the unacceptable range. As a result, we believe that the quality of the process will be improved by increasing the frequency of training on sampling and transfer.

Anahtar Kelimeler

Quality indicators , Preanalytical phase , Hemolysis

Kaynakça

• 1. Hallworth MJ. The ‘70% claim’: what is the evidence base?SAGE Publications Sage UK: London, England. 2011;48(6): 487-8.
• 2. Sciacovelli L, O’Kane M, Skaik YA, et al. Quality Indicators in Laboratory Medicine: From theory to practice: Preliminary data from the IFCC Working Group Project “laboratory Errors and Patient Safety”. Clinical Chemistry and Laboratory Medicine. 2011;49(5):835-44.
• 3. Sciacovelli L, Lippi G, Sumarac Z, et al. Pre-analytical quality indicators in laboratory medicine: Performance of laboratories participating in the IFCC working group “Laboratory Errors and Patient Safety” project. Clinica Chimica Acta. 2019;497:35-40.
• 4. Pereira P. ISO 15189: 2012 Medical laboratories-Requirements for quality and competence. Westgard QC: Madison, WI, USA. 2020.
• 5. Zorbozan N, Zorbozan O. Evaluation of preanalytical and postanalytical phases in clinical biochemistry laboratory according to IFCC laboratory errors and patient safety specifications. Biochemia Medica. 2022;32(3):357-65.
• 6. Alsina MJ, Alvarez V, Barba N, Bullich S, Cortés M, Escoda I, Martínez-Brú C. Preanalytical quality control program - an overview of results (2001-2005 summary). Clin Chem Lab Med. 2008;46:849-54.
• 7. Ricós C, García-Victoria M, de la Fuente B. Quality indicators and specifications for the extra-analytical phases in clinical laboratory management. Clin Chem Lab Med. 2004;42:578-82.
• 8. Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin ChemLab Med. 2006;44:750-9.
• 9. Dolci A, Panteghini M. Harmonization of automated hemolysis index assessment and use: Is it possible? Clinica Chimica Acta. 2014;432:38-43.
• 10. Lippi G, Salvagno G, Brocco G, Guid G. Preanalytical variability in laboratory testing: influence of the blood drawing technique. Clin Chem Lab Med. 2005;43:319-25.
• 11. Von Meyer A, Cadamuro J, Lippi G, Simundic A-M. Call for more transparency in manufacturers declarations on serum indices: On behalf of the Working Group for Preanalytical Phase (WG-PRE), European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clinica Chimica Acta. 2018;9(484):328-332.