The laboratory is a key partner in assuring patient safety

Medical errors have a great impact on patient outcomes. They can cause serious injury to patients or even result in their deaths. However, morbidity and mortality can sometimes be prevented by the timely and effective action of health care workers. Several IOM Reports have focused on the problem of errors in the United States health care system and identified gaps that need to be addressed. As part of the overall health care system, clinical laboratories are vulnerable to medical errors. Because of significant efforts on the part of both the laboratories and the manufacturers of laboratory equipment and reagents, the errors in the analytic phase of the total testing process now represent the smallest portion of testing errors. Currently, laboratory testing errors occur most frequently in the preanalytic phase. The primary reason for the high prevalence of preanalytic errors is that, at the present time, it is difficult to monitor all preanalytic variables and to implement necessary improvement processes, particularly when some of the variables (like phlebotomy) are not under the control of the laboratory. Considerable efforts have been made by laboratory professionals and other stakeholders to decrease testing errors. Minimal quality requirements have been set through regulations for both laboratory testing and the manufacture of medical equipment and reagents. At the same time, nonregulatory approaches have greatly affected the quality of laboratory testing. These include laboratory standards, various quality improvement programs, voluntary reporting of adverse events, and, in the near future, the National Report on the Quality of Laboratory Services. The introduction of successful approaches from other industries, such as Six Sigma and Lean, also will help reduce the rate of laboratory errors. The clinical laboratory has done more than most other sectors of health care to decrease the occurrence of medical errors, making it a key partner inpatient safety.     

The laboratory and patient safety

Laboratory data are used extensively in patient care; consequently, laboratory errors have a tremendous impact on patient safety. Clinical laboratories were early leaders in efforts to minimize medical errors and improve patient safety. These efforts continue in many areas, including patient and specimen identification, laboratory result notification, and assistance in laboratory data interpretation. Emerging ideas on identifying and reducing laboratory errors, as well as specific strategies are reviewed and discussed with examples.     

Errors in laboratory medicine and patient safety: the road ahead.

The Institute of Medicine (IOM) report, To err is human, galvanized a dramatically increased level of concern about adverse events and patient safety in healthcare, including errors in laboratory medicine. While a significant decrease in the error rates of clinical laboratories has been achieved and documented in recent decades, available evidence demonstrates that the pre- and post-analytical phases of the total testing process are more vulnerable to errors than the analytical phase. However, analytical quality is still a major issue, particularly in some areas of laboratory medicine such as immunoassaying. In the present paper, current trends and factors that could effect future changes in the frequency and types of errors in laboratory services are analyzed and discussed. A more effective integration of automation and information technology could allow clinical laboratories to identify, control and decrease error rates in the total testing process, but interdepartmental cooperation and communication with clinicians and other stakeholders are essential to improving patient safety. Moreover, a fundamental shift in improving patient safety in laboratory medicine is to move from error reporting to risk management.     

Making patient safety work: the Health Foundation snapshot

John Tingle discusses two recent publications from The Health Foundation charity which showcases their current patient safety work.     

Making patients safer: nurses' responses to patient safety alerts

Title. Making patients safer: nurses’ responses to patient safety alerts. Aim. This paper is a report of a study to determine whether action required by patient safety alerts was effectively taken. Background. Over the last 10 years, there has been a growing awareness of the number of patients unintentionally harmed in the course of their treatment. Safety alerts are designed to reduce the incidence of adverse events by removing these predisposing factors. Method. A multi‐method study was carried out in 20 acute, two mental health, four ambulance and 15 primary care provider organizations in the United Kingdom in 2006–2007 using surveys, interviews with senior managers and front‐line staff, collection of documentary evidence and equipment audit. The implementation of three safety alerts for nursing action is reported. Findings. Most staff were aware of the dangers posed by gloves to staff with latex allergy, but only 20% were aware of the types of common equipment that posed a danger to sensitive patients. Almost 40% of nurses were unable to give a correct acidity value to allow nasogastric feeding to commence. One alert, on needle‐free intravascular connectors, was distributed in only a few organizations as the term used was unfamiliar at all levels of the organization. Conclusion. Healthcare providers have succeeded in setting up successful systems to disseminate alerts to middle management level, but there is evidence that implementation of recommendations by nurses is sub‐optimal.     

The IFCC Working Group on laboratory errors and patient safety

The increasing attention paid to patient safety, and the awareness that the information provided by clinical laboratories impacts directly on the treatment received by patients, has made it a priority for clinical laboratories to reduce their error rates and promote an excellent level of quality.The capacity for reporting, analysing and learning from experience is still seriously hampered by a lack of methodological uniformity in identification and measurement, inadequate reporting schemes for error events, the fear of professional liability, and weak information systems. In previous years, the use of quality indicators to assess and monitor the quality systems of clinical laboratories considerably benefited quality management. Yet currently there are no guidelines available for identifying and correcting development of quality indicators in laboratory medicine, although the International Standard ISO 15189:2007 for Accreditation of Medical Laboratory requires them to be implemented. The aim of this work was therefore to report on the project, nominated “Model of Quality Indicator”, undertaken by the Working Group, “Laboratory Errors and Patient Safety (WG-LEPS)” instituted by the division of Education and Management (EMD) of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). The mission of the WG-LEPS is to promote and encourage investigations into errors in laboratory medicine, collect data available on this issue and recommend strategies and procedures for improving patient safety.     

Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence

It has been suggested that the increase in gambling activity nationally has resulted in an increase in intimate partner violence (IPV). There are apparently no studies that have assessed problem gambling as a risk factor for IPV. To determine if problem gambling in the partner is a risk factor for IPV, a cross-sectional study was conducted at a university-based Emergency Department (ED). All women aged 19 to 65 years who presented to the ED for treatment and were not decisionally incapacitated or acutely ill were eligible. Data were collected by a research assistant during 4 or 8-h blocks covering each day of the week over a 10-week period during the months of June through August 1999. There were 300 consecutive women approached, and 286 (95%) agreed to participate. Of the women who agreed to participate, 237 (83%) reported having an intimate partner in the last year, and 61 (25.7%) of these women were categorized as experiencing IPV. The odds ratio (OR) of experiencing IPV was the main outcome measure, estimated using standard logistic regression, given the presence of various personal and partner characteristics, including problem gambling in the partner. The results revealed that the relative odds were elevated for women whose partners were problem gamblers (adjusted OR: 10.5; 95% CI: 1.3-82) or problem drinkers (adjusted OR: 6.1; 95% CI: 2.5-14). The presence of both problem gambling and problem drinking in the partner was associated with an even higher OR (adjusted OR: 50; 95% CI: 9-280). Our study shows that problem gambling in the partner is associated with IPV. The causes of IPV are not fully known, but the association of problem gambling in the partner with IPV could lead to new intervention strategies and Emergency Medicine research in the future.     

Body piercing: a patient safety issue.

Body piercing is a common form of self-expression around the world. Although a common practice among many cultures and age groups, there is very little published as to the care of the patient with body piercings in the perianesthesia setting. This article explores the type, site, care, and removal of body piercings in the preoperative setting. A focus on issues in the United States and New Zealand is provided.