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Two Significant Stats
70 % 40%
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Errors in the Stat Lab: 2007
Plebani M, Carraro P. Clin Chem; 2007
51, 746 tests performed
393 questionable results (0.7%)
160 confirmed laboratory errors (0.3%)
46 caused inappropriate pt. care (.01%)
24 of these were analytical errors (52%)
These data reflect ‘mistakes’ after those runs with QC rejects were omitted from the tally.
Sample Collection - Venipuncture
• Proper patient identification• Length of time tourniquet is applied• Proper antiseptic to cleanse site• Proper tube; • Proper amount of blood• Proper order of draw• Proper mixing of blood with
anticoagulant
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APPLICATION FLOW
Orders Sent from LIS to Server
Orders distributed to Handhelds
View Collection List / Select Patient-Review Inventory
(tubes/tests), Patient History, & Open vs. Collected Draws
Scan Bracelet - Positive Patient ID
Collect Specimens Print Barcode Specimen Labels at Bedside
Route Specimens to Lab
Collection Data Transferred to LIS
Received-In Specimens are Scanned
Print Label at the Patient’s Bedside
• After specimen is collected, user is prompted to ‘SCAN CONTAINER’
• Specimen label prints when correct container bar code is scanned using the BD Vacutainers.
• Label applied by aligning notches when using BD Vacutainers
Stro
ng
, Oscar
Strong, Oscar
Reviewing Patients with Open Orders
W-440-A (Allen, Angelo)
W-442-A (Rodriguez, Carlos)
W-444-B (Johnson, Kimberly)
Viewing Patients with Open Orders
W-444-B (Johnson, Kimberly)
Blue PT, PTT
Red BMP
Some (not all) of the Icons
These icons merely indicate a specimen
This icon indicates an incomplete order
This icon indicates a missed order – could not be completed at this time.
Some (more, not all) of the Icons
This icon indicates a completed order
• This icon indicates a stat request
• This icon indicates a timed sample that is incomplete at this time
Scanning the Patient’s Wrist Band
Please ID the Patient by scanning the correct field
Johnson, Kimberly
DOB Age Sex Bed 4.24.32 79 F W444B
MRN MHC3579B
FIN Incorrect PT ID !
The PT bar codeon the wrist isscanned to givethe Medical RecordNumber.
The bar codedid not matchthe patient’s financial ID
Order of Draw
1. Blood culture tube
2. Sodium citrate (light. blue)
3. Serum tubes (w/ or w/o clot activator, w/ or w/o gel separator)
4. Heparin tubes (green)
5. EDTA tubes (lavender)
6. Glycolytic inhibitor (gray)
7. Revision reflects increased use of plastic tubes
8. Plastic red top tubes (serum) contain a clot activator that may interfere with coag. testing
9. Glass non-additive red top tubes may still be drawn before the coagulation tube
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Delta Checks
Absolute Delta Hemoglobin 11/10/07 12.1
11/11/07 9.2 ?% Delta Creatinine 08/12/07 0.9 11/13/07 1.2 % 33%
Johnson and Stelmach Clin. Lab News September, 2007
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Delta Checks
Absolute or % Delta
BUN If < 19.9 mg/dL 10 mg/dL >20 40%
Consider the time between samples, e.g. 7 d for BUN
Johnson and Stelmach Clin. Lab News September, 2007
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Follow up of rejected data
Once a value is NOT auto-released,
it must be verified.
Repeated?Discussed with clinician?Compared with other data Same patient – different time Same patient – different tests
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Advantages
• Increases physician confidence• Ability to Increase Volume without
Increasing Staff• Enables Further Technologist
Development in Manual Areas• Provides for Consistent Release of
Results• Reduces TAT and costs• Reduces frustration
