Minimizing Pre-analytical Variability

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Course Objectives
  1. Summarize the concept of pre-analytical errors and variability
  2. Recognize errors before, during, and after collection
  3. Apply strategies for improvement to reduce the overall total of pre-analytical errors
Course Content
Course Creator: Kirsten Hermens, NCMA-P
Total CE Hours: 1 Credit Hour
Pace Course #: 586-2504-25

Outline:
  • Pre-analytical errors overview
    • Patient identification
      • Misdiagnosis
      • Inappropriate treatment decisions
      •  Potential harm to patients 
    • Collection Medium
      • Blood tube additives
      • Transport media
    • Collection time
      • Documentation time
      •  TDM collections
      •  First morning void
    •  Patient-led Pre-analytical Errors
      •  Dehydration
      •  Medication and supplements
      •  Inadequate fasting
    •  Requisitions/Orders
      •  Illegible writing 
      • Verbal orders
      •  Incomplete requisition
    •  Contamination
      •  Order of draw
      •  Urine collection contamination
    •  Specimen Quantity
      •  QNS
  •  Venipuncture Collected Specimens
    •  Duration of tourniquet use
    •  Order of draw
    • Tube inversion
    • Hemolysis
    • Centrifugation
  •  Urine Specimen Collection
    • Collection method
      •  Random collection
      •  Clean Catch midstream collection
      •  Morning Collection
      •  24-hour collection
      •  Postprandial collection
    •  Storage and Handling
  •  Post Specimen Collection and Sample Processing Errors
    • Processing Windows
    • Reagents
      •  Incorrect reagent choice
      •  Expired reagent
      •  Incorrectly stored reagent
      •  Lot-to-lot variations
    •  Testing Equipment
    • Calculation and Input
      •  Dilution errors
      •  Decimal errors
      •  Calibration calculation errors
      •  Patient charting errors
  •  Measures to Reduce Pre-Analytical Variability
    • Harmonization and Standard Guidelines 
    • Quality Monitoring 
    • Education and Training 
    • Hemolyzed, Icteric, and Lipemic (HIL) Index

References: 
  1. Nordin, N., Ab, N., Farhana, W., Zulkarnain, S., Sinha, S., Kumar, S., & Haque, M. (2024). Pre-analytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures. Curēus. https://doi.org/10.7759/cureus.57243
  2. Doke, G. (2024, May 26). The Foundation of Accuracy: Minimizing Pre-Analytical Errors in Laboratory Testing. CrelioHealth for Diagnostics. https://blog.creliohealth.com/minimizing-pre-analytical-errors-in-laboratory-testing/
  3. Lexington Medical Center. (n.d.). Specimen Collection, Handling and Transport. https://www.testmenu.com/lexington/TestDirectory/SiteFile?fileName=sidebar%5CSpecimenCollectionHandlingTransport032715.pdf
  4. Dahal, P. (2023, September 27). Transport Media: Principle, uses, types, examples. Microbe Notes. https://microbenotes.com/transport-media/#some-common-transport-medium-and-intended-use
  5. (2009, March 6). Overview of Therapeutic Drug Monitoring. National Library Of Medicine. Retrieved December 10, 2024, from https://pmc.ncbi.nlm.nih.gov/articles/PMC2687654
  6. Medico. (2024, August 26). The Importance of Morning Urine Samples for Accurate Health Assessments - Medico. Medico. https://medicogrp.com/urine-sample-first-thing-morning/
  7. Block-Galarza, J. (2016). Vol 11 Issue 12 p.3-4 | American Thyroid Association. American Thyroid Association. https://www.thyroid.org/patient-thyroid-information/ct-for-patients/december-2018/vol-11-issue-12-p-3-4/
  8. Regina Boyle Wheeler. (2016, July 14). Fasting for Blood Tests. WebMD; WebMD. https://www.webmd.com/cholesterol-management/fasting-blood-tests
  9. Abdollahi, A., Saffar, H., & Saffar, H. (2014). Types and Frequency of Errors during Different Phases of Testing At a Clinical Medical Laboratory of a Teaching Hospital in Tehran, Iran. North American journal of medical sciences, 6(5), 224–228. https://doi.org/10.4103/1947-2714.132941
  10. Clean Catch (Midstream) Urine Specimen Collection Instructions. (2024, January 29). Cleveland Clinic Laboratories. https://clevelandcliniclabs.com/laboratory-resources/specimen-collection-transport/collection/clean-catch-urine-collection-instructions/#female
  11. Parizad, N., Hassanpour, A., & Goli, R. (2022). Preventing the complications of forgotten tourniquet by using intelligent tourniquet: A letter to the editor. International journal of surgery case reports, 90, 106402. https://doi.org/10.1016/j.ijscr.2021.106402
  12. Hoover, A. C., Segal, R. S., Zimmerman, M. B., Lee-Son, K., Porterfield, H. S., Stewart, S. A., & Rysavy, M. A. (2021). Urine Trouble: Reducing Midstream Clean Catch Urine Contamination Among Children 3–17 Years Old. Pediatrics, 148(2), e2020049787. https://doi.org/10.1542/peds.2020-049787
  13. How should I collect and store a urine sample? (n.d.). Healthily. https://www.livehealthily.com/health-library/medical-exams/how-should-i-collect-and-store-a-urine-sample
  14. Lippi, G., Simundic, A.-M., & European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). (2017). The EFLM Strategy for Harmonization of the preanalytical phase. De Gruyter, Clin Chem Lab Med 2017; aop, 1–5. https://doi.org/10.1515/cclm-2017-0277
  15. Editorial Team. (2022, March 7). Tests affected by hemolyzed, lipemic and icteric samples and their mechanism - Laboratoryinfo.com. Laboratoryinfo.com. https://laboratoryinfo.com/tests-affected-hemolyzed-lipemic-icteric-samples-mechanism/ 

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