The quality and scope of information provided by medical laboratories to patients before laboratory testing: Survey of the Working Group for Patient Preparation of the Croatian Society of Medical Biochemistry and Laboratory Medicine

Nikolac, Nora; Šimundić, Ana-Maria; Kačkov, Sanja; Serdar, Tihana; Dorotić, Adrijana; Fumić, Ksenija; Gudasic-Vrdoljak, Jelena; Klenkar, Kornelija; Sambunjak, Jadranka; Vidranski, Valentina

doi:10.1016/j.cca.2015.08.001

Cited by 12 publications

(11 citation statements)

References 17 publications

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“…Despite the many national and international guidelines on collection of diagnostic blood specimens substantially agree about the fact that patient posture should be standardized before and during venipuncture ( 15 - 18 ), their effective implementation throughout different healthcare settings, as well as the compliance with these, are both dramatically insufficient ( 19 ). This is especially true in the ED, where overcrowding and frenetic activities may lead the personnel to disregard SOPs for blood collection and overlook the best practices ( 1 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Acutely developing, spurious anaemia without actual blood loss. A paradigmatic case report

Lippi

Cervellin

2017

Biochemia Medica

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We describe the case of a 55-year old women admitted at night to the emergency department (ED), complaining for acute abdominal pain lasting for nearly 5 hours. A first blood testing, performed immediately after admission, revealed mild anaemia. A second blood sample, drawn two hours after admission, revealed a considerable decrease of haemoglobin, haematocrit, total white blood cell and platelet counts (between 10-15% reduction). Abdominal ultrasonography was normal and the patient had no signs or symptoms of internal or external haemorrhage. Pre-analytical and analytical errors were accurately excluded. No infusion therapy was administered. After thoughtful discussing the sequence of events, it was ascertained that the first set of blood samples was drawn with the patient in seated position, immediately after ED admission (i.e., approximately 1 min passed from standing to seated position before venipuncture), whereas the second set of blood samples was drawn with the patient lying for two hours in supine position. This case report highlights the importance of standardizing patient position before venous blood collection, along with the crucial role played by cooperation and communication between laboratory and clinical wards for identifying and troubleshooting potential causes of spurious results of in vitro diagnostic testing.

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Section: Discussionmentioning

confidence: 99%

Acutely developing, spurious anaemia without actual blood loss. A paradigmatic case report

Lippi

Cervellin

2017

Biochemia Medica

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“…Several studies have demonstrated that patients go to the laboratory for blood sample collection without adequate preparation. This is attributed to the fact that they lack information regarding the pre-analytical requirements for routine blood tests as well as to the absence of harmonization among laboratories ( 5 - 8 ). These two factors are indicative of the need for standardized, updated and evidence-based recommendations for patient preparation to minimize patient risks ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Fasting conditions: Influence of water intake on clinical chemistry analytes

et al. 2017

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IntroductionCurrently available recommendations regarding fasting requirements before phlebotomy do not specify any maximum water intake volume permitted during the fasting period. The aim was to study the effects of 300 mL water intake 1 h before phlebotomy on specific analytes.Materials and methodsBlood was collected from 20 women (median age (min-max): 24 (22 - 50) years) in basal state (T0) and 1 h after 300 mL water intake (T1). Glucose, total proteins (TP), urea, creatinine, cystatin C, total bilirubin (BT), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (Tg), uric acid (UA), high-sensitivity C-reactive protein, gamma-glutamyl transferase (GGT), aspartate-aminotransferase (AST), alanine-aminotransferase and lactate-dehydrogenase (LD) were studied. Results were analyzed using Wilcoxon test. Mean difference (%) was calculated for each analyte and was further compared with reference change value (RCV). Only mean differences (%) higher than RCV were considered clinically significant.ResultsSignificant differences (median T0 vs median T1, P) were observed for TP (73 vs 74 g/L, 0.001); urea (4.08 vs 4.16 mmol/L, 0.010); BT (12 vs 13 µmol/L, 0.021); total cholesterol (4.9 vs 4.9 mmol/L, 0.042); Tg (1.05 vs 1.06 mmol/L, 0.002); UA (260 vs 270 µmol/L, 0.006); GGT (12 vs 12 U/L, 0.046); AST (22 vs 24 U/L, 0.001); and LD (364 vs 386 U/L, 0.001). Although the differences observed were statistically significant, they were not indicative of clinically significant changes.ConclusionsA water intake of 300 mL 1 h prior to phlebotomy does not interfere with the analytes studied in the present work.

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“…However, only fasting status was presented in a preanalytical case and no other specific preparations were investigated here. Working Group for Patient Preparation of the Croatian Society of Medical Biochemistry and Laboratory Medicine (WGPP CSMBLM) recently published results of a survey on instructions for patient preparation in Croatian laboratories ( 18 ). Although results showed that instructions are not standardized and that the information is lacking for some specific areas like therapeutic drug monitoring, coagulation and endocrinology, instructions in the field of clinical chemistry were rather uniform.…”

Section: Discussionmentioning

confidence: 99%

“…This is probably a result of availability of patient preparation instructions in the field of clinical chemistry ( 19 ). The study discovered that adherence to existing guidelines is rather high, but where guidelines are lacking, laboratories fail to issue their own guidelines ( 18 ). WGPP CSMBLM identified the need for the standardized evidence based guidelines for all areas of laboratory medicine.…”

Section: Discussionmentioning

confidence: 99%

Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

2017

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IntroductionThe aim of this paper is to present results of first two years of preanalytical external quality assessment (EQA) in Croatia.Materials and methodsThis paper summarizes results from 6 rounds of preanalytical EQA during 2014-2016 in 161-175 Croatian laboratories (number ranged between cycles). EQA was designed as an online survey of the compliance with National recommendations for phlebotomy (NRP). Forty-seven questions in 5 categories are analyzed (materials and equipment, patient identification, patient preparation, sampling and storage). Additionally, preanalytical cases are presented. Overall performance scores (Question score (Qscore) for compliance with NRP and Case score (Cscore) for preanalytical cases) are calculated for each question/case as a proportion of laboratories with satisfactory procedure (x 100). Qscores and Cscores ≥ 70 were classified as acceptable (maximal score = 100).ResultsIn investigation of compliance with NRP, acceptable Qscores were obtained for 34/47 questions. The lowest scores were observed for the availability of sterile disposable tourniquets (Qscore = 15) and safe-sharp needles (Qscore = 34), obtaining patients address as an identifier (Qscore = 21), using glycolysis inhibitor tubes for glucose concentration measurement (Qscore = 21) and verification of manufacturers declarations on temperature and time of storage (Qscore = 31). There was no statistically significant difference in overall Qscore according to different categories of phlebotomy procedures (P = 0.284). The results of preanalytical cases showed acceptable Cscore values for all cases (89-96).ConclusionFirst two years of preanalytical EQA showed good compliance with the NRP and excellent expertise in resolving complex preanalytical issues. Major critical spots are lack of availability of safe-sharp needles, disposable tourniquets and glucose inhibitor tubes.

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The quality and scope of information provided by medical laboratories to patients before laboratory testing: Survey of the Working Group for Patient Preparation of the Croatian Society of Medical Biochemistry and Laboratory Medicine

Cited by 12 publications

References 17 publications

Acutely developing, spurious anaemia without actual blood loss. A paradigmatic case report

Acutely developing, spurious anaemia without actual blood loss. A paradigmatic case report

Fasting conditions: Influence of water intake on clinical chemistry analytes

Preanalytical external quality assessment of the Croatian Society of Medical Biochemistry and Laboratory Medicine and CROQALM: finding undetected weak spots

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