Utilization of a healthcare failure mode and effects analysis to identify error sources in the preanalytical phase in two tertiary hospital laboratories

Abstract

IntroductionThe presence of errors in the preanalytical phase is a thoroughly studied problem. A strategy to increase their source detection might be the use of the Healthcare Failure Mode and Effects Analysis (HFMEA). The aim of this study is improving the capacity of identifying sources of error during the preanalytical period in samples provided by primary care clinics (PCC) with the use of the HFMEA as a tool in the laboratories of two tertiary hospitals.Materials and methodsA HFMEA was carried out in each laboratory, by means of the creation of groups of experts with similar characteristics (doctors and nurses from PCC and laboratory, support staff, and laboratory technicians). The Risk Priority Number (RPN) was calculated.ResultsItems with elevated RPN were presented in both centers. The highest RPN were in LAB1: “two request notes for a patient” and “the segregation of oncology urgent samples” (both with 384), while in LAB2 was “the lack of information in patients with oral glucose overload test” (RPN 576). Considering the different steps in the preanalytical phase, LAB1 paid attention in sampling, samples reception and the programming in the Laboratory Information System, while LAB2 paid attention in the request form, the appointment system, sampling procedures, transport and reception.ConclusionThe laboratories prioritized the problems differently. However, both centers offer solutions to these possible sources of error. We proposed improvement actions that can be resolved easily, with a low cost for the system, mainly to schedule a specific formative programme and a deep revision of the existing protocols.

Preanalytical Phase Errors: Experience of a Central Laboratory

“…Preanalytical error types especially occur outside the laboratory, and the root cause of the error is human [4,14]. A study of Romero et al, which consists of two tertiary hospital laboratories, also reported that the preanalytical phase potential errors were mainly detected outside the laboratory facilities [15].…”

“…Makhumula-Nkhoma et al also published that the importance of continued education and training and monitoring and evaluating the hemolysis rate is crucial [19]. Romero et al stated that they prioritized the potential problems in the preanalytical phase with the use of Healthcare Failure Mode and Effects Analysis (HFMEA), and then to improve their quality, they mainly focused on a specific training program and revision of the existing protocols [15].…”

Transcultural Adaptation and Piloting of the “Regarding Blood-Sampling Practices at Primary Health Care Centres” Questionnaire

“…As previously mentioned, the study of preanalytical errors and their origin and possible prevention has become a research area that has been offering results in recent years [6][7][8][9][10][11]. One of the most relevant observed aspects is that knowledge about the procedures associated with the nursing practice in PC is more directly related to the preanalytical phase: sampling, especially blood sampling.…”

“…While quality control systems designed to ensure the quality of the analytical phase are highly developed and in use in most clinical laboratories, this is not as prevalent in the preanalytical phase, even though it is considered as a possible threat for the process [7] and that accreditation procedures were described years ago [17].…”

“…In our field, these errors are more likely to appear in greater numbers in samples coming from Primary Care (PC) [6], so developing procedures towards tackling this problem is considered a priority. Among other options, specific training activities have been designed and quantitative and qualitative analyses of the problem have been carried out [7][8][9][10][11].…”