Sources of preanalytical error in primary health care -Implications for patient safety

1 ORIGINAL ARTICLES 2 ABBREVIATIONS 3 DEFINITIONS 4 INTRODUCTION 5 Patient safety 5 Systems perspective 6 Primary health care 7 Laboratory testing 7 Venous blood sample collection 8 Context for blood sample collection 8 The total testing process 9 The preanalytical phase 11 Patient preparation 11 Patient identification 12 Test request management 12 Test tube labelling 13 Sample collection and handling 13 Information search 14 Preanalytical incident reporting 16 Haemolysis 16 The analytical phase 18 The postanalytical phase 18 RATIONALE 19 AIMS 21 MATERIAL AND METHODS 23 The questionnaire survey 23 Setting 23 The investigated county councils 24 Participants 25 The questionnaire 25 Data management 27 Data collection 28 Statistics 28 Survey of haemolysis index 29 Subjects and setting 29 Sample collection and measurements 29 Data collection 30 Statistical analysis 30 CONSIDERATIONS 33 The questionnaire survey 33 Study design 33 Data collection 33 Validity and reliability 34 Ethical considerations 36 Statistical analysis 36 Survey of haemolysis index 37 Study design and data collection 37 HI determination 37 Statistical analysis 38 Ethical considerations 38 RESULTS AND DISCUSSION 39 Patient identification in PHCs 39 Test request management in PHCs 39 Test tube labelling in PHCs 40 Patient rest and venous stasis practices in PHCs 41 Sample handling in PHCs 41 Information search in PHCs 42 Comparisons between PHCs and clinical laboratories 43 Differences between subgroups of respondents in PHCs 43 VBS re-education and documented routines 43 Participant characteristics 44 PHCs and hospital wards 44 Reporting of preanalytical incidents 45 Staff opinions and suggestions 46 Haemolysis 49 CONCLUSIONS 51 IMPLICATIONS FOR PATIENT SAFETY 53 FUTURE RESEARCH 56 POPULÄRVETENSKAPLIG SAMMANFATTNING 57 ACKNOWLEDGMENTS 58 REFERENCES 60