davidplaut@yahoo
DESCRIPTION
WELCOME. [email protected]. Two Significant Stats 70 % 40%. Errors in the Stat Lab: 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%). - PowerPoint PPT PresentationTRANSCRIPT
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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.
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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
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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
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Reviewing Patients with Open Orders
W-440-A (Allen, Angelo)
W-442-A (Rodriguez, Carlos)
W-444-B (Johnson, Kimberly)
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Viewing Patients with Open Orders
W-444-B (Johnson, Kimberly)
Blue PT, PTT
Red BMP
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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.
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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
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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
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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