Risk Analysis In a Routine Haematology Lab

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Risk Analysis: From blood collection to doctor receiving result of Full Blood Counts samples. Errors in the laboratory can be classified as pre-analytical, analytical and post-analytical. Studies done by various individuals and groups have found that most errors occur in the preanalytic stage.1 It worsens if the personnel performing phlebotomy is a non-laboratory personnel, as in the Singapore General Hospital. One of these could occur during phlebotomy 1. Wrong patient identification 2. Wrong tube used, eg citrate tube instead of EDTA tubes 3. Blood not well mixed after blood taking, inducing clots 4. Hemolysed samples 5. Insufficient blood taken due to underestimation or inability to draw blood 6. Wrongly labeled sample or/and form 7. Blood not sent to laboratory promptly, left in room temperature to deteriorate The most vital step in avoiding these mistakes is thorough staff training. Standard protocols for the nurses, doctors or phlebotomists should be made available for them, encompassing proper steps and possible sources of preanalytical variability like sample storage and transportation of samples. A two identifier method is recommended during phlebotomy to prevent misidentification. To improve on this, an automated system should be introduced. An effort is underway to implement identification by barcoded wristbands in our hospital. Together with a portable computer system that can scan and print the labels for the sample tubes at the bedside, misidentification may be avoided altogether. It has also been suggested the method of “one patient at a time” be the practice in the wards, in which, a phlebotomist would go to another patient only after the sample for the first patient has been taken, labelled and sent out for dispatch so as to prevent confusion.2 For full blood count samples, maximum standing time before analysis is 5

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