6. Sample Preparation and Accessioning

What are referral samples concerning specimen preparation?

Specimens sent to another laboratory for tests not performed in-house.

What is the purpose of identifying preanalytical errors?

To ensure accuracy and integrity of laboratory test results before they are analyzed.

What technology is used to manage laboratory patient data?

Laboratory Information System (LIS).

How does interfacing with LIS improve laboratory productivity?

It decreases the risk of error by directing patient data/results to patient charts for review.

What are the three areas covered by LIS?

Pre-analytical, analytical, and post-analytical areas of patient testing.

What do barcodes on specimens help ensure?

They verify the patient and the tests requested on each patient.

How do one-dimensional (1D) barcodes differ from two-dimensional (2D) barcodes?

1D barcodes are linear require laser scanners, while 2D barcodes store more information and require imaged-based scanners.

What is the goal of specimen accessioning?

To receive, verify, and enter patient specimens into the Laboratory Information System.

What should be confirmed during specimen receipt?

Specimen identification, integrity, and correct labeling against test requests.

What are at least two patient identifiers used for verification?

Full name and date of birth (DOB).

What happens if specimen identification discrepancies are found?

They should be rejected or corrected according to facility standard operating procedures (SOP).

What should be assessed for specimen integrity?

Container type, volume, labeling, transport conditions, and presence of hemolysis or clots.

What to do if a specimen fails visual inspection?

Document the unacceptable specimens and follow rejection procedures.

What should be verified for the tests requested?

That tests are clearly indicated and appropriate for the specimen submitted.

What information should be included when accessioning in the LIS?

Patient demographics, requesting physician, specimen type, collection date, and all requested tests.

What should LIS-generated barcoded labels not cover?

Fill lines or important areas on the tube/container.

What is the purpose of quality assurance in specimen handling?

To monitor the accuracy of accessioning and error tracking through audits.

What common preanalytical errors are recognizable?

Wrong patient, mislabeled specimens, improper specimen storage, or delays beyond stability limits.

What actions should be taken if an error is suspected in testing a specimen?

Stop testing the specimen and determine if recollection is necessary.

What is included when documenting a preanalytical error in LIS?

Patient information, date/time of discovery, description of the error, and actions taken.

What is root cause analysis used for?

To investigate repeat or significant errors to improve accuracy in testing.

What are implausible results in laboratory testing?

Results that are inaccurate or inconsistent with clinical expectations.

What should be done if implausible results are received?

Do not report results and check for specimen issues and possible preanalytical errors.

What are critical values in laboratory results?

Results indicating a life-threatening or medically urgent condition needing prompt action.

What examples of critical values should be communicated urgently?

Glucose < 2.0 mmol/L, platelet count < 20 x 10^9/L, hemoglobin < 70 g/L.

What should be verified before phoning critical value results?

The accuracy of the critical value and check for any potential errors in testing.

What should lab staff do to ensure complete testing?

Verify that all tests ordered have results and that none were missed or pending.

What to do if a specimen is not suitable for testing?

Notify the patient area or physician and document in LIS for traceability.

How should lab documents be maintained?

They should be comprehensive for future reference and analysis.

What are the pre-analytical steps necessary for specimen integrity?

Verify specimen and requisition, assess specimen suitability, and prepare for testing.

What is included in the accessioning steps of the LIS?

Creation of accession number, entering patient demographics, and applying barcoded labels.

How can lab professionals track specimens efficiently?

By using LIS for traceability and documenting preanalytical issues.

What technology is essential for printing 2D barcodes?

Special thermal printing technology.

What should be included in the documentation of preanalytical issues?

Observed issues, corrective actions taken, and comments for additional context.

What should lab staff verify regarding the condition of specimens?

The temperature and proper storage conditions, protecting specimens as needed.

What is crucial in managing unexpected or implausible lab results?

Recognizing the results and taking necessary corrective actions.

What is required for a quality assurance audit in labs?

Monitoring accessioning accuracy and cleaning up any discrepancies.

How should lab staff respond to critical values?

Address them promptly by calling results and ensuring verification.

What do delta checks help to identify?

Discrepancies in patient results over time.

What critical steps should be taken upon identifying a preanalytical error?

Stop all testing, rescind the sample if necessary, and document findings.

Why is it important for all tests to have assigned units and reference ranges?

To ensure accurate result interpretation and facilitate treatment decisions.

How are laboratory metrics and data typically documented?

In the Laboratory Information System (LIS) for accuracy and traceability.

What is the primary goal of accessioning procedures?

Ensuring all specimens are properly collected, labeled and tracked.

What happens if there is a failure due to instrumentation?

Staff must verify tests and evaluate for any needed repairs or recalibrations.

What is meant by 'specimen integrity'?

The state where a specimen is collected under proper conditions and remains uncontaminated.

What role do corrective actions play in lab error management?

To rectify issues and prevent similar errors from occurring in the future.

What types of errors occur preanalytically?

Errors occurring before testing starts, including handling, preparation, and transport.

What is the necessity of labeling and barcoding in sample preparation?

To minimize handling errors and ensure correct sample identification.

Why is documentation vital in laboratory processes?

It ensures accuracy for future reference and adherence to procedural compliance.

What is the function of a computer-based algorithm in labs?

To automatically verify test results and flag critical values.

What should lab professionals remember about test result consistency?

Results must consistently correlate with patient's history and clinical expectations.

What principle guides the immediacy of addressing critical lab test results?

Patient safety and the urgency of resolving life-threatening conditions.

What kind of tests require immediate reporting if critical results are identified?

Tests indicating severe patient conditions, like low glucose or high potassium.

How should a laboratory track and manage tests that are pending?

By ensuring they are monitored for completion and resolution within the LIS.