MLS 407 | Patient Safety

Define patient safety, including the clinical laboratory professional’s responsibility in the total testing process. 

Patient Safety: discipline that focuses on preventing and reducing risks, errors, and harm to patients during care. Lab professionals are responsible at every analytical stage.

Discuss the five core competencies needed for all healthcare professionals as proposed by the Institute of Medicine (IOM).

· Provide patient care

· Work in interdisciplinary teams (to ensure care is continuous and reliable)

· Employ evidence-based practice

· Apply quality improvement (identify hazards and errors in care, work to fix them)

· Utilize informatics (communicate, manage knowledge, mitigate error, and support decision-making using information technology)

These are all fundamental to improving patient outcomes

Describe common errors that can adversely affect patient safety at the pre-analytical, analytical, and post-analytical phases of testing.

Pre-Analytical

· Error in phlebotomy technique (hematoma, fainting, multiple attempts, reactions, infection)

· Wrong patient drawn, errors in identification

· Error in specimen labeling

· Incorrect order entry

· Specimen integrity

· Wrong tests

 

Analytic

· Errors in verifying accuracy of abnormal test results

 

Post-Analytical

· Wrong blood product administered

· Incorrect interpretation, follow-up tests, or continuing to reorder the same test

· Failure to follow best practice protocol and informing provider of abnormal results

Discuss situations that are considered nosocomial infections, including preventative measures used to avoid them.

Nosocomial Infections: infections acquired during a hospital stay (C. diff, S. aureus, Enterococcus). Avoided by employee screening and immunization programs, proper hygiene

Assault

Act/threat causing another to be in fear of immediate battery (harmful touching)

Battery

Intentional harmful or offensive touching of, or use force on, another person without consent or legal justification (Example: phlebotomist who attempts to collect blood without patient consent = assault and battery)

Breach of confidentiality

Failure to keep privileged medical information private (Example: unauthorized release of patient information)

Invasion of privacy

Violation of one’s right to be left alone. (Ex: physical intrusion or release of private information)

Negligence

Doing something a reasonable person would not do, or not doing something a reasonable person would do. (Ex: causing injury during a procedure with no intent to injure)  

Expressed consent

Required for treatment that involves surgery, experimental drugs, or high-risk procedures, given verbally or in writing (written is best for protection)

Implied consent

Patient’s actions imply consent without a verbal/written expression of consent. Can be necessary in emergency procedures (Ex: CPR)

Informed consent

Implies voluntary and competent permission for a medical procedure, test, or medication. Requires that a patient be given adequate information regarding the procedure before consenting to it.

Consent for minors

Minors cannot give consent, parental/guardian consent required. If violated, healthcare personnel can be liable for assault and battery.

Vicarious liability

Holds one party responsible for the wrongful or negligent actions of another, even if the first party was not directly at fault.

Chain of custody

: chronological documentation and paper trail that records chronological sequence of custody, control, transfer, analysis, and disposition of physical/electronic evidence

At-risk behavior

a choice that increases risk, where risk is unrecognized or mistakenly believed to be justified. (Intentional action, unintended outcome) = educate

Reckless behavior

: Conscious choice to disregard a substantial and unjustifiable risk. (Intentional action, knowing the probable bad outcome) = punish

Unintended human error

Accidental mistakes (unintentional action with unintended outcome) = redesign the system

To help maintain patient safety, the Clinical Laboratory Improvement Amendments of 1988 (CLIA 1988) require laboratories to implement quality controls, as well as: 

• Adopt quality measures

• participate in proficiency testing programs

• follow personnel requirements

• monitor test use

Most errors occur during the _________ phase(s) of testing.

pre and post-analytic

Strategies to reduce non-cognitive patient safety errors include both:

Minimizing distractions and interruptions; Adding checkpoints

A MLS receives a patient specimen for crossmatch testing. The Blood Bank identification band sticker was not affixed to the tube at the time of collection as required by the Standard Operating Procedure (SOP). There is, however, a Blood Bank sticker in the specimen bag. Instead of having the specimen redrawn, the technologist checked to be sure no one was looking, and then attached the sticker to the specimen tube. This would be classified as:  

Reckless behavior

A MLS performing data entry of a patient’s blood bank testing is interrupted by a phone call. Since the operating room is waiting for these results, she continues to enter the results while talking on the phone. The patient typed O Positive, but she enters the result as A Positive. This would be classified as:

Unintended human error

Failure to order follow-up testing affects the _________ phase(s) of testing.

post-analytical

An overlooked specimen integrity issue that affects laboratory results is considered an error in the _______ phase(s) of testing.

pre-analytic and analytic

A patient is admitted to the hospital with a diagnosis of pneumonia. The second day after admission, the organism Streptococcus pneumoniae is isolated from the patient’s blood. This (is / is not) an example of a nosocomial infection. 

Is not

What is the BEST method for controlling nosocomial infections?

Washing your hands after removing your gloves, every time you leave the laboratory or patient room