COMPLETENESS OF LABORATORY INVESTIGATION REQUEST FORMS BY DOCTORS Dr. Aniakwo, Luke Adagrah (MBChB)

AN AUDIT OF LABORATORY REQUEST FORMS IN A TEACHING HOSPITAL IN GHANA

Outline Introduction Literature review Objectives Methodology Results Conclusion Recommendation

Introduction It has been estimated that more than 70% of clinical decisions are based on information derived from laboratory test results. ( Nutt L et al. Incomplete laboratory request forms: the extent and impact on critical results at a tertiary hospital in South Africa. Ann ClinBiochem. 2008; 45(5): 463-466. PubMed) What happens to clinical methods? History Physical examination Investigations

Introduction cont. Do we benefit from the results and reports we get from the laboratory? How well do we depend on the laboratory results to make clinical decisions? How much do we as clinicians contribute to the poor quality of results we get from the laboratory?

Introduction cont. Laboratory error; defined as any defect that occurs during the entire testing process, from ordering tests to reporting results, that in any way influence the quality of laboratory services. (Green S. The cost of poor blood specimen quality and errors in pre-analytical processes; clinbiochem.2013.06.001) So then it starts with the clinician…

Introduction cont. Types of laboratory errors Pre-analytical Post analytical

Introduction cont. Pre-analytical errors Misidentification Omission of clinical information Incorrect samples Clotted samples Inadequate samples Diluted samples Haemolysed samples

Introduction cont. Pre-analytical errors contribute about 46% to 68% of all laboratory errors. (Plebani M. Errors in clinical laboratories or errors in clinical medicine?. ClinChem Lab Med. 2006; 44(6):750-759. PubMed) Patient misidentification is responsible for the highest sample rejection from laboratories, 16-47% 25% of all sources of laboratory errors had a negative impact on patient outcomes. (Upreti S et al. Types and frequency of pre-analytical errors in Haematology Lab. Journal of Clinical and Diagnostic Research. 2013; 7(11): 2491-2493)

Introduction cont. Some of the negative impacts on patients Further inappropriate investigations Inappropriate care Inappropriate or delay in modification of therapy Unjustified cost to the patient

Introduction cont. Impact on facility Increase in operating cost Lost of confidence in the laboratory services in facility

Introduction cont. On the average, pre-analytical errors represent between 0.23% to 1.2% of total hospital operating cost. When extrapolated to a typical U S hospital with approximately 650 bed capacity, it cost $ 1.2 million per year. ( N. Kaushik, S. Green. Pre-analytical errors: their impact and how to minimise them, Medical Laboratory Observer, 2014)

Literature Review

Study Objective Methodology Sample size to evaluate completeness of the laboratory request forms by doctors in CCTH Methodology a cross-sectional study involving the use of secondary data on laboratory request forms. Data was taken from request forms to the haematology and biochemistry benches for the month of June, 2016. Sample size 554 forms, 285 for haematology and 269 for biochemistry

Study Data was obtained on the name, age and sex/gender of patient, date sample was taken, ward/unit sample was taken, name and signature of requesting doctor and relevant clinical details Information on the time sample was collected was omitted.

Study

Results 153 (27.6%) forms were completed in their entirety per the seven variables

Results All the request forms were completed with the name of the patient, 554 (100%)

Results

Results

Results

Results

Results

Results

Results Average time spent filling the laboratory request form fully and properly is 1minute 15 seconds (Aniakwo et al, 2016 unpublished)

Conclusion Less than 1/3 of request forms are completed in their entirety. The name/signature of requesting doctor and relevant clinical details were the two variables least completed, 46% and 66% respectively. Almost all, > 95% of forms lacked adequate clinical details.

Recommendation We should all endeavour to complete the laboratory request forms properly with all the relevant clinical details. Request forms which are not properly filled should be rejected. Continuous evaluation to prevent all forms of laboratory errors.

Recommendation

THANK YOU

References Plebani M. Errors in clinical laboratories or errors in clinical medicine?. ClinChem Lab Med. 2006; 44(6):750-759. PubMed Nutt L et al. Incomplete laboratory request forms: the extent and impact on critical results at a tertiary hospital in South Africa. Ann ClinBiochem. 2008; 45(5): 463-466. PubMed Green S. The cost of poor blood specimen quality and errors in pre-analytical processes; clinbiochem.2013.06.001 Olufemi A O, Abiola A O, Sandra O I; An audit of request forms submitted in a multidisciplinary diagnostic centre in Lagos, http://www.panafrican-med-journal.com/content/article/20/423/full/ Feyisayo J..; Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in northwest Nigeria (2015) Edeghonghon O, Asiamah-Broni; Evaluation of request forms submitted to the haematology laboratory in a Ghanaian tertiary hospital Paingha J A, Ezenwa P U; Laboratory request forms-How well do doctors fill them? A look at the practice at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria Adegoke O A, Idowu A A, Jeje O A; Incomplete laboratory request forms as a contributory factor to preanalytical errors in a Nigerian teaching hospital Upreti S et al. Types and frequency of pre-analytical errors in Haematology Lab. Journal of Clinical and Diagnostic Research. 2013; 7(11): 2491-2493 N. Kaushik, S. Green. Pre-analytical errors: their impact and how to minimise them, Medical Laboratory Observer, 2014