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

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

3. Outline Introduction Literature review Objectives Methodology Results
Conclusion
Recommendation

4. 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): PubMed)
What happens to clinical methods?
History
Physical examination
Investigations

5. 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?

6. 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 )
So then it starts with the clinician…

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

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

9. 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): 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): )

10. 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

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

12. 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)

13. Literature Review

17. 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

18. 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.

19. Study

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

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

22. Results

23. Results

24. Results

25. Results

26. Results

27. Results

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Average time spent filling the laboratory request form fully and properly is 1minute 15 seconds (Aniakwo et al, 2016 unpublished)

29. 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.

30. 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.

31. Recommendation

32. THANK YOU

34. References
Plebani M. Errors in clinical laboratories or errors in clinical medicine?. ClinChem Lab Med. 2006; 44(6): 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): PubMed
Green S. The cost of poor blood specimen quality and errors in pre-analytical processes; clinbiochem
Olufemi A O, Abiola A O, Sandra O I; An audit of request forms submitted in a multidisciplinary diagnostic centre in Lagos,
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):
N. Kaushik, S. Green. Pre-analytical errors: their impact and how to minimise them, Medical Laboratory Observer, 2014