Identificação de não conformidades pré-analíticas do laboratório de patologia clínica do Hospital do Câncer I

Abstract

The laboratory exam is divided into three phases: pre-analytical, analytical and post-analytical, with the pre-analytical phase having the highest incidence of errors in the process of performing a laboratory exam. The clinical pathology service at the Cancer Hospital I, did not track the indicators of errors in the process of performing the tests. The laboratory processed more than 220,000 samples, with an approximate volume of 1.8 million tests in the year 2019.Considering the volume of samples processed, it has become essential for patient safety and to ensure the quality of the service provided, to track the errors that occur most in this institution. Based on this precept, this study aimed to track the main errors in the process of the pre-analytical phase of the clinical pathology laboratory of the Hospital do Câncer I, perform a benchmarking of the data obtained from the results of the Brazilian study PBIL- Benchmarking and Laboratory Indicators Program/SBPC and the international study coordinated by the IFCC (International Federation of Clinical Chemistry) and elaborate an Actions Manual to avoid the repetition of these same errors in the work routine. There were 14 indicators belonging to the pre-analytical phase that were tracked, using the data contained in the LIS system used in the Laboratory. Data were prospected from two sectors, Immunochemistry and Hematology, which had a pattern of reporting errors found and produce about 75% of the samples processed by the laboratory. Based on these data, the percentage of occurrence, DPMO and SIGMA of each indicator were calculated. From these calculations, benchmarking was performed with two other studies: PBIL (SBPC and Controllab) and IFCC (working group on patient safety and laboratory errors). A total of 5,541 errors were tracked in the 14 indicators, and 12 of these Instituto Nacional de Câncer (INCA) indicators were, in the year 2019, with a higher or equal behavior when compared to the other two studies (PBIL and IFCC). Hemolysis and fibrin after centrifugation were the indicators with the worst behavior and should have a greater focus for correction by the laboratory teams involved in this process. The Pre-analytical Error Management Manual was prepared in order to standardize processes and improve indicators below the desired level and maintain the quality of indicators that are at minimally acceptable levels. Continuous monitoring, coverage of all sectors of the laboratory and expansion of indicators tracked is essential to guarantee the quality of service provided by the laboratory and patient safety.