Аннотация
Рутинное отслеживание преаналитических индикаторов качества (ИК) дает возможность своевременно изменять процессы работы персонала внутри и вне лаборатории для снижения числа ошибок, что значительно улучшает оказание медицинской помощи пациенту. Целью работы являлась оценка распространенности мониторинга преаналитических ошибок в клинико-диагностических лабораториях. Материал и методы. Исследование выполнено на основании анализа результатов анкетирования сотрудников лабораторий в сети Интернет. Опрос включал вопросы о преаналитических ошибках и их отслеживании. Участники заполняли онлайн-анкету один раз для каждой лаборатории в период с 3 октября по 20 ноября 2022 года. Результаты. Было получено 134 ответа из 70 населенных пунктов РФ. 107 (79,9%) отслеживали преаналитические ошибки. Для регистрации ошибок 44,9% использовали ручное документирование, 22,4% использовали лабораторную информационную систему и 29,9% использовали сочетание ручного и автоматического документирования. Самыми отслеживаемыми ИК, согласно Модели ИК IFCC, были: число гемолизированных проб (100%), образцы со сгустком (94,4%), несоответствующий уровень наполнения (92,5%). Остальные преаналитические ИК, такие как: неверная идентификация пациента и/или пробы, неверный тип пробы, нарушение условий хранения и/или транспортировки, загрязненные образцы, несоответствующий запрос на исследование, нарушение времени взятия пробы — отслеживались в 45,8-91,6% лабораторий. Не занимаются регистрацией преаналитических ошибок 27 (20,1%) лабораторий, из них 6 (22,2%) отметили себя аккредитованными. Отсутствие мониторинга связывают с небольшим размером лаборатории (48,1%), нехваткой персонала (44,4%), техническими трудностями (37%), отсутствием необходимости мониторинга в связи с единичными ошибками по данным лаборатории (33,3%). Приверженность к отслеживанию преаналитических ИК мало зависит от вида собственности лабораторий (80% государственных и 78,6% частных лабораторий), но возрастает по мере увеличения их мощности.
Заключение. Результаты проведенного опроса демонстрируют недостаточную приверженность клинико-диагностических лабораторий к отслеживанию качества преаналитического этапа лабораторного процесса. Только 79,9% обращают внимание, документируют и исправляют ошибки на основании индикаторов качества.
Annotation
Routine monitoring of preanalytical quality indicators (QIs) allows for timely adjustments to staff processes both inside and outside the laboratory to reduce the number of errors, significantly improving patient care. The aim of the study was to evaluate the prevalence of monitoring pre-analytical errors in laboratories.
Material and methods. The study was conducted based on the analysis of survey results from laboratory staff in an online network. The survey included questions about preanalytical errors and their monitoring. Participants were asked to fill in the online-form once per laboratory between October 3 and November 20, 2022.
Results. A total of 134 responses were obtained from 70 cities in Russia. 107 (79,9%) participants reported monitoring of preanalytical errors. The manual documentation of errors was used by 44,9% of laboratories. Another 22,4% entered errors directly into the laboratory information system, and 29,9% used a combination of manual and electronic documentation. The most frequent QIs, according to the IFCC Preanalytical Quality Indicators Model, were monitored by laboratories are listed below: haemolyzed sample (100,0%), clotted samples (94,4%), incorrect fill level (92,5%). Other QIs such as misidentification errors, incorrect sample type, unsuitable samples for transportation and storage problems, contaminated samples, inappropriate test requests and inappropriate time in sample collection were monitored from 91,6% to 45,8% of laboratories. 27 (20.1%) laboratories reported non-monitoring of preanalytical errors, of which 6 (22.2%) identified themselves as accredited. These laboratories were pointing to small samples per working shift (48,1%), staff scarcity (44,4%), technical challenges (37%) and no need (low number of errors according to the laboratory) (33,3%) as the reasons for the non-monitoring of preanalytical errors. The commitment to monitoring QIs was not significantly influenced by the type of laboratory ownership (80% public laboratories and 78,6% privately owned laboratories), but increased with the quantity of samples per day.
Conclusions. The results of the conducted survey demonstrate insufficient commitment of clinical diagnostic laboratories to monitoring the quality of the preanalytical phase of the laboratory process. Only 79,9% pay attention, document, and correct errors based on quality indicators.
Key words: Preanalytical error; quality indicators; clinical laboratories; survey.
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