Estrategias para la mejora del conocimiento y la prevención de los errores en la fase preanalítica

Laburpena

BACKGROUND The presence of errors in the pre-analytical phase is a problem widely studied in recent years, but these studies have not, to date, proposed fully effective action to monitor them at all levels and settings. HYPOTHESIS Healthcare professionals involved in the pre analytical phase, both in the laboratory and in primary healthcare, are able to identify the source of most errors and find the best solutions and strategies for their reduction and prevention. Using a combination of methodologies could enhance our understanding of the sources of errors in the pre-analytical phase. AIMS To establish strategies which allow us to detect sources of errors in the pre-analytical phase and propose measures for their prevention METHODOLOGY A multidisciplinary and multicenter study was performed comprising mixed use of qualitative and quantitative paradigms in several stages. Within the qualitative approach, a phenomenological study was carried out within clinical laboratories at the Virgen de la Victoria Hospital (Málaga), a phenomenological study in primary healthcare and a triangulation of methods integrating the emerging discourses of the 4 focus groups through conceptual networks. With a quantitative approach, three studies were performed: a study on best sampling practices, a cross sectional study of pre-analytical errors found in the laboratories of the Juan Ramón Jiménez Hospital and Virgen de la Victoria in 2012 and 2013, and an exploratory study in relation to the degree of implementation of the Clinical Laboratory Process and its quality within the pre-analitycal phase. RESULTS AND DISCUSSION After triangulation methods integrating the emerging discourses from the 4 focus groups with conceptual networks and quantitative analysis, it has been established that the dimensions rated as critical by participants were essentially focused, from a negative perspective, on the existence of infrastructure and training deficits, problems arising from poor or nonoptimized organization and an increased workload. From a positive perspective, the importance of professionalism and commitment to the processes of the workers involved were highlighted, as was the exchange of information along with the presence of web computing environments as areas for improvement. From the study of good practice, it was found that the translation and cultural adaptation and piloting of the questionnaire did not show significant difficulties being understood in its entirety by professionals, offering similar results to the original data. Descriptive data from healthcare professionals generally has good indicators in the practice of sampling in each of the studied aspects of the questionnaire, nevertheless identifying some aspects which could be improved. In the cross-sectional study of pre-analytical errors found in the laboratories of the Juan Ramón Jiménez and Virgen de la Victoria Hospitals, in 2012 and 2013, the most common mistake made in the laboratory of Juan Ramón Jiménez Hospital was �missing sample� (FM) with a total figure of 10,059 (1.73%). The second most important issue was incorrect volume of the sample (IVM) with 3236 errors (0.55%). In the Virgen de la Victoria University Hospital the most frequent sign was �hemolyzed sample� (MH), with 22 092 detected errors (2.47%), followed by FM, with 6,609 (0.74%). The differences were statistically significant in most of the errors. In the exploratory study of the degree of implementation of the Clinical Laboratory Process and quality in the pre-analytical phase, the analysis was focused on nurses in the province of Huelva, which mostly rated as very good items (7-8 out of 10) or excellent (9-10 of 10) with regard to the degree of implementation of the process and characteristics of quality of work performed in their pre-analytical phase. Regarding the research and development of a patent proposal for reducing pre-analytical errors, the device designed streamlines the process of blood sampling and subsequent transport to the laboratory for analysis, reducing patient discomfort, handling by professionals, including risk of accidental pricking with a needle, time, and possible errors in the pre-analytical phase with consequent cost savings, improved safety and increased satisfaction of both users and professionals. CONCLUSIONS The integration of methods, techniques and tools seems to be the way to further increase knowledge in this area, thereby improving the prevention of errors in the pre-analytical phase. Incorporating the vision of patients and families, as well as professional profiles in the field of management and enhancement of quantitative instruments measured through questionnaires or inventories, in order to increase their robustness and measure both specific issues and global process evaluations which will provide greater consistency in future research towards investigations and transfer which reflects in the improvement of quality and patient safety.