The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
This paper discusses potential vulnerabilities in the laboratory diagnosis of COVID-19, such as sample misidentification, inappropriate or inadequate sample collection, sample contamination, as well as the challenges to the diagnostic accuracy of current COVID-19 tests.
Cornes M, Ibarz M, Ivanov H, et al. Diagnosis (Berl). 2019;6:33-37.
Common blood sample errors, such as mislabeling or patient misidentification, can contribute to diagnostic delays. This review highlights the importance of using open-ended questions to gather information from patients and suggests that specimens be labeled with the patient present to ensure accurate verification. A WebM&M commentary explored problems associated with mislabeled blood samples.
Lippi G, Mattiuzzi C, Bovo C, et al. Clin Biochem. 2017;50:562-567.
Patient identification mistakes associated with diagnostic blood testing can have serious consequences. This commentary recommends several strategies to redesign laboratory processes to reduce risks of specimen misidentification, such as utilizing at least two patient identifiers, providing staff training, and using technologies to track and manage specimens.
van Dongen-Lases EC, Cornes MP, Grankvist K, et al. Clinical Chemistry and Laboratory Medicine (CCLM). 2016;54.
Specimen labeling errors can result in patient misidentification and harm. This position paper draws from international guidelines to advocate for standardizing the processes involved in phlebotomy to reduce the potential for both patient and sample labeling errors. The authors recommend strategies for improvement including barcoding, staff training, and monitoring of mistakes to inform process enhancements.
Most errors in laboratory medicine occur in the preanalytical phase, that is, before the sample reaches the laboratory. This survey found that phlebotomists frequently do not follow recommended procedures to minimize labeling and documentation errors.