The Contribution of Education to the Correction of Preanalytical Errors in Laboratory Testing: A Systematic Review
DOI:
https://doi.org/10.56294/saludcyt20251781Keywords:
Blood chemical analysis, Quality of health care, Pre-analytical phase, Laboratory testAbstract
Introduction: laboratory medicine generates clinical information by analyzing various analytes in body fluids. This process requires trained personnel capable of developing strategies to prevent errors that could compromise patient safety. Recent studies highlight the importance of training and the implementation of protocols to reduce these errors.
Objective: to identify available evidence on the contribution of education to correcting preanalytical errors in clinical laboratory testing.
Method: a systematic review was conducted using Google Scholar and PubMed, including articles in English, Spanish, and Portuguese published between 2020 and 2024. Only peer-reviewed journal articles were considered.
Results: three main thematic categories were identified: Impact of Training in Laboratory Settings, Educational Interventions on Preanalytical Errors, and Methodologies to Reduce Preanalytical Errors Linked to Education.
Conclusion: Reducing preanalytical errors in the laboratory depends on continuous training and protocol adherence. Initial and ongoing education is key to improving sample quality and patient safety.
References
1. Lippi G, von Meyer A, Cadamuro J, Simundic AM. PREDICT: a checklist for preventing preanalytical diagnostic errors in clinical trials. Clin Chem Lab Med. 2020;58(4):518-526. https://doi.org/10.1515/cclm-2019-1089.
2. Nashi M, et al. Analyzing Errors in laboratory testing: causes and prevention strategies. NPPH [Internet]. 2023 Jan 22 [cited 2024 Jul 8];21(1). Available from: http://neuropsychopharmacologiahungarica.com/index.php/NPPH/article/view/207.
3. Leonard A, Boran G, Kane A, Cornes M. Monitoring and capturing patient identification errors in laboratory medicine. Ann Clin Biochem. 2020;57(3):266-270. https://doi.org/10.1177/0004563220903076.
4. Caballero A, Gómez-Rioja R, Ventura M, Llopis MA, Bauça JM, Gómez-Gómez C, et al. Evaluación de 18 indicadores de calidad del Programa de Garantía Externa de la Calidad de Preanalítica de la Sociedad Española de Medicina de Laboratorio (SEQCML). Adv Lab Med. 2022;3(2):188-200. https://doi.org/10.1515/almed-2022-0036.
5. Vermeersch P, Frans G, Meyer A, Costelloe S, Lippi G, Simundic AM. How to meet ISO15189:2012 pre-analytical requirements in clinical laboratories? A consensus document by the EFLM WG-PRE. Clin Chem Lab Med. 2021;59(6):1047-1061. https://doi.org/10.1515/cclm-2020-1859.
6. Rodrigues AB, Costa HP, Frota SS, Benedito FCS, Vasconcelos MA, Santos RSS, et al. Preanalytical interferences in laboratory tests: a narrative review. RSD [Internet]. 2022 Jan 28 [cited 2024 Jul 8];11(2) Available from: https://rsdjournal.org/index.php/rsd/article/view/25839.
7. Cadamuro J, Baird G, Baumann G, Bolenius K, Cornes M, Ibarz M, et al. Preanalytical quality improvement - an interdisciplinary journey, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med. 2022 Mar 7. https://doi.org/10.1515/cclm-2022-0117.
8. Nordin N, Ab Rahim SN, Wan Omar WFA, Zulkarnain S, Sinha S, Kumar S, et al. Preanalytical errors in clinical laboratory testing at a glance: source and control measures. Cureus. 2024;16(3) https://doi.org/10.7759/cureus.57243.
9. Cornes M. The preanalytical phase - past, present and future. Ann Clin Biochem. 2020;57(1):4-6. https://doi.org/10.1177/0004563219867989.
10. Badu E, O’Brien AP, Mitchell R. An integrative review on methodological considerations in mental health research – design, sampling, data collection procedure and quality assurance. Arch Public Health. 2019;77:37. https://doi.org/10.1186/s13690-019-0363-z.
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating the PRISMA reporting guideline: results of a survey and the PRISMA 2020 statement. Syst Rev. 2021;10(1):108.
12. Gaur K, Puri V, Shukla S, Sharma S, Suman S, Singh R. Finish before the start: analyzing preanalytical sample errors in a tertiary care hematology laboratory. Indian J Pathol Microbiol. 2020;63(3):435-440.
13. Dey S, Rai N, Bansal A, Kumari B, Das B, Kumari A. A Knowledge, Attitude, and Practice (KAP) Study on Phlebotomy Among Nurses in a Tertiary Hospital in Patna, India. Cureus. 2023 Dec 12;15(12). https://doi.org/10.7759/cureus.50372.
14. Naseem Akhtar, Hussain M, Afzal M, Gilani SA, Jamil A. Assessment of Standard Nursing Practices Implementation during Blood Culture Sampling in Emergency Department. Zenodo [Internet]. 2020 [cited 2024 Jul 14].
15. Zaki A, Zak A, El-Sayed A, Abd El Aziz A. Nurses' malpractices during blood samples withdrawal at neonatal intensive care unit. Mansoura Nurs J. 2022;9(1):2735-413X.
16. Elsayed Ahmed Allawy M, Hassan Ibrahim M. Nurses' performance regarding prevention of hemolysis in venous blood sampling: suggested nursing guidelines. Egypt J Health Care. 2023;14(3):821-837.
17. Modibo C, Abdelaye K, Diawara M, Sagara V, Bhrehima T, Oumar G, et al. High preanalytical non-compliance and sample rejection rate in clinical biochemistry laboratory are decreased by nurse staff training in phlebotomy and sample handling. GSC Biol Pharm Sci. 2020;13(3):113-118. https://doi.org/10.30574/gscbps.2020.13.3.0400.
18. Romero A, Gómez-Salgado J, Romero-Arana A, Ortega-Moreno M, Jódar-Sánchez F, Ruiz-Frutos C. Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples. Medicine. 2020;99(31).
19. Sawadogo S, Nebie K, Appolinaire B, Dondebzanga, Nikiema M, Kima D, Kafando E. Knowledge, attitudes and practices of caregivers and laboratory agents on the pre-analytical phase of haematological analyses in Burkina Faso. Int J Biol Chem Sci. 2022;16(1):23-33. https://doi.org/10.4314/ijbcs.v16i1.3.
20. Hjelmgren H, Ygge BM, Nordlund B, et al. Nurses' experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care. BMC Nurs. 2022;21(1):62. https://doi.org/10.1186/s12912-022-00840-2.
21. Stonys R, Vitkus D. A survey on the practice of phlebotomy in Lithuania and adherence to the EFLM-COLABIOCLI recommendations: continuous training and clear standard operating procedures as tools for better quality. Biochem Med. 2024;34(2):020702. https://doi.org/10.11613/BM.2024.020702.
22. Rana MZ, Khan NU, Batool N, Anwar H, Khizer. Observational study on adherence to modified Clinical and Laboratory Standard Institute H3-A6 guidelines on blood sampling procedures. J Health Res Rev. 2024;4(1):406-411.
23. Aggarwal K, Jhajharia S, Acharya V, Tapaswini P, Swarnakar R, Mahapatra S. Assessment of phlebotomy errors by direct observation of sample collection procedure in a NABL Accredited Hospital: An Observational study. Indian J Med Spec. 2022;15(2):154-158.
24. Ojeda J, López C, Menéndez E, Terán J, Huesca L. Conocimiento de la fase preanalítica y postanalítica de la gasometría arterial en médicos residentes e internos. Arch Bronconeumol. 2020;56(6):345-350.
25. Alizai S, Ehtizaz L, Ansar A, Khilji S, Saad M, Ali A. Pre-analytical quality assurance; an important milestone to be achieved. Ann PIMS Shaheed Zulfiqar Ali Bhutto Med Univ. 2024;19(4):404-409.
26. Bashir B, Abdarabo A. Auditing of the phlebotomy system in medical laboratories in Port Sudan City, Sudan. East Mediterr Health J. 2020;26(7):741-746.
27. Bandara T, Sandamali J. Processes and practices improvement of sample receiving counter at government clinical laboratory in Sri Lanka. Int J Curr Sci Res Rev. 2022;5(6):19. https://doi.org/10.47191/ijcsrr/V5-i6-19.
28. Dundar C, Bahadir O. Preanalytical errors in clinical biochemistry laboratory and relationship with hospital departments and staff: a record-based study. J Patient Saf. 2023;19(4):239-242. https://doi.org/10.1097/PTS.0000000000001115.
29. Erdim L, Zengin N, Karaca B. Investigation of the preanalytical process practices in primary care in Istanbul regarding the newborn screening tests. Turk J Biochem. 2023;48(1):12-18. https://doi.org/10.1515/tjb-2022-0116.
30. Sonmez C, Yıldız U, Akkaya N, Taneli F. Preanalytical phase errors: experience of a central laboratory. Cureus. 2020;12(3). https://doi.org/10.7759/cureus.7335.
31. Alcantara JC, Alharbi B, Almotairi Y, Alam MJ, Muddathir ARM, Alshaghdali K. Analysis of preanalytical errors in a clinical chemistry laboratory: a 2-year study. Medicine. 2022;101(27). https://doi.org/10.1097/MD.0000000000029853.
32. Tasneem A, Zubair M, Rasool Z, Tareen FZ. Frequency and types of pre-analytical errors in a clinical laboratory of a specialized healthcare hospital. Pak J Med Sci. 2024;40(2ICON Suppl). https://doi.org/10.12669/pjms.40.2(ICON).8963.
33. Subhan SS, Malathi RD, Ahmed MI. Effect of training on improvement in the preanalytical errors in venous blood sampling at a tertiary care center. MRIMS J Health Sci. 2023. https://doi.org/10.4103/mjhs.mjhs_15_23.
34. Jafri L, Abid MA, Rehman J, Ahmed S, Abbas G, Ali H, et al. Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique. PLoS One. 2022;17(4). https://doi.org/10.1371/journal.pone.0264447.
35. Pasha E, Mehndiratta M, Almeida E. Quality indicators for evaluating errors in the preanalytical phase. J Lab Physicians. 2021;13(02):169-174. https://doi.org/10.1055/s-0041-1729473.
36. Khalki H, Errabhi C, Aabida M, Sbai H. Role of a simulation workshop training in the preanalytical phase in medical biology: experience of the Biochemistry Laboratory of the University Hospital of Tangier – Morocco. Saudi J Pathol Microbiol. 2022;7(7):276-279.
37. Muzzamil F, Rafiq M, Siddiqui Z, Hamza A, Arooj A, Lail R. Awareness of pre-analytical errors amongst healthcare workers of DHQ teaching hospital, Sahiwal, Pakistan. Rawal Med J. 2022;47(2):261-265.
38. Oprea O, Molnar A, Mănescu I. A novel multimodal approach for the assessment of phlebotomy performance in nurses. J Lab Med. 2023;47(5):217-223. https://doi.org/10.1515/labmed-2023-0055.
39. Bench S. Critical care nurses' views and experiences of preanalytical factors influencing point-of-care testing: A qualitative study. Point Care. 2020;19(4):97-100. https://doi.org/10.1097/POC.0000000000000212.
40. Aykal G, Esen H, Yeğin A, Öz C. The results of a close follow-up of trainees to gain a good blood collection practice. J Med Biochem. 2020;39(3):355-362. https://doi.org/10.2478/jomb-2019-0053.
41. Ballesteros Ugarte V, Trunzo CG. Nursing organization and management in the practice of blood sample collection. Salud, Ciencia y Tecnología. 2021;1:27. https://revista.saludcyt.ar/ojs/index.php/sct/article/view/33.
42. Zorbozan N, Zorbozan O. Evaluation of preanalytical and postanalytical phases in clinical biochemistry laboratory according to IFCC laboratory errors and patient safety specifications. Biochem Med. 2022;32(3):030701. https://doi.org/10.11613/BM.2022.030701.
43. du Toit M, Chapanduka ZC, Zemlin AE. The impact of laboratory staff training workshops on coagulation specimen rejection rates. PLoS One. 2022;17(6). https://doi.org/10.1371/journal.pone.0268764.
44. Tóth J, Oláh AV, Petercsák T, Kovács T, Kappelmayer J. Detection of haemolysis, a frequent preanalytical problem in the serum of newborns and adults. EJIFCC. 2020;31(1):6-14.
45. Mehndiratta M, Pasha E, Chandra N, Almeida E. Quality indicators for evaluating errors in the preanalytical phase. J Lab Physicians. 2021;13(02):169-174.
46. Alshaghdali K, Alcantara TY, Rezgui R, Cruz CP, Alshammary MH, Almotairi YA, et al. Detecting preanalytical errors using quality indicators in a hematology laboratory. Qual Manag Health Care. 2022;31(3):176-183. https://doi.org/10.1097/QMH.0000000000000343.
47. Mesganaw B, Hassen F, Molla H, Misganaw K. Laboratory specimen rejection rate and associated factors among referred specimens at Debre Markos Referral Hospital, Ethiopia: prospective cross-sectional study. Pan Afr Med J. 2024;47:112. https://doi.org/10.11604/pamj.2024.47.112.33795.
48. Degfe C, Mohammed O. Magnitude of extra-analytical errors and associated factors in medical laboratories in thirteen public hospitals in Addis Ababa, Ethiopia. SAGE Open Med. 2023;11:20503121221148062. https://doi.org/10.1177/20503121221148062.
49. Arthy Y, Ogony J, Oyugi B, Mambo F, Omoro G, Omondi K. Assessment of pre-analytical quality indicators and the associated errors in clinical laboratory testing at Kombewa Sub County Hospital, Kenya. Int J Sci Res Innov Technol. 2021;8(1):5-11.
50. Panjeta M, Dervisevic A, Hajro S, Panjeta E, Kovacevic M, Pepic E, Duskan S. Types and frequency of errors in the pre-analytical phase in the clinical laboratory - single center study from Bosnia and Herzegovina. Clin Lab. 2022;68(3). https://doi.org/10.7754/Clin.Lab.2021.210413.
51. Dos Santos J, Henrique de Almeida K, Ribeiro de Oliveira S. Percepção dos flebotomistas frente aos cuidados pré-analíticos nas unidades básicas de saúde no agreste pernambucano. Rev Interdiscip. 2020;13(1).
52. Shaji R, Madigubba H, Priyadarshi K, Anandh P, Nathan B, Vivekanandan M, et al. Effectiveness of multimodal intervention to improve blood culture collection in the emergency department. J Glob Infect Dis. 2022;14(1):10-16. https://doi.org/10.4103/jgid.jgid_138_21.
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Copyright (c) 2025 Francisca Sepúlveda Maturana , Ignacio Azocar González , María Loreto González González , Claudia Azocar González, Mirliana Ramírez-Pereira (Author)
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