Patient Safety – serie

Herbal supplements are available without prescription in many countries throughout the world and accounting for over $30 billion U.S dollar in sale. A majority of U.S population (25-40%) use herbal supplements while alternative medicines are major forms of therapy in third world countries used by as much as 80% population. Contrary to the popular belief that herbal remedies are safe and effective, many herbal supplements have known toxicity and unexpected laboratory test results may be the early indications of such toxicity. In addition, some herbal products such as St. John’s wort can interact with many Western drugs causing increased clearance of such drugs and hence treatment failure. This monograph would provide information on how herbal supplements affect laboratory test results thus patient’s safety. This monograph would provide a comprehensive and concise practical guide for laboratory professionals, physicians and other health care professionals. The emphasis of this monograph is to provide clinically relevant information rather than discussing in detail mechanisms of such effect, although brief explanations would be provided for such unexpected test results.

Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, hemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of hemolytic specimens referred to the clinical laboratories for clinical chemistry testing. This book will help identify the areas where hemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce hemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs.

Today most of immunochemistry methods for the determination of proteins, peptides, drugs, and many small molecules are fully automated, with good precision, excellent sensitivity and short reaction time. However, inaccuracy due to poor standardization and the presence of interfering substances in biological samples is still a serious and life-threatening issue. Proper validation of methods and quality assurance have little effect on frequency of occurrence of false positive or false negative results, which, if unrecognized, may lead to patient's misdiagnosis, unnecessary treatment or even unnecessary surgery. Deep knowledge of basic principles of immunochemical methods (antigen-antibody reaction, standardization, matrix effect, limit of detection, cross-reactivity, etc.), sources of analyte-independent interferences (preanalitycal errors, the presence of binding proteins, the presence of autoantibodies) and analyte-dependent interferences (presence of heterophilic antibodies, high-dose effect) are very important to understand, detect, reduce and/or eliminate the interferences. This book helps to reduce false results and, at the same time, improve patient's care and patient's safety.

Is the reporting of medical errors changing? This book shows with real cases from health care and beyond that most errors come from flaws in the system. It also shows why they don't get reported and how medical error disclosure around the world is shifting away from blaming people, to a "no-fault" model that seeks to improve the whole system of care. The book intends to provide an introduction to medical errors that result in preventable adverse events. It will examine issues that stymie efforts made to reduce preventable adverse events and medical errors, and will moreover highlight their impact on clinical laboratories and other areas, including educational, bioethical, and regulatory issues. Varying error rates of 0.1-9.3% in clinical diagnostic laboratories have been reported in the literature. While it is suggested that fewer errors occur in the laboratory than in other hospital settings, the quantum of laboratory tests used in healthcare entails that even a small error rate may reflect a large number of errors. The interdependence of surgical specialties, emergency rooms, and intensive care units - all of which are prone to higher rates of medical errors - with clinical diagnostic laboratories entails that reducing error rates in laboratories is essential to ensuring patient safety in other critical areas of healthcare. The author maintains that many such errors are preventable provided that appropriate attention is paid to systemic factors involved in laboratory errors. This book identifies possible intelligent system approaches that can be adopted to help control and eliminate these errors. It is a valuable tool for physicians, clinical biochemists, research scientists, laboratory technologists and anyone interested in reducing adverse events at all levels of healthcare processes.

The goal of clinical laboratories is to produce accurate information for clinical decision making in medicine. More than half of the medical decisions made depend on clinical laboratory tests.Patient safety represents an important and critical problem for laboratories. They need to assure that the information they deliver to physicians is accurate, and therefore safe for clinicians to use. Endogenous compounds can interfere with laboratory tests, decreasing accuracy and threatening patient safety. Elevated bilirubin (bilirubinemia) and elevated lipids (lipemia) are common conditions that cause significant interferences with laboratory results. Clinicians depend on laboratories to detect these endogenous interferences. Laboratories must have a means to detect these endogenous interferences, make decisions about reporting results, and evaluate their impact.Most clinical pathology books provide only an abbreviated introduction to the subject, or provide a long list of references, without the necessary foundation for evaluating their significance. Package inserts typically provide scant information. This book provides the empirical and theoretical foundation for these interferences, describes the clinical settings where they occur, and explains their evaluation and detection, allowing the laboratory to interpret the available data on interferences and make the appropriate decision to effectively report test results while protecting patient safety.

Tentative estimates suggest that one in ten patients suffers from an adverse event in hospital. In Germany, approx. 1.8 million out of approx. 18 million inpatients suffer from adverse events; 50 percent of these cases are estimated to be avoidable. In the US, nearly 100,000 people die from the consequences of mistreatment.The intensive care units record 1.7 medical errors per patient and day. The most affected disciplines are the operative disciplines, particularly general surgery. Medical errors mainly occur when the indication for surgery is being made, during surgery and post-surgery. Suspicious oncological diagnostic results and post-operative complications are also often ignored.This book deals with complications and typical medical errors in surgery. It shows solutions and ways of dealing effectively with these errors and how to establish an efficient security management system.

This comprehensive book takes a psychological perspective on patient safety. It is based on the most recent theoretical and empirical research evidence from psychology (including clinical, work, and organizational psychology) and adjacent social and behavioral sciences such as human factors. Factors that influence safety-related experiences, behaviors, and outcomes of patients and professionals working in clinical settings such as medical practices and hospitals are reviewed, structured, and critically evaluated. Consistent with the complexity of the topic, the author takes a multi-level approach to patient safety, which includes a review of individual, team, and organizational factors and outcomes. The book describes how these factors, by themselves and in combination, can facilitate or impede patient safety. Individual factors include safety-relevant knowledge, skills, abilities, and personality traits such as conscientiousness and emotional stability. Team factors include group communication, training, and leadership. Finally, organizational factors include the safety culture and climate. Throughout the book, different evidence-based intervention programs are described that can help practitioners promote patient safety and prevent accidents. The book is a valuable resource for both researchers and practitioners interested in understanding, maintaining, and improving patient safety in a variety of applied settings. It is based on the most up-to-date research evidence from psychology and neighboring disciplines, and it is written in a clear and non-technical language understandable for a wide audience.

Blood transfusion is considered a life-saving therapy since ancient times, but, at the same time, a high-risk procedure. Nowadays the common perception is that infection is the greatest risk, even if the blood has never been safer from this point of view. Currently, the residual risk of transfusion must be related mainly to immunological mechanisms underlying to AB0 and minor blood systems, to compatibility of blood transfused and to development of irregular antibodies in transfused patients. "Transfusion Medicine and Patient Safety" aims to provide the basic of immunohematology to readers and to analyze the transfusional process highlighting the most critical points, thus more exposed to errors.Screening on blood and blood components for infectious diseases along with the surveillance action on emerging viruses results in the drastic reduction of post-transfusion infection, together with the potential to further increase the level of security from infection through the inactivation of blood components.The text also describes the major diagnostic systems and organizational models that modern technology provides us with a correct immunohematological diagnosis and an appropriate trasfusional therapy.

Every clinical laboratory devotes considerable resources to Quality Control. Recently, the advent of concepts such as Analytical Goals, Biological Variation, Six Sigma and Risk Management has generated a renewed interest in the way to perform QC. However, laboratory QC practices remain highly non-standardized and a lot of QC questions are left unanswered. The objective of this book is to propose a roadmap for the application of an integrated QC protocol that ensures the safety of patient results in the everyday lab routine.

The global medical process is a chain of different medical multidisciplinary procedures. The success in global Patient Safety will depend on the Safety of the consecutive medical processes that intervene in this complex system. Laboratory data is an essential part of health care, indeed it is used in 70% of clinical decisions. Inappropriate laboratory test over requesting is extremely frequent. The prevalence of under requesting has been less studied. The consequences of under requesting are clear, we are missing a diagnosis. Inappropriate over requesting can result not only in a problem of cost but also in a problem regarding patient safety. Additionally, another important consequence of inappropriate tests over requesting is that such amount of unnecessary tests has probably contributed to a significant increase in the volume of those over the last years. In all, there is general consensus that the inadequacy of test requesting must be corrected through strategies and monitored over time through indicators to assure the optimal laboratory contribution to clinical decision-making and patient safety.