Factors contributing to preanalytical errors in pathology laboratory sampling among clinicians in Erongo region, Namibia
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Date
2024
Authors
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Publisher
University of Namibia
Abstract
Introduction: Clinical laboratory is the epicenter of health care sector, and it is therefore
imperative that the quality of laboratory services is guaranteed to ensure quality patient
management. However, in the laboratory setting, specimens may be rejected for a variety
of reasons, which may have substantial clinical consequences for patient safety. The pre analytical phase of sample collection, occurs outside of the laboratory and is thus beyond
the control of the laboratory professionals. This phase has been highlighted as the leading
contributor of diagnostics error rates, accounting for 70% of errors in the laboratory.
Owing to this, the study aimed to determine the major factors contributing to pre analytical errors during pathology laboratory sampling among clinicians in Erongo
region, Namibia.
Methods: This study utilized a mixed method, cross-sectional design. A total of 129
health care workers (HCWs) compromised of 19 doctors and 110 nurses at district
hospitals in Erongo region participated in the study. A self-administered questionnaire
containing close and open-ended descriptive questions was used to collect data among the
clinicians. Data on the prevalence of sample rejections recorded from four Namibia
Institute Pathology (NIP) laboratories in Erongo region, between 2020 and 2021 was
collected. Quantitative data were analyzed using Statistical Package for Social Science
(SPSS) 26.0 program. Microsoft Word was used to analyze qualitative data. Data were
presented using frequency tables.
Results: During the period between 2020 and 2021, NIP had a sample rejection rate of
1.6% and 1.1% for 2020 and 2021, respectively. NIP Walvis Bay recorded the highest
rejection rates in both years. The study found that missing specimen/ no specimen
received was the most predominant reason for sample rejections among the laboratories
in Erongo region, accounting for 21.2% and 28.5% of rejected samples in 2020 and 2021
respectively. Moreover, the study found that the major factors contributing to pre analytical sampling errors were mainly due to difficulties in finding veins (75.2%), non availability of sample collecting materials (53.5%), heavy workload (36.4%), and delays
in transportation for samples to the laboratory (3.1%) as well a lack of training (2.3%).
Majority of the clinicians (82.9%) indicated that they had not been trained on sample
management.
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Conclusion: The major contributing factors of pre-analytical errors mainly centered
around difficulties in allocating suitable veins for blood collection, inadequate supply of
collecting materials and a lack of training in sample collection and management of
samples among clinicians. It was further concluded that there is no relationship between
the socio-demographic characteristics and the knowledge of the preanalytical phase of
sample management. The study highlights major gaps in clinicians’ knowledge regarding
collection and management of samples. There is a need for NIP and Ministry of Health
and Social Services (MoHSS) to focus strengthening laboratory sample collection and
management through concerted efforts to ensure the availability of sufficient materials for
sample collection and to provide adequate training to clinicians. Furthermore, there is a
need for collaboration between clinicians and laboratory staff to optimize the collection
and handling of samples to avoid further sample rejections in the region
Description
A thesis submitted in partial fulfilment of the requirements for the degree of master of public health
Keywords
Pre-analytical errors, Sample rejections, Rejection rate, Sample collection, Specimen, Namibia