ATS Pulmonary Function Laboratory Manual

chapter  16

Error messages received during the analytic phase of testing and potential erroneous results need to be evaluated and recorded. In addition, the names of all individuals associated with the blood gas test need to be recorded in case questions related to the results are investigated (7). Comments regarding quality of the specimen when it was received, transportation delays, and improper storage should also be documented. This information is helpful to the operator of the analyzer in judging the quality of the results, and the clinician in evaluating the relevance to the patient (3). The laboratory’s policy and procedure manual should include the procedure for handling blood gas specimens of questionable quality on delivery (2, 3, 8). Improperly labeled or transported specimens received from within the healthcare system may be refused. The ordering physician or the nurse directly responsible for the patient’s care should be notified of the problem by the laboratory and asked if another specimen is required. If the specimen is analyzed, the results should be reported, but marked to show the questionable nature of the values. Rejected specimens, whether due to temperature storage, air bubble contamination, or improper labeling, require immediate notification and documentation for rectification and/or repeat sample collection. The individual or department responsible for collecting the specimen should be contacted by phone, informed of the concerns, and given the opportunity to provide another specimen, if appropriate. The laboratory’s policy and procedure manual should describe how to handle unacceptable or questionable blood gas results (3, 8). When results are incorrectly reported due to clerical error, operator mistake, or equipment failure the problem should be remediated by reporting the correct results in a timely fashion. A “Revised Report” or “Revised Data” should be recorded on the blood gas report form, including the date the revision was made. The ordering physician and nursing unit should be notified. The individual reporting the correct results will note on the report the date, time, and individual to whom the correct results were reported. Quality Management of the Blood Gas Laboratory A laboratory quality management system is an integration of policies and procedures that transform a physician’s order into laboratory information. The objectives of a quality management system are to provide quality, accurate diagnostic test results and reduce the potential for medical errors (9). The quality management system includes: policy and procedure manual, quality control, proficiency testing, system audits, training and competency certifica- tion, and inventory management. Policy and Procedure Manual The policy and procedure manual is a set of documents that clearly describe the guidelines related to all testing as defined by the institution. An annual review of the manual and revisions, if appropriate, are required by the medical director named on the CLIA license (9). Quality Control A robust quality control (QC) program assures that the instruments used for patient testing meet the manufacturers’ specifications for optimal performance. Periodic monitoring of QC provides data and trend analysis of the test system’s function. Some instruments are equipped with a self-contained QC test that checks the integrity of the electronic circuity of the analyzer. These systems are known as Internal or Electronic QC tests. Commercial external controls, known as Liquid Quality Controls, are also available and aremanually introduced into the analyzer by the operator. LiquidQuality Control tests evaluate the entire system performance, analyzer function, reagent or sensor accuracy, and operator technique.

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