1. COMPLETENESS OF LABORATORY INVESTIGATION REQUEST FORMS BY DOCTORS
Dr. Aniakwo, Luke Adagrah (MBChB)

2. Outline Introduction Literature review Objectives Methodology Results
Conclusion
Recommendation

3. Introduction
It has been estimated that more than 70% of clinical decisions are based on information derived from laboratory test results
What happened to clinical methods?
History
Physical examination
Investigations

4. Introduction cont.
Do we benefit from the results and reports we get from the laboratory?
How well do we depend on the laboratory results to make clinical decisions?
How much do we as clinicians contribute to the poor quality of results we get from the laboratory?

5. Introduction cont.
Laboratory error; defined as any defect that occurs during the entire testing process, from ordering tests to reporting results, that in any way influence the quality of laboratory services. (Green S F, Phd, 2013)
So then it starts with the clinician…
Types of laboratory errors

6. Introduction cont. Types of laboratory errors Pre-analytical
Post analytical

7. Introduction cont. Pre-analytical errors Misidentification
Omission of clinical information
Incorrect samples
Clotted samples
Inadequate samples
Diluted samples
Haemolysed samples

8. Introduction cont.
Pre-analytical errors contribute about 46% to 68% of all laboratory errors.
Patient misidentification is responsible for the highest sample rejection from laboratories, 16-47%
25% of all sources of laboratory errors had a negative impact on patient outcomes. (Shashi Upreti-2013)

9. Introduction cont. Some of the negative impacts on patients
Further inappropriate investigations
Inappropriate care
Inappropriate or delay in modification of therapy
Unjustified cost to the patient

10. Introduction cont. Impact on facility Increase in operating cost
Lost of confidence in the laboratory services in facility

11. Introduction cont.
On the average, pre-analytical errors represent between 0.23% to 1.2% of total hospital operating cost.
When extrapolated to a typical U S hospital with approximately 650 bed capacity, it cost $ 1.2 million per year.

12. Literature review
Audit of request forms (multidisciplinary diagnostic centre in Lagos), it reported that only 1.3% of forms were fully completed for a total of 7841 forms analysed.
Patient name, referring physician’s name and gender were the most completed..99.0%, 99.0% and 90.3% respectively.
Clinical details of patient was completed on 65.9% of forms. (Olufemi Abiola O, 2014)

13. Literature review cont.
Muluberhan Ali (2015), from the Addis Ababa Hawassa University Referral Hospital in a similar study, reported that none of the request forms were fully completed. Sample size of 1306.
E Olayemi & R Asiamah-Broni (2010), a study conducted in a tertiary hospital in Ghana where 3000 request forms were evaluated, age & sex of patient were missing on 25.6% and 32.7% of forms respectively.
No clinical details provided on 22.7% of forms in same study

14. Study
Objective
to evaluate completeness of the laboratory request forms by doctors in CCTH
Methodology; a cross-sectional study involving the use of secondary on laboratory request forms. Data was taken from request forms to the haematology and biochemistry benches for the month of June, 2016.
Sample size – 554 forms, 285 for haematology and 269 for biochemistry

15. Study
Data was obtained on the name, age and sex of patient, date sample was taken, ward/unit sample was taken, name and signature of requesting doctor and relevant clinical details
Information on the time sample was collected was omitted.

16. Study

17. Results
153 (27.6%) forms were completed in their entirety per the seven variables

18. Results
All the request forms were completed with the name of the patient, 554 (100%)

19. Results

20. Results

21. Results

22. Results

23. Results

24. Results

25. Results
Average time spent filling the laboratory request form fully and properly is 1minute 15 seconds

26. Conclusion
Less than 1/3 of request forms are completed in their entirety.
The name/signature of requesting doctor and relevant clinical details were the two variables least completed, 46% and 66% respectively.
Almost all, > 95% of forms lacked adequate clinical details.

27. Recommendation
We should all endeavour to complete the laboratory request forms properly with all the relevant clinical details.
Create protocols to check pre-analytical errors.
Request forms which are not properly filled should be rejected.
Continuous evaluation to prevent all forms of laboratory errors.

28. Recommendation

29. THANK YOU

30. References
Olufemi A O, Abiola A O, Sandra O I; An audit of request forms submitted in a multidisciplinary diagnostic centre in Lagos,
Feyisayo J..; Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in northwest Nigeria (2015)
Muluberhan Ali; Assessment of medical laboratory request form completeness and non-communicated result to clinicians in two public hospitals found in Hawassa city, southern Ethiopia
Edeghonghon O, Asiamah-Broni; Evaluation of request forms submitted to the haematology laboratory in a Ghanaian tertiary hospital
Paingha J A, Ezenwa P U; Laboratory request forms-How well do doctors fill them? A look at the practice at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
Adegoke O A, Idowu A A, Jeje O A; Incomplete laboratory request forms as a contributory factor to preanalytical errors in a Nigerian teaching hospital