Quality and error (Tony Landgren, RMH) Flashcards
competence is…
practising safely and to a standard
minimising harm
being capable/qualified
who determines competence?
examiners, advisers and supervisors
via the Board of Censors
to the RCPA Council
how is Standard of Competence measured?
- continuous formative assessment (supervisor)
- summative assessments (exams)
who is involved in lab accreditation?
IANZ (NATA in Australia), RCPA, ISO
what is ISO and how is it relevant to medical labs?
International Organisation for Standardization
Sets ISO 15189: requirements for quality and competence in medical laboratories
Give examples of internal quality systems
document control system
error analysis tools
quality training
quality reporting
controls (eg target result, positive result, negative result)
audit (path, clinical and multidisciplinary)
what external quality programmes are used?
RCPA QAP:
technical and diagnostic branches
uses national and international benchmarking
what is credentialling?
- a pathologist’s Scope of Practice
- continuing medical education
Why is AP prone to error?
subjective results
variable quality of evidence for diagnostic criteria
variable application of diagnostic criteria
no validated decision support (as in chem path)
What does AP do to reduce error?
externally benchmarked techincal and diagnostic programmes (QAP)
clinical correlation
internal audit
review of critical diagnoses
categories of pre-analytic error (4)
patient and specimen identification
clinical information
biopsy technique/handling
specimen handing/storage
categories of analytic/post-analytic error (3)
analytic
laboratory technical work
diagnostic interpretation/documentation
post-analytic
communication
what errors can occur in reporting other than ‘diagnosis’?
error of omission: eg important to prognosis and therapy
error of inclusion: eg fudging morphology to fit clinical, attributing significance to features inappropriately
how can you avoid errors?
obtain/verify clinical information
correlate with imaging
correlate with previous diagnoses
use ancillary tests
use structured reports
proof read
seek advice
participate in audit
