Patient Safety and Clinical Laboratory Science

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Document: Patient Safety and Clinical Laboratory Science 
Classification: Position Paper
Status: Approved by the ASCLS House of Delegates, July 2015

Introduction:

ASCLS has a long history of supporting the role of Medical Laboratory Professionals (defined for the purposes of this paper as Medical Laboratory Scientists, Medical Laboratory Technicians, Clinical Laboratory Assistants and Phlebotomists) in improving patient care, by promoting improvements in the delivery of laboratory testing services, enhancing educational requirements for Medical Laboratory Professionals, and identifying advanced practice opportunities for the profession.  The next step in improving patient care is to fully integrate patient safety concepts and competencies into clinical laboratory science practice.

Background:

Dramatic changes have taken place throughout the healthcare delivery system since To Err is Human and Crossing the Quality Chasm were published by the Institute of Medicine (IOM) in 2000 and 2001, respectively. As a result of these publications, healthcare providers and delivery systems have focused on ameliorating the systematic errors that can result in harm to patients. ASCLS adopted the position paper, Medical Errors and Patient Safety in 2001 in support of the proposals identified in To Err is Human. The IOM identified six aims in Crossing the Quality Chasm as the foci for improving healthcare: safe, effective, patient-centered, timely, efficient and equitable.

Healthcare professions, specifically medicine, nursing and pharmacy, have revised their curricula and practice to include the competencies identified as necessary to improve patient safety and healthcare quality by the IOM Health Professions Education Summit. Five competencies were designated as essential for all healthcare practitioners to master in order to improve healthcare quality and patient safety:

  • practice evidence-based medicine,
  • focus on quality improvement,
  • use information technology,
  • deliver patient-centered care, and
  • work in interdisciplinary teams.

Because of its vital role in patient care, the Clinical Laboratory Science profession must incorporate IOM aims as a framework for the evaluation and improvement of its services, integrate IOM aims and competencies into pre-certification curricula and entry-level competency requirements, and include patient safety concepts in certification exams.

 

ASCLS Believes:

1. Medical Laboratory Professionals are stewards of patient safety and must promote a culture of safety defined by the IOM as safe, effective, patient-centered, timely, efficient, and equitable practice.

  • The aim of clinical laboratory science and the services it provides is to improve patients' lives during the total testing process.
  • Although each phase of the total testing process is important to safe care, increased efforts must be placed on evaluating diagnostic services by IOM measures of health outcomes:
  • Safe laboratory testing assures care that avoids harm to patients and enhances safe care outcomes through error prevention, continuous process improvement, and appropriate care for each individual.
  • Effective care uses scientific knowledge to limit overuse, underuse, and misuse of laboratory testing services.
  • Patient-centered laboratory care is responsive to, and respectful of, patient preferences, needs, and values, and must include either face-to-face or written communication for patients about medical laboratory tests and patient rights.
  • Timely laboratory services reduce wait times for patients and other providers of healthcare, so that the next step in care is not delayed.
  • Efficient laboratory services avoid waste, which includes time, supplies, equipment, energy, and ideas.
  • Equitable laboratory services do not vary in quality due to patient characteristics such as gender, ethnicity, geographic location or socioeconomic status, and are tailored for individual circumstances.

2. Medical Laboratory Professionals must incorporate each of these IOM competencies into daily practice, i.e. provide patient-centered care, employ evidence-based laboratory practice, apply quality improvement principles, use informatics, and work on interprofessional healthcare teams. Medical Laboratory Professionals:

  • Recognize that the patient is the focus of our practice;
  • Acknowledge that evidence-based laboratory practice is critical to providing effective healthcare;
  • Apply quality improvement principles to healthcare processes to reduce opportunities for errors that could harm patients and to improve patient outcomes;
  •  Use informatics as an essential component of their practice, due to advanced technology of laboratory testing systems and integrated systems to manage and communicate information for laboratory testing systems;
  • Bring laboratory testing expertise to interprofessional healthcare teams as they develop and provide standards of care.

3. Medical Laboratory Professionals promote the culture of safety as an organizing principle in certification and licensure of professionals at every practice level and in accreditation of programs at all educational levels.

  • Medical Laboratory Professionals must adopt a 'fair and just culture' philosophy, recognizing that humans make errors, and understanding the science of safety and error prevention.
  • Patient safety competencies must be an integral component of the accreditation requirements for all Clinical Laboratory Science educational programs.
    • Educational curricula must address competencies necessary to improve patient safety and add value to services delivery as measured by IOM aims of safe, effective, patient-centered, timely, efficient and equitable healthcare.
    • Curricula must be expanded beyond the basics of patient identification and analytical accuracy by enhancing students' understanding of additional pre- and post-analytic sources of error, quality improvement strategies that measure impact of diagnostics on health outcomes, utilization of evidence-based practice methods and basic principles of integrated electronic health record systems and reporting.
  • Patient Safety competencies must be foundational components of the certification and licensure requirements for all Clinical Laboratory Science practice levels.

 

References:

Committee on Quality of Health Care in America. Institute of Medicine, Kohn L, Corrigan J, Donaldson M. eds. To err is human: building a safety health system. Washington, DC: National Academy Press; 2000.

American Society for Clinical Laboratory Science. Position Paper: Medical Errors and Patient Safety. August 2, 2001.

Committee on Quality of Health Care in America. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.

Committee on the Health Professions Education Summit, National Academies press. Greiner AC, Knebel E. Eds. Health Professions Education: A Bridge to Quality. Washington DC: National Academy Press; 2003.

American Society for Clinical Laboratory Science. Position Paper: Value of Clinical Laboratory Services in Healthcare. July 2005.

Otto CN. Patient Safety and the Medical Laboratory: An Introduction. Clin Lab Sci 2011; 24: 105-107.

Otto CN. Patient Safety and the Medical Laboratory: Using the IOM Aims. Clin Lab Sci 2011; 24: 108-113.

Morris S, Otto CN, Golemboski K. Improving Patient Safety and Healthcare Quality in the 21st Century--Competencies Required of Future Medical Laboratory Science Practitioners. Clin Lab Sci 2013; 26: 200-204.