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Tech & Science Thousands of Queenslanders have blood tests mislabelled

15:26  12 december  2019
15:26  12 december  2019 Source:   brisbanetimes.com.au

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More than 2600 patients have potentially had their blood tests mislabelled in Queensland's public hospitals over the past three years, risking wrong diagnosis and treatment.

Data released to Brisbane Times under Right to Information shows between September 2016 and November 2019, there were 2697 suspected 'wrong blood in tubes' incidents statewide.

Mislabelling blood tubes can lead to patients being given the wrong treatment, misdiagnosed with conditions they don't actually have, or having health conditions entirely missed.

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A Queensland Health spokeswoman said the rate of suspected incidents was declining, with only 0.014 per cent of the 5 million blood tests taken across 2018 suspected of being mislabelled.

"Since the introduction of incident reporting in September 2016 there have been no identified cases of patient harm," the spokeswoman said.

"This is being made possible through improved staff training; better reporting and monitoring of incidents; and improved technology.

"We believe these robust checks and balances ensure errors are identified and acted upon quickly."

Not all suspected incidents will be a wrong blood in tube incident, and Hospital and Health Services investigate each case.

In 2016, clinicians at Cairns Hospital raised concerns that the rollout of Queensland Health's integrated electronic medical record (ieMR) software was causing a spike in the mislabelling of blood tubes.

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The ieMR records patient data across all hospitals and is accessible to all clinicians and administrative staff statewide.

Between September and December of 2016, Cairns Hospital reported 43 suspected 'wrong blood in tubes' incidents, after rolling out the ieMR in March 2016.

Across 2017, Cairns Hospital reported 127 suspected incidents, followed by 106 suspected incidents in 2018, and 85 up to November this year.

The Princess Alexandra Hospital, which went live in March 2017, reported 175 incidents in that year, followed by 181 incidents in 2018.

This year the number of suspected incidents was 138 up to November.

But the Royal Brisbane and Women's Hospital, which has not rolled out the pathology software of the ieMR, reported only 27 suspected incidents this year and 29 the year before.

A December 2018 auditor-general's report into the ieMR noted the Princess Alexandra was the only hospital that had identified blood tube mislabelling as a potential "dis-benefit" of the ieMR.

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This does not account for the fact that many incidences of mislabelling would not be attributed to the delay in treatment or implicated in the death of a patient. He continued: “A small number of those examples, there will be really serious problems. A good example of that are blood transfusions if the

Software and staff

University of Melbourne chair of anaesthesia David Story said 'wrong blood in tube' incidents could happen due to a change in systems and a lack of training, and electronic medical records added a "degree of complexity".

"The major issue for any individual patient would be that they get somebody else's results," Professor Story said.

He said the most serious risk was when clinicians took blood for cross-match, ahead of a blood transfusion, to protect against "life-threatening reactions" if the wrong blood type was transfused.

The Gold Coast University Hospital, where the ieMR went live in April this year, reported 13 suspected 'wrong blood in tubes' incidents in 2018, and 55 this year to November.

Logan Hospital, where the ieMR went live in December 2017, saw 33 incidents in September to December 2017, then 88 suspected incidents in 2018.

That figure dropped to 43 to November this year.

Professor Story said hospitals had strict procedures to ensure the patients' name, date of birth and patient number matched the blood test tubes.

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"If you look at the total number of blood samples, it is a major problem when that happens, but it is, I would think, quite rare that you actually have the wrong label of a vial of blood," Professor Story said.

"But ... with the rollout of an electronic medical record, it’s introduced new problems and dealing with those needs to be part of it."

Concerns and training

Last year the Australian Medical Association of Queensland wrote to Queensland Health on behalf of Mackay Hospital clinicians, warning that ordering tests in the ieMR was "complicated, time consuming and error prone".

Clinicians warned that scanners for patients' wristbands - a key identifier to ensure the right patient was being treated - often failed. That could contribute to wrong blood in tubes, the letter said.

Mackay Hospital saw 65 incidents in 2017, 42 in 2018, and 30 this year to November; it went live with the ieMR in October 2017.

The AMAQ wrote that label printers in hospital wards regularly jammed or were out of battery, and clinicians frequently had to move patients to or from scanners that were hardwired.

Earlier this year the AMAQ urged the state government to pause the ieMR's rollout. The association was contacted for comment.

"Generating the pathology request on a computer away from the patient and then printing it off ... that's a theoretical risk," Professor Story said.

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Theranos has issued corrections for thousands of blood tests and has voided two years' worth of results from one of its devices. Theranos spokeswoman Brooke Buchanan said Wednesday that no patients suffered harm due to the inaccurate tests , citing an analysis conducted by the company.

He said if there was an uptick in reported blood test errors, "that's something you'd be wanting to look at".

Professor Story said Queensland's statewide ieMR, purchased from US medical giant Cerner in 2011, was ahead of Victoria's as it linked all public hospitals.

"It's a credit to Queensland that it's one system, interlinked, I think that's an enormous advantage. That's a positive," he said.

"But this has been the thing with EMRs in that the dark side, the negatives are there, particularly I think in workforce welfare."

Risks and training

Griffith University cancer researcher Nigel McMillan said the economic cost of repeated blood test errors was another reason to ensure the testing was correct.

Professor McMillan said a delayed diagnosis would eventually come to light, but would require more tests, more money and more time to resolve.

The ieMR's 2016 business case estimated a $7 million saving in reducing the number of incorrect blood tests.

Professor Story said the risk of 'wrong blood in tubes' incidents was also increased with staff moving from hospital to hospital, where procedures and requirements could be different.

Junior doctors in particular might never have been taught the correct procedure, he said, and senior doctors had to adjust from writing everything on paper, to entering data in a complex IT system.

"To their credit often the nurses are the best at this stuff because they've been doing it for years and they have a degree of rigour in the way they're trained," he said.

"You may have an intern that's been taught to diagnose a heart attack, but the safest sequence to label a blood tube may never have been taught to them."

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