Incident Response and Reporting Flashcards

A flow cytometry result for a pediatric patient is reported with the wrong patient identifier. This type of error is best classified as which category of laboratory incident?

Answer: Post-analytical error

Wrong patient identifier on a reported result is a post-analytical error because it occurs after the specimen has been analyzed and during the reporting phase.

Which element is LEAST important to include in a formal laboratory incident report for a cytometry specimen mix-up?

Answer: The laboratory's annual revenue figures

Financial data is irrelevant to an incident report; the focus should be on the event details, involved personnel, and corrective actions.

In a flow cytometry laboratory, what is the primary purpose of conducting a 'failure mode and effects analysis' (FMEA) proactively?

Answer: To identify potential failure points before they cause actual incidents

FMEA is a prospective risk assessment tool used to identify, prioritize, and mitigate potential failure modes before they result in patient harm or laboratory errors.

After a critical cytometry result (e.g., blasts consistent with acute leukemia) is identified, what is the most appropriate communication action?

Answer: Directly contact the ordering physician or clinical team by phone and document the notification

Critical values require immediate verbal notification to the responsible clinician with documentation of who was notified, when, and what information was conveyed.

A cytometry laboratory receives a blood sample that arrived hemolyzed and at ambient temperature after a 6-hour transit delay. What is the best course of action?

Answer: Reject the specimen, document the rejection reason, and notify the ordering provider to recollect

A specimen that is hemolyzed and temperature-compromised will yield unreliable flow cytometry results; rejection with documented reason and recollection request is the appropriate action.

Which of the following scenarios would most likely trigger mandatory external reporting to a state health department laboratory program?

Answer: A pattern of systematic reportable disease misclassification affecting multiple patients

Systematic errors affecting disease classification and public health reporting obligations require notification to the state health department as part of mandatory external reporting frameworks.

When should a corrective action plan (CAP) be implemented following a laboratory incident investigation?

Answer: After root cause analysis identifies contributing factors, regardless of incident severity

A corrective action plan should be implemented after any root cause analysis identifies contributing factors, as even low-severity incidents can reveal systemic vulnerabilities.