Page 64 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
PP-26

Reducing Blood Sample Rejection in Pathology Department, Institut Kanser Negara,
Putrajaya

Azilah AA, Rafidah A, Mohd Hakimi J, Shahirah Niza N, Siti Shahirah CM, Suhaila MH
Jabatan Patologi, Institut Kanser Negara, Putrajaya

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Blood sample rejection in the Pathology Department is a serious issue that negatively affects patient
management. Repetitions of blood draw cause pain and distress to the patient and consequently lead to wastage
of cost and time. This study aims to minimise the rejection percentage of blood samples.

KEY MEASURES FOR IMPROVEMENT:
The key measures for improvement were measured by the percentage of blood sample rejection calculated
monthly. The standard is <1% based on MSQH 5 edition: Service Standard 15 (Pathology Services).
th
PROCESS OF GATHERING INFORMATION:
A cross-sectional study was performed from January to December 2019. All blood samples received in the
Pathology Department were included, and rejections were based on standardised rejection criteria. Monthly
data of rejected samples and reasons for rejection were extracted from the Laboratory Information System
(LIS). Implementation of remedial measures was carried out in May 2019, and post-remedial evaluation was
conducted from June to December 2019.

ANALYSIS AND INTERPRETATION:
A verification study conducted from January to April 2019 showed the average rejection percentage was 1.61%,
with Achievable Benefit Not Achieved (ABNA) being 0.61%. Sample rejections were due to haemolysed
(57%), clotted (15%), insufficient samples (9%), and others.

STRATEGIES FOR CHANGE:
The Haemolysis Index Method was implemented, which accurately determines the degree of lysed samples.
Only gross haemolysed samples with Haemolysis Index greater than 4+ were rejected. Other measures included
Continuous Medical Education (CME), onsite visits, and refreshment training.

EFFECT OF CHANGE:
The Haemolysis Index Method has reduced the rejection of haemolysed samples, thus significantly reducing
the total rejection percentage in the Pathology Department. Starting from June 2019, the rejection percentage
was successfully brought down to 0.88%, suggesting the sustainability of remedial measures.

THE NEXT STEP:
All strategies will be continued to maintain the rejection percentage. Measurement of the Haemolysis Index
will be incorporated for all samples as this will improve the quality of laboratory results.

60