IMPORTANCE OF PATIENT PREPARATION BEFORE ANALYSIS OF SAMPLE

IMPORTANCE OF PATIENT PREPARATION BEFORE ANALYSIS OF SAMPLE FOR BETTER MANAGEMENT OF THE DISEASE Mr. Joydeb Pradhan Mrs. Tanusri Bera Pradhan

Introduction A clinical laboratory is responsible for conducting medical tests that provide valuable information for physician’s decision-making process. Laboratory tests not only help diagnose diseases but also aids monitoring and providing the right treatment for patients. In order to guarantee the quality of laboratory test results, the patient should cooperate by preparing themselves for the sample collection. After all, it is the sample from the body of the patient (blood, urine, body fluids, etc. ) on which the test will be conducted. The majority of medical decisions are based upon results obtained from the laboratory and because of that it is crucial for patients to get the most accurate information….

Aim of Patient Preparation Proper preparation of patients for blood sampling is of vital significance for ensuring the quality of the sample and test results. Many outpatients are not sufficiently familiar with the correct way of preparing for the laboratory tests, for which the patient needs to be at fasting. This study aimed to investigate: i) whether patients are aware of how they need to prepare properly for laboratory tests; ii) the way in which users are informed about how to prepare for laboratory testing; and iii) whether users arrive to the laboratory for phlebotomy properly prepared.

Factors Influence Test Result There is a significant influence on several laboratory tests after a regular meal. That is an important reason for standardization of the fasting time for all laboratory tests. Thus, it could be possible to prevent false results… Moreover, beside lipemia, patients’ variables including exercise, diet, age, sex, obesity, stress, smoking and medication may affect laboratory test results. It influences alteration of various metabolic, endocrine, oxidation and others mechanisms and the concentration of parameters is completely changed.

Way to Information Providing Laboratories need to have updated, clear and understandable written instructions for the preparation of patients prior to arrival at the laboratory, depending on the type of the required tests. Those instructions need to be available on-line and disseminated to all users of laboratory services. The information is provided on the laboratory web page, as well as in the written form, as a leaflet which can be obtained in the laboratory. Laboratory experts are also responsible to educate physicians & Nurses about the importance of the proper patient preparation and should try to motivate physicians to improve the way they inform patients about the fasting requirements. It is important to mention other resources of information (television etc. ).

Information for Patient The fasting state and patient preparation generally are very important because it could significantly interfere in during analysis the most parameters. It is, therefore, generally recommended that patients avoid high-fat food and do not eat or drink anything except water for a minimum 12 hours prior to the arrival to the laboratory. Fasting implies NO tea, coffee, milk, breakfast, juices, fruits, medications till the blood sample is collected. Water consumption is allowed at any time before the sample collection, preferably in regular sips.

Various Test Preparation Fasting Sample (Mandatory) ESR Lipid Profile Blood Suger (F) Blood Suger (PP) : 12 -14 hrs. : 10 -12 hrs. : Exactly 2 hrs. after a regular lunch. Vitamin B 12 & Folate : 12 -14 hrs. (not mandatory) C-Peptide : 12 -14 hrs. Apolipoprotein A 1/B : 14 -16 hrs Cortisol : At 8 am (as per Physician) Thyroid Profile : 12 -14 hrs. Serum Iron /TIBC : 10 -12 hrs. Homocystine : 10 -12 hrs. etc. Fasting Sample (Not Mandatory) Serum Electrolytes CBC BT, CT, PT, TT, APTT Blood Grouping, DCT, ICT Liver Function Test Kidney Function Test HBA 1 C Vitamin-D PSA HBs. Ag, HCV, HIV, VDRL Dengu Antigen, Malaria Antigen WIDAL, Microfilaria, TORCH Profile etc

Patient Preparation for GTT The patient should be on balanced diet (containing normal daily requirement of carbohydrates) at least for 2 – 3 days prior to the test. All drugs known to influence carbohydrate metabolism should be discontinued for at least 2 days prior to the test. The patients should avoid strenuous exercise on the previous day of the test. The patient should report to the laboratory after fasting for 12 – 16 hours. He/She can drink water. He/She should bring fasting midstream urine sample collected in a clean and dry container. During the course of GTT, the person should be comfortably seated and should abstaining smoking and exercise. The patient should be waiting in the laboratory for at least 2 – 3 hours, since five blood sample and urine sample are collected at the interval of 30 minutes.

Conclusion (Whats Need……. ) This questionnaire can become good quality indicator in the laboratory. Thus, the laboratory staff would able to systematically monitor frequency of visits to the laboratory of patients with lack of information about preparing for phlebotomy. Based on that, corrective actions could be introduced in order to improve informing of the patient about the proper preparation for laboratory testing. laboratory personnel task is also to raise the public awareness about the importance of the preanalytical phase and its influence on the quality of the sample. By doing so, the laboratory personnel will be able to reach patients and motivate them to seek available information when they come to the laboratory next time. Only by joint effort of all stakeholders involved, a common goal shall be reached – an educated patient aware of the fasting requirements and motivated to adhere to the laboratory instructions. The lack of knowledge and poor education is a shared responsibility of all stakeholders involved in the total testing process: requesting physicians, nurses, laboratory professionals and patients. The quality of communication between patients and health care workers and the amount the time spent with the patient were identified as the major area of potential improvement.

THANKs To All of YOU……