Follow up of standard analytical procedures and implementation of internal & external quality control by medical laboratory technician is a foundation of accurate detection of patient disease.

Prospects for quality control at Medical Laboratories in PakistanMedical laboratory is one of the category of allied sciences, that is a broad field and encompasses of diverse range of disciplines such as clinical chemistry, haematology, serology, immunology, microbiology etc. In this modern era, where the diseases are more common than the health, Medical Laboratory Technologists (MLTs) play prime role to aid the diagnosis of upset health or diseases. Patient treatment rely on what the technologist identify and how does it identify this mean that the work method of technologist, specimen analysis procedure, performance of laboratory analysers, the corrective actions and the steps they follow to troubleshoot the mess or problem impact on patients treatment.

This article will apprise about management of quality control and how the quality of analytical system is enhance and accurate by the regular monitoring and quality control. Theoretically, quality control is a bunch of procedures that are essential, to avoid any unreliability and errors in laboratory diagnosis. Quality control work as a security and safeguard the system.

Clinical laboratories have multiplex analytical systems that is every section is house with different type of analysers according to their nature of examination. The stability of analytical system affected by many factors like untrained operator, quality of reagents using for analysis, environment and analysers temperature, storing temperature of kits and samples, quality of laboratory water use for analysis etc.  Therefore it is crucial to monitor the analytical system before performing the samples analysis to exclude the harsh result outcome.

Basically, the reliability of test result based on three types of laboratory phases; pre analytical phase, analytical phase and post analytical phase. There are numbers of strict quality control rules for all three phases, and it is very important to catch up these quality control tool in every phase, so that dispatch test report can make patient treatment well effective. When an assayed is perform in laboratory, that assayed result tell the doctor about patient health status, and if the result is misleading then definitely patient have to suffer more sick day by day instead of getting well due to onerous test result. To eliminate this type of result or for check the result prior to report that its correct or not? Control materials are needed to run for visualize the analytical systems before patient samples testing.

Controls are used to monitor the accuracy, reproducibility and precision of analytical system result. In a stable analytical system control values are not  same on daily run it shows the variation in result and this variation is acceptable at certain level that is called precision. As the time pass every stable analytical system become unstable and give imprecise control values which are  not acceptable, here an operator need to calibrate the system for make the system analysis reliable and precise. This is what an operator need to implement in  laboratory to control the internal quality through regular monitoring of control values.

Fully automated analysers have quality control module system which means  they  can  graphically  represent the control values. Control values  are  plot  on  Levey  Jenningy (LJ) chart. To understand the  chart operator  should  have knowledge of Westgard rules which tell about  control values  whether they  are in range or out of the range. Without the knowledge and understanding of Westgard rules no quality control can be implement in  laboratory. Violation in rules help the operator to understand the type of error because every error occur due to different reason so before going to take any corrective action it is important to understand the error type.

Daily run of control material is a main step in the management of internal quality control. Because the omit or skipping of this step make the test report doubtful and inaccurate which not only affect the confidence and satisfactory of laboratory workers but also affect the reputation of laboratory. After implementation and self-assessment of internal quality control, laboratory should go for the External quality assurance program or proficiency testing. Aim of these programs  is to check the  laboratory testing performances.

If it’s not possible for the laboratory to participate in these  programs, they can compare  their quality by exchanging their laboratory results with standardize laboratory for checking the performance of laboratory work. But the advantage of participating in external quality program is huge rather than exchanging of samples between laboratory  that is it’s not only assist the laboratory  testing performance   it  make the accreditation possible on national and international level  which gives worldwide recognition .

In Pakistan, most of the private and government laboratories neglect the quality control procedures, because they don’t have knowledge, they think that quality control procedures are just a time wasting that have no such importance. To get rid of this thought Government of Pakistan should have to launch training programs about the quality control that educate the laboratory technicians about quality control and management according to the plan of ISO 15189. Chances of incorrect diagnosis start from the earliest step (collection phase) and remain till the final step.

Improper collection, sample analysis and carelessness in report dispatch  hurt the patient financially and physically. In Pakistan most of the laboratory technicians join the laboratory without the proper education that is they do not know about quality control. They do not monitor the control daily and even that they do not know how to check the graph, what type of rule violation is occurring  and what the reason behind it. They just start the sample analysis. It’s very obvious that practice make the person perfect but except this,  proper knowledge and right guideline is also mandatory. This  knowledge  is only be possible by specific training programs. It is compulsory, that the program aim and content should be design in a way that  covered the knowledge of all laboratory phases.

It is a responsibility of government and health planners that they put consideration on both government and private laboratories to enhance the healthcare standards. As our peoples are in torture from all sides, the rate of poverty and malnutrition is on rising as-well. In such a condition, if system will not be change, then the uneven and deficient work together with insufficient knowledge, will never  let be meet us with prosper and healthy environment. It is a right time to do the healthcare system cost effective,  by managing the well quality at least in diagnostic sector, that will directly influence the laboratory diagnosis and healthcare.

By NayabQaimkhani

B.S (Medical Laboratory Technology) student at University of Sindh, Jamshoro.