A high priority for a quality laboratory operation is a commitment to safety, and the key to making such a commitment is support from lab leadership for a culture of safety consciousness. Managing safety is more than having a top-down list of do’s and don’ts, a library of educational videos, and a stock of protective gear (though all are important). It’s about having an awareness of your working environment, having strategies in place that anticipate potential problems, and having the ability to provide effective solutions. A safe lab environment requires active involvement by everyone; it’s about teamwork; it’s about leadership.
While there are universal guidelines for safe laboratory practices, each laboratory’s policies and procedures also should reflect particular considerations of potential hazards within its own physical environment. Such specifics might be related to instrumentation, test protocols, physical structure, workflow, and traffic patterns, among others.
Safety, of course, begins with rigorous adherence to the structured safety guidelines with which all laboratorians are familiar. But creating a culture of safety also requires that laboratory personnel realize that the welfare and safety of each individual depends upon adopted values of teamwork, transparency, and personal responsibility, and that laboratory safety is tied to behavior as well as process. In this way, a culture of laboratory safety becomes an internalized attitude, not just an external expectation driven by institutional rules.
Building a culture of safety
Creating a program of safety awareness in the laboratory requires a deliberate decision by the laboratory director to change the way the laboratory operates. Leadership by those in charge ensures that an effective safety program is adopted and embraced by all, inspiring laboratory staff toward greater cooperation, communication and trust, and away from fear when errors are uncovered.1 Here are the primary responsibilities that laboratory leadership needs to assume to ensure a safe work environment and promote a culture of safety.2
Conduct safety orientation, training, and competency assessment for all employees. Lab leaders need to institute, train, and motivate employees to follow all safety protocols for their work. They must know what personal protective equipment (PPE) is needed for each task and how this equipment must be properly used, stored, and maintained, and make sure that all staff know this. They must ensure that all employees take mandated safety training courses and document attendance.
Enforce safe work practices. There should be no exceptions or “just this once’s”; straying from safe laboratory work practices and procedures is an invitation for accidents to occur. Staff should be encouraged to identify unsafe or unhealthful working conditions or hazards and not fear being questioned for doing so.
Correct unsafe conditions. Lab directors should take immediate steps to correct unsafe or unhealthful working conditions or hazards. When these cannot be immediately corrected, the supervisor must take temporary precautionary measures. Follow-up should be done to ensure that corrective measures are completed in a timely manner that addresses the hazard.
Investigate workplace accidents. Incident management reporting and protocols should be in place and utilized as required.
Initiatives to encourage openness and transparency3
Creating a culture of safety also means supporting behavior that encourages openness and transparency when errors are made or accidents happen. This means building a supportive work environment wherein the reporting of safety issues, problems, events, and errors are supported, and handled with an eye toward resolution and prevention. When honest mistakes are made, and acknowledged, these should be viewed as a learning opportunity to improve performance and quality through education, training, and mentoring.
Ensuring safety competency
One area of special importance is ensuring the proper training and competency of all non-laboratory staff that are also involved in the pre-analytic and post-analytic phases of testing. This is especially true for the pre-analytic phase of patient testing, as office staff are often involved in specimen acquisition and handling, frequently interacting with the testing staff, and proximate to instrumentation and other equipment.
This group of front office personnel includes receptionists, medical assistants, secretaries, phlebotomists, couriers, and even the office manager; they should be properly trained for anything they do that affects any aspect of the laboratory operation.
The Incident Management Plan4
No matter how strong a safety program is in place, no matter how committed the laboratory is to supporting a culture of safety, situations occur where safety may be compromised and the potential for harm exists. Thus, an important part of any laboratory safety program is having an Incident Management Plan, defined as a plan that provides a process for the investigation of reported events in order to determine if the occurrences or situations reported have the potential to cause harm or injury to staff and visitors. If this is the case, appropriate corrective actions can then be taken, and the safety program modified, if necessary, to reduce the risk of re-occurrence.
The laboratory must establish policies and procedures and document their use in managing incidents, particularly those that cause or may potentially cause death or serious injury to patients or laboratory staff. There should be three broad goals of an Incident Management Plan: preventing future incidents from occurring; reducing the risk of injury; and encouraging open communication regarding the discovery of incidents and the effectiveness of improvements.
Events or activities related to employee safety that are considered incidents include systemic non-compliance with established laboratory policies and procedures; repeated failures in safety procedures; accidents or improper disposal of contaminated waste, causing injury; and death (unexplained or unexpected).
Process for incident investigation
Each incident should be reviewed on a case-by-case basis and discussed promptly so that the causes can be identified and the problem addressed immediately. The following process should be used for incident investigation:
1.Staff who witness or become aware of an incident report the occurrence to the laboratory director or supervisor within 24 hours of discovering the incident. All facts related to the incident are documented on an Incident Management Investigation Form.
2.The laboratory director determines whether any outside agency reporting requirements apply to the incident.
3.The laboratory director or supervisor performs the evaluation and investigation of the incident:
- a. Whoever conducts the investigation must have the authority to recommend changes in policy, process, and procedure to effectively resolve and prevent a recurrence of the
incident. - b. The investigator analyzes the impact of the incident during the time prior to the initial report of the incident, during the investigation of the incident, and for future testing.
- c. The investigator analyzes the true cause of the incident by conducting a root-cause analysis.
- d. The investigator documents the facts, findings, and conclusion on the Incident Management Investigation Form.
4.The laboratory director then determines appropriate corrective actions to be taken to prevent recurrence of the incident.
5.The date that each corrective action step is completed is documented.
6.The investigation findings and outcome are communicated to the staff.
7.Necessary policy or procedure revisions or re-training of personnel are undertaken.
8.The laboratory director follows up on the corrective actions taken to ensure that they were effective.
9.All documentation regarding the incident is retained in the laboratory quality assessment manual.
Creating and sustaining a culture of safety within the laboratory requires a commitment to employees that goes beyond providing top-down mandates. It is a commitment that encourages and supports buy-in from the entire staff, and an attitude of “if you see something, say something,” without repercussion; appreciation for open communication and feedback; and, when errors are made, an ethic of learning from these, rather than playing the “blame game.” In summary, lab safety is enhanced through constant awareness of one’s working environment, having mechanisms in place to investigate incidents and apply corrective steps, and a constant reinforcement of teamwork and transparency.
REFERENCES
- Reliableplant. Seven steps to creating a more transparent organization. http://www.reliableplant.com/Read/23472/Seven-steps-transparent-organization.
- National Institutes of Health Office of Management: Division of Occupational Health and Safety. Safety responsibilities for supervisors. https://www.ors.od.nih.gov/sr/dohs/HealthAndWellness/Pages/Safety-Responsibilities-for-Supervisors.aspx.
- Shenkel R, Gardner C. Five ways to retain good staff. Fam Pract Manag. 2004;11(10):57-62. http://www.aafp.org/fpm/2004/1100/p57.html.
- Incident Management Plan. COLA. https://connect.cola.org/sites/iso/qualitymanual/Documents for Accreditation Customers/Templates for Customer Use/Quality
Assessment/Incident Management Plan.docx.
Irwin Z. Rothenberg is a Technical Writer/Quality Advisor for COLA’s Educational subsidiary, COLA Resources, Inc. CRI offers continuing education through online courses, informational products in both electronic and hard copy form, webinars on technology and regulatory issues, and CRI on-site Symposia for Clinical Laboratories, providing live educational sessions and interactive workshops with industry organizations.
