Experience in BFMP

Management in Serology

Laboratory, Hospital Sibu

By Makmal Serologi

Jabatan Patologi Hospital Sibu

Introduction Blood Film for Malaria Parasite (BFMP) as both routine and

critical test in Sarawak.

In Hospital Sibu, BFMP results adhere to 1-hour Lab Turn-

Around Time, for both office hours and after office hours

Use Geimsa staining

457

352

495

416

372

390

359

246

483500

305

160

0

100

200

300

400

500

600

Monthly BFMP Slides Workload for 2012

Total BFMP Slides (4535)

60

68

44

26

39

3442

77

67

101

64

21

0

20

40

60

80

100

120

Monthly Trend for Positive Malaria Samples 2012

TOTAL POS (643)

Prevalence rate of positive slides

14.17%

14%

24%

4%

58%

0%

Percentage of Malaria Species from patient BFMP slides for 2012

P.Falciparum (90) P. Vivax (157) P.Malariae (23)

P.Knowlesi (372) P.Ovale (1)

NIA BFMP 2012• Observing 1-hour LTAT suggested by NIA.

• Emergency & Trauma samples contributed to 98% of total TAT forms received.

Feb-May

2012

June-Sept

2012

Oct-Dec

2012

Jan-May

2013

Forms 155 171 129 222

Feb-May 2012

June-Sept 2012

Oct-Dec 2012

Jan-May 2013

Mean LTAT(mins)

44.3 43 46.49 45.74

41424344454647

Mean LTAT(mins)

96.77%

93.56%

92.18%

90.09%

Feb-May 2012

June-Sept 2012

Oct-Dec 2012 Jan-May 2013

Compliance rate for 1-hour LTAT

Compliance rate

Internal QC

Internal QC for Giemsa staining

3% GIEMSA QUALITY CONTROL FOR BFMP STAINING

Date

Reagent Batch

Operator

QC Slide

VerificationStock Buffer Working Buffer Background RBC

WBC

Nucleus Cytoplasm

Kes salah lapor 1 case in 2012

Root-cause Analysis done

New microscope supplied by JKNS post-RCA

2 cases in 2013

RCA of Incident : BFMP Epid

Week 36 Wrong Reporting

Team Members

1. Alexander Beemer Mijen

2. Siti Syartinah Shawkawi

3. Noel Ting Yong Yin

4. Saiful Ungo

5. Siti Syazwana Taip

6. Faiz Osen

Brief Summary of Incident A (Iban)

31st August 2012 (Friday, PH) sample Alexander Amit received by

oncall staff at 3pm. Oncall staff reported as negative.

1st September 2012 (Saturday, WE) Sero staff A counterchecked (AM

clearing) positive for P.Falciparum.

3rd September 2012 (Monday) Sero staff B countercheck (AM routine)

positive for P.Knowlesi, send slide to Vector Control Sibu.

Define the problem

(Using process diagram / sequence of

events)

Ref Date Time Location Event Description Key person(s) involved

Comment/ Queries

31st August 2012 (PH)

1500hrs Lab sample Alexander Amit received by oncall staff at

3pm. Oncall staff reported as negative

Oncall MLT Was the sample

properly prepared

smear? (YES)

Was the smear

properly stained?

(YES)

1st September 2012 (Saturday)

AMClearing

Lab Sero staff A counterchecked (AM clearing) positive

for P.Falciparum.

MLT Organism clearly seen

on microscope? Can

make out for sure the

physical properties of

the said organism?

3rd

September

2012

AM

routine

Lab Sero Staff B countercheck (AM routine) positive for

P.Knowlesi, send slide to Vector Control Sibu

MLT Organism clearly seen

on microscope? Can

make out for sure the

physical properties of

the said organism?

Specimen

collection

Receive by

MLT, stained

View thru

microscope, res

ult released as

negative

Countercheck,

release as

positive for

P.falciparum

Routine

countercheck,

reported as

P.knowlesi

Send to

vector, vector

report as

P.falciparum

Smear

okayStain okay

Parasite

cannot be seen

Microscope not

clear, yellow light

not suitable for

viewing parasite

1st Sept 201231st August 2012

Identify contributory factors

(cause effect diagram/fishbone /5why)

3rd September 2012

Parasite can

be seen, can

confirm

positive, physio

logy not clear.

Parasite can

be seen, can

confirm

positive, physio

logy not clear.

Brief Summary of Incident B (Cina)

30th August 2012 (Thursday) – sample for Tan Kai Yung received by lab

staff, reported as P.Falciparum. Sent to Vector Control Sibu.

Vector Control reported as P.knowlesi, followed by State Vector as

P.knowlesi.

Define the problem

(Using process diagram / sequence of

events)

Ref Date Time Location Event Description Key person(s) involved

Comment/ Queries

30th August

2012

(Thursday)

Routine Lab sample for Tan Kai Yung received by lab staff,

reported as P.Falciparum. Sent to Vector Control

Sibu

MLT Was the sample

properly prepared

smear? (YES)

Was the smear

properly stained?

(YES)

Organism clearly seen

on microscope? Can

make out for sure the

physical properties of

the said organism?

Vector Control reported as P.knowlesi, followed by

State Vector as P.knowlesi.

Vector

control staff,

State vector

liaison officer

N/A

Specimen

collection

Receive by

MLT, stained

View thru

microscope,

reported as

positive for

P.falciparum

Send to vector Vector Control

report as

P.knowlesi, State

vector as

P.Knowlesi

Smear

okayStain okay

Microscope not

clear, yellow light

not suitable for

viewing parasite

3rd Sept

201230th August 2012

Identify contributory factors

(cause effect diagram/fishbone /5why)

Parasite can be

seen, can confirm

positive, physiology

not clear.

4th Sept

2012

Plan of actionNo Root cause Action Responsibility Date due

1

2

Microscope condition not good, yellow light not suitable for viewing parasite morphology, microscope lens not clear

Current microscope is old, >10 years

To ask Faber to change the yellow bulb into white bulb

To ask Faber to change lens

To replace current microscope with new unit

Laboratory and Faber

Laboratory Management

Immediate

As soon as possible

External QA Programme MKA Kota Kinabalu BFMP EQA Programme

Series 1 / 2013 participated

Vektor Negeri EQA Programme

Sending of all positive BFMP slides to Vektor Sibu and Vektor

Negeri.

Staff Training Oncall staff BFMP training in 2012, 2013

July 2013 – estimate to send mnimum 15 oncall staff to

Vektor Sibu for refresher course

Hospital Staff BFMP Smear

Training Done in 2012 and 2013

Targets doctors and nurses responsible to prepare BFMP

slide smears

Multiples sessions weekly, 10-15 participants per session

Facilitated by Serology/Parasitology MLTs under supervision

by MLT Siti Syartinah Sharkawi

Thank you and have a

nice day!