Assessment of Patients’ Medical Laboratory Request Forms for Compliance in Jos University Teaching Hospital, Jos-Nigeria

Background: Medical laboratory request forms are important medium of communication between the physicians and the medical laboratory practitioners. The request form provides demographic information of the patients as well as clinical conditions, clinician, specimen information and the targeted laboratory. Inability of the physician to indicate any of the information mentioned above could pose a negative effect in accurate definitive diagnosis of the patients’ disease which could affect proper treatment or management. Aim of study: The study seeks to assess the level of completeness of patients request forms in Jos University Teaching Hospital. Study volunteers and methods: A retrospective study was carried out on 4,310 in and out Patients request forms as filled by the physician and sent to four laboratory departments of the hospital between the period of January and July 2017 having gotten Ethical clearance from the ethical committee of the teaching hospital. Results: The result of the findings revealed that from the 4310 request forms assessed, patient’ demographic information, recorded 20.9%, 17.2%, 14.9%, 1.3%, 0.9% and 0.0% incomplete rate for age, ward, department, hospital number, sex and name of the patient respectively. Patients’ clinical information revealed 54.7% and 8.0% incomplete rate for patients’ clinical data and provisional diagnosis respectively. For Clinician information, incomplete rate of 54.7%, 17.8% and 8.2% was recorded for signature of the doctor, name of doctor and the consultant respectively. On specimen information, an incomplete rate of 98.2%, 9.0%, 7.6% and 2.9% was observed for time of specimen collection, date, nature of specimen and investigation required respectively. On targeted laboratory, the study recorded an incomplete rate of 8.6%. The result also show that from all the 4310 request form assessed, none is 100% completely filled. Conclusion: This study reveals incomplete filling of medical laboratory request forms in JUTH. There is the need to adhere to International Standard Organization guidelines in filling the laboratory request forms for a better patient care and improvement of quality since most decision are taken by the physician or the nurse depends on medical laboratory results.


Introduction
Medical Laboratory testing plays a very important role in the detection, diagnosis and treatment of a patient's disease. The timely result generated in the medical laboratory guides the physician or the nurse in decision making pertaining to the treatment, discharge and/ or the management options for a patient [1,2]. An estimated 60-70% of all decisions regarding a patients' diagnosis and treatment, hospital admission and discharge are based on the medical laboratory results [3]. In a hospital setting, patients' medical laboratory tests are conducted based on request made on a medical laboratory request form filled by the Physician or the Nurse in some cases [4]. The medical laboratory request form in the Jos University Teaching Hospital's contains demographic information such as patients' full name, Age, Sex, Hospital Number, Specimen, Tribe, Ward, Department, Clinical Data, Provisional Diagnosis, Investigation Required, Date, and Time of sample Collection, Consultant's Name, Name and Signature of the Doctor. Research has it that most medical laboratory errors emanate from the preanalytical phase of diagnosis [5]. Among these, is filling of medical laboratory request forms, where adequate information provided plays a vital role in the definitive diagnosis thereby encouraging quality management system and international standard ( Figure 1). The inability of the Doctor to indicate any of the information above could pose a negative effect in accurate definitive diagnosis of the patient's disease and could affect proper treatment or management [6].
This study therefore seeks to assess the level of completeness of patients' medical laboratory request forms in Jos University Teaching Hospital, since there has been no study on the trend of incompletely filled patients' medical laboratory request forms in the tertiary hospital.

Materials and Methodology
This research was carried out on 4,310 in and out patient request forms which had been filled by the physicians and sent to any of the four components of medical laboratory department of Jos University Teaching Hospital (JUTH), a 500 bed tertiary hospital in Jos, the Plateau state capital in north central Nigeria.
JUTH provides a measure of emergency, inpatient and outpatient services. These include medical, surgical, laboratory, emergency/ trauma, obstetrical, gynaecological, and paediatric services. This retrospective study was carried out on request forms received in the medical laboratories between the period of January and July 2017.     [9], in which only the name of the patients was completely filled, this is not startling because of the importance affix to a person's name in our society and it is also very likely that the sample would not be accepted by the laboratories if the patients name was absent. Hence, the requesters were subservient in filling the name in all the request forms. Oladiende and colleagues [10] observed that name of the patient and the name of the attending physician were completely filled in all the forms they analysed. Paingha & Ezenwa [11] revealed that the name of the patient and the investigation requested for were filled out in all the request form they evaluated.

Age
We found out that 20.9% of the request forms evaluated did not have the age of the patient, this is a big challenge for proper research and epidemiological studies, apart from the fact that certain parameters have difference age ranges. This may be due to some clinicians lack of recognition of age as a prerequisite to accurate diagnosis Most often, many a clinician sees the age demography as an information to overlook in cases of emergency when samples are to be sent to the laboratory. Clinical Data of 46.7% and Nutt et al. [13] with an incomplete rate of 19.1%. This is however a little bit lower than that of the studies of Kapil et al. e) Regular assessment of medical laboratory request forms should be carried out to improve the health care delivery [15].
f) Provision for patients and doctors phone number should be included in the request forms as this will enable the medical laboratory users to place a call on either the patient or the doctor's as the case may require.