introduction 45-1 laboratory testing – integral part of patient care medical assistant must know...

Introduction

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Laboratory testing – integral part of patient care

Medical assistant must know Common laboratory

equipment

Safety in the laboratory

Steps to prevent accidents

CLIA ’88 – impact on laboratory settingQuality assurance

Quality control procedures

Required record-keeping

Role of Laboratory Testing in Patient CareAnalysis of blood, urine, and other body fluids

Regular monitoring to identify diseases or other problems

Confirm initial diagnosis

Determine and monitor dosage of a medication

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Role of Laboratory Testing (cont.)

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Kinds of laboratoriesReference laboratory

Owned and operated by an organization outside the practice

Have technological resources beyond the POL

POLQuicker

turnaroundEliminates need

for patient travel to other test location

Some managed care companies require their subscribers to use a specific reference laboratory.

Role of Laboratory Testing (cont.)

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Purpose of POLAccurate and timely processing of routine

testsReporting test results to physicianTests

Chemical analysisHematologic tests Microbiologic testsUrinalysis

Apply Your Knowledge

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Compare a reference laboratory and the POL.

ANSWER: A reference laboratory is lab facility usually run by an organization separate from the practice. It has technologies beyond the POL. Patients have to travel to this facility. A POL provides quicker turnaround on results but is limited in the testing that can be performed. Patients are able to have testing done during an appointment without leaving the office.

Super!

Medical Assistant’s Role

Processing tests done in POLPreparing the patientCollecting the sampleCompleting the testReporting the resultsCommunicating information about the test

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Medical Assistant’s Role (cont.)

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Additional responsibilities

Understand regulations

Accident prevention

Waste disposal

Housekeeping and maintenance

Quality assurance and control

Record-keeping

Inventory and order equipment and supplies

Use reference materials

Screen and follow-up results


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What are the duties of a medical assistant related to testing done in the POL?

ANSWER: The medical assistant duties may include preparing the patient, collecting the sample, running the test, reporting the results, and, once the physician has reviewed the results, communicating the results to the patient.

Use of Laboratory Equipment

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You may routinely use the following: AutoclaveCentrifugeMicroscopeElectronic equipmentEquipment used for

measurement

Use of Laboratory Equipment (cont.)

Autoclave - sterilizes surfaces of instruments and equipment

Centrifuge – spins and separates specimen into its component parts

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Optical microscopeUses light, concentrated

through a condenser and focused through the object, to project an image

Compound microscope – two lenses magnify the image created by condensed light

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Use of Laboratory Equipment: Microscope

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OcularsEyepieces

MonocularBinocular

Contain a magnifying lens – magnify image 10 times (10X lens)

ObjectivesContain another

magnifying lensMoved under

ocular when needed

Three objectivesTwo dry One oil-

immersionMicroscope

Use of Laboratory Equipment: Microscope (cont.)

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Arm and focus controlsArm – attaches

oculars and objectives to body

Focus controls – used to focus the object

Light source Under stage and

substageAdjustable intensity

Stage and substage Stage – platform

for slideSubstage –

condenser

Specimen slides / coverslip

Microscope


Using an optical microscopeOperate correctlyCare and maintenance

Clean after each useStore under plastic coverMove by holding arm and supporting the

base

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Electronic equipment and softwareUsed to create and

maintain clinical data

More accurate, safer, and more efficient than manual methods

Photometer – measures light intensity

Equipment used for measurementPipettesFlasks or beakersHemocytometer Thermometers


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Matching:

___ Measures light intensity A. Focus controls

___ Platform for slide B. Hemocytometer

___ Contains magnifying lens C. Stage

___ One is an oil-immersion D. Photometer

___ Condenser to concentrate light E. Ocular

___ Move body tube up and down F. Substage

___ Calibrated to count cells G. Objective

ANSWER:

G

F

E

D

C

B

ANice Job!

Safety in the Laboratory

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Primary concernOSHA

Protection of employees in the workplaceSpecific guidelines General duty clause

If no specific guidelinesWorkplace free from recognized hazards

Enforces guidelines from CDC

Safety in the Laboratory (cont.)

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OSHA guidelinesStandard Precautions

Hazard communication standards

OSHA Bloodborne Pathogens Standard

Hazardous Waste Operations and Emergency

Response Final Rule

Needlestick Safety and Prevention Act

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Safety in the Laboratory (cont.) Standard Precautions

Assume that all blood, blood products, human tissue, and body fluids are contaminated

PPE guidelinesGlovesEye protection

Use equipment appropriately

Proper biohazard disposal


Hazard communication Biohazard labels

Material Safety Data Sheets (MSDS)

Hazard labelsName of materialHazardous effects

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OSHA Blood-borne Pathogens StandardWritten OSHA Exposure Control Plan

Training Bloodborne pathogensPPE Universal PrecautionsPrevention of exposure

Hepatitis B vaccination

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Hazardous wasteDispose in proper

containersSharps Other biohazardous

waste

Location of containers

Reduce spillage

Needlestick Safety and Prevention ActRevision of

Bloodborne Pathogen Standard

Use of devices to reduce risk


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Accident prevention guidelinesPhysical safety

Common sensePPEManufacturers’ guidelines

Fire and electrical safetyFire drillsFire extinguishersReduce electrical hazards


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Chemical safetyMSDSPPE

Biologic safetyStandard

PrecautionsDisinfection Waste disposal

Accident reportingOffice procedures

Ensure safety / first aid

Clean up


HousekeepingReduce risk of disease transmissionGuidelines

Written policies and proceduresClean up spills / splashes

immediatelyClean equipment after useDispose of waste correctly

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What information must be included on the MSDS?ANSWER: MSDS must include:

Name of the product Chemical and common name of ingredients Chemical characteristics of the products Physical hazards Health hazards Guidelines for safe handling Emergency and first-aid procedures for exposure

Quality Assurance Programs

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Monitor the quality of patient careEnsure safety of

workersAssess the

quality of tests performed

CLIARegulation of

laboratoriesTest categories

Certificate of WaiverModerate complexityHigh complexity

QA Programs: Certificate of Waiver Tests

Tests Pose insignificant risk to the patient if they are

performed or interpreted incorrectlySimple and accurate, so the risk of obtaining

incorrect results is minimalApproved by the FDA for home use

Office must apply for a Certificate of Waiver Exempt from CLIA ’88 standardsMay be randomly inspected

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QA Programs (cont.)

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Moderate-complexity tests75% of testsQualified

laboratory personnel

Random inspections

High-complexity testsTests for specialties

and subspecialties Qualified laboratory

personnelRandom inspections

QA Programs (cont.)

Components Quality control program

Adherence to proceduresCareful documentation

Instrument and equipment maintenanceProficiency testingTraining and continuing educationStandard operating procedures documentation

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QA Programs: Quality Control and MaintenanceEnsure accuracy in test results by carefully

monitoring test proceduresProcedures

Equipment calibrationUse control samplesPerform reagent controlsMaintain equipmentDocumentation of above procedures

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QA Programs: Quality Control and Maintenance (cont.)

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Equipment maintenanceManufacturer’s guidelinesTroubleshooting a problem –

investigating the cause using a systematic approach

DocumentationQuality control logReagent control logEquipment

maintenance log

Reference laboratory log

Daily workload log

QA Programs: Proficiency Testing

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Proficiency testing programAccuracy of test resultsAdherence to standard operating procedures

Control sample, documentation sent to proficiency testing organizationPass – continue performing testFail – discontinue performing tests

QA Programs (cont.)

Training, continuing education, and documentationEmployer responsibilityReference material

MSDS / safety manuals / SOPsManufacturers’ user or reference guidesClinical Lab Technical Procedure ManualsRegulatory documentation (OSHA, CLIA ’88)Maintenance and housekeeping schedules

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QA Programs (cont.)

Requisition formsMedical assistant’s

responsibility

Complete information

Include with specimen or send with patient to laboratory

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What is the purpose of a quality assurance program for a laboratory?ANSWER: The purpose of a QA program for a lab is to monitor the quality of patient care, ensure safety of workers, and assess the quality of tests performed.

QualityAnswer!

Communicating with the PatientBefore testing

Patient preparationVerification of patient preparation

During specimen collectionProper patient identificationVerbal and nonverbal

After specimen collectionPost-procedure instructionsSchedule for further testing, if needed

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Communicating with the Patient (cont.)

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Test resultsReport to physician for

interpretationReport to patient, if

instructed to by the physician

Patient questionsAnswer if within your scopeRefer to physician

Record-KeepingQuality control and equipment

maintenance

Inventory control

Record test results in patient records

Tracking of specimens

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Record-Keeping (cont.)

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Patient recordsIdentify unusual

findingsFollow office

procedures

Specimen identificationPatient

informationPerson who

collected specimen

Physician Patient: Jason JonesDOB: 10/22/0000Date / time: 04/14/0000 @ 9:00 AMCollected by: shf Physician: M. Welby

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1. Mr. Jones called for his laboratory results but the physician has not reviewed the results. What should the medical assistant do?

ANSWER: The medical assistant should tell Mr. Jones that the physician has to review the results before releasing them to the patient. She should also tell Mr. Jones that she or the physician will call with the results once they are reviewed.

2. When she reviews Mr. Jones’ laboratory results, she notes that his glucose is elevated. What should the medical assistant do?

ANSWER: She should identify the test result that is out-of-range by circling or underlining it based on office policy.

Bravo!

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While performing a test using a reagent test kit, you notice that the positive control yields a negative result. What action should you take?

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What non-verbal communication techniques can you use when you are instructing patients during the specimen collection process?

In Summary

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Medical assistant and the POLMaintain and improve technical skillsKeep up on technological, legislative, and

regulatory developments Prevent transmission of disease and

occurrence of accidentsSeek ways to improve quality of patient carePerform tests efficiently and accuratelyMaintain equipment properly

introduction 45-1 laboratory testing – integral part of patient care medical assistant must know...

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