Y khoa - Dược - Chapter 45: Orientation to the lab

45Orientation to the Lab45.1 Describe the purpose of the physician’s office laboratory. 45.2 Identify the medical assistant’s duties in the physician’s office laboratory. 45.3 Identify important pieces of laboratory equipment. 45.4 Illustrate measures to prevent accidents. Learning Outcomes (cont.)Learning Outcomes (cont.)45.5 Describe the goal of a quality assurance program in a physician’s office laboratory. 45.6 Carry out communication with patients regarding test preparation and follow-up. 45.7 Carry out accurate documentation, including all logs related to quality control. IntroductionMedical assistant must know Common laboratory equipmentSafety in the laboratory Steps to prevent accidents Impact of CLIA ’88 Quality assuranceQuality control proceduresRecord keepingRole of Laboratory Testing in Patient CareAnalysis of blood, urine, and other body fluidsIdentify diseases or other problemsConfirm or contradict initial diagnosisDetermine and monitor dosage of a medicationRole of Laboratory Testing in Patient Care (cont.) Kinds of laboratoriesReference laboratory Outside the practiceTechnological resources Frees staff for patient care dutiesPhysician’s office laboratory (POL)Quicker turnaroundEliminates need for patient travel Some managed care companies require their subscribers to use a specific reference laboratory.The Purpose of the POLAccurate and timely processing of routine testsTestsChemical analysisHematologic tests Microbiologic testsUrinalysis Apply Your KnowledgeCompare a reference laboratory and the POL.ANSWER: A reference laboratory is a lab facility usually run by an organization separate from the practice. It has technologies beyond the POL. Patients may 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 RoleProcessing tests done in POLPreparing the patientCollecting the sampleCompleting the testReporting the resultsCommunicating information about the testMedical Assistant’s Role (cont.)Additional responsibilities includeUnderstand regulationsAccident preventionWaste disposal Housekeeping and maintenanceQuality assurance and controlMedical Assistant’s Role (cont.)Additional responsibilities includeRecord keeping of test specimens, procedures, and results Inventory and ordering of equipment and supplies Use of reference materials in the POL Screening and follow-up of test results Apply Your KnowledgeWhat 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.Very Good!Use of Laboratory Equipment Equipment used in a POLAutoclaveCentrifugeMicroscopeElectronic equipmentEquipment used for measurementUse of Laboratory Equipment (cont.)Autoclave – sterilizes surfaces of instruments and equipmentCentrifuge – spins and separates specimen into its component partsMicroscopeMost often used in a POLOnsite blood smear evaluationProvider performed microscopy procedures must be CLIA-approvedMicroscope (cont.)Optical microscopeUses light to project an imageCompound microscope ~ two lenses magnify the imageMicroscope (cont.)Oculars – eyepieces Monocular Binocular Magnifying lens ~ (10x lens)MicroscopeMicroscope (cont.)ObjectivesContain another magnifying lensMoved under ocular when neededThree objectivesTwo dry One oil-immersionMicroscopeMicroscope (cont.)Arm ~ attaches oculars and objectives to bodyFocus controls Located on the armUsed to focus the objectMicroscopeStage – platform for slideSubstage CondenserIris Microscope (cont.)Light source Under stage and substageAdjustable intensitySpecimen slides/ coverslipMicroscopeOculars (eyepieces)Revolving nosepieceObjectivesStage Arm Slide clipsCondenserIrisLight sourceFineCoarseFocus controlsBase Microscope (cont.)BackMicroscope (cont.)Using an optical microscopeOperate correctlyArtifacts Care and maintenanceClean after each useStore under plastic coverMove by holding arm and supporting the baseElectronic Equipment and SoftwareUsed to create and maintain clinical dataMore accurate, safer, and more efficient than manual methodsPhotometer – measures light intensityEquipment used for measurementPrecise measurement is critical in the POLEquipment includesPipettesFlasks or beakersHemocytometer ThermometersApply Your KnowledgeMatching:___ 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. ObjectiveANSWER:GFEDCBANice Job!Safety in the LaboratoryUse Standard PrecautionsGuidelinesWear gloves and change between patientsWash hand after removing glovesUse PPEAvoid sharps injuriesUse only recommended instruments and equipmentSafety in the Laboratory (cont.)Guidelines (cont.)Prevent spills and splashesDisinfect areas contaminated by spills / splashesDispose of waste correctlyRemove protective gear before leaving laboratorySafety in the Laboratory (cont.)Biologic safetyTreat all specimens as if contaminatedFollow Standard Precautions Accident ReportingRefer to office policyOSHA requirementsHousekeepingReduce risk of contaminationGuidelinesRefer to office policies and proceduresClean up spills immediatelyClean equipment after useDispose of waste correctlyTake care with sharpsApply Your KnowledgeList some guidelines for maintaining safety in a POL?ANSWER: Wear gloves and change between patientsWash hand after removing glovesUse PPEAvoid sharps injuriesUse only recommended instruments and equipmentPrevent spills and splashesDisinfect areas contaminated by spills / splashesDispose of waste correctlyRemove protective gear before leaving laboratoryEXCELLENT!Quality Assurance ProgramsMonitor the quality of patient careEnsure safety of workersAssess the quality of tests performed Qualityis #1Clinical Laboratory Improvement Amendments (CLIA)Enacted in 1988 and updated in 1992Federal regulation of all laboratory facilitiesStandards apply toStandards – depend on testFeesEnforcement Accreditation programs CLIA (cont.)Certificate of Waiver Tests Pose insignificant risk to the patient if performed or interpreted incorrectlySimple and accurateApproved by the FDA for home useCLIA (cont.)Moderate-complexity tests75% of testsQualified laboratory personnelQuality assurance programRandom inspectionsCLIA (cont.)High-complexity testsTests for specialties and subspecialties Qualified laboratory personnelQuality assurance programsRandom inspectionsComponents of Quality AssuranceQuality control Instrument and equipment maintenanceProficiency testingTraining and continuing educationStandard operating procedures documentationQuality Control and MaintenanceCalibration Ensures equipment is operating correctly StandardsControl samplesKnown valuesUsed each time a patient sample is processesQualitative test responseQuantitative test resultsQuality Control and Maintenance (cont.)Reagent controlReagents Keep a reagent control logMaintain equipmentFollow manufacturer’s guidelinesTroubleshoot problemsKeep a maintenance logQuality Control and Maintenance (cont.)DocumentationQuality controlReagent controlEquipment maintenanceReference laboratory Daily workloadProficiency Testing ProgramsMeasure test result accuracyAdherence to standard operating proceduresTraining, Continuing Education, and DocumentationEmployer providesOpportunities for training and continuing educationWritten reference materials and documentation procedures for POLEmployee Consult reference materialsTake part in available trainingFilling Out a Laboratory Requisition FormMedical assistant responsibilityComplete properlyPatient informationInsurance informationPhysician informationSpecimen informationTest(s) requestedPreliminary diagnosis45-*Apply Your KnowledgeWhat 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 testingPatient instructionsVerify patient’s preparationDuring specimen collectionIdentify patientInstruct patient Provide reassuranceCommunicating with the PatientAfter specimen collectionPost-test instructionsSchedule for further testing Test resultsReport to physician for interpretationReport to patientAnswer patient questionsApply Your KnowledgeMr. 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.Good Job!Record KeepingInventory controlList of items routinely usedReorder systematicallyPatient records – identify unusual findingsRecord Keeping (cont.)Specimen identificationPatient informationPerson who collected the specimenDate and time collectedPhysicianUnidentified or misidentified specimensApply Your KnowledgeWhen 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!In Summary45.1 The physician’s office laboratory (POL) is responsible for accurate and timely processing of routine tests, usually involving blood or urine, and for reporting test results to the physician.45.2 The medical assistant’s duties in a physician’s office laboratory include preparing the patient for the test, collecting the sample, completing the test, reporting the results to the physician, and communicating information about the test from the physician to the patient.In Summary (cont.)45.3 Common laboratory equipment includes autoclaves, centrifuges, microscopes, electronic equipment and software, and equipment used for measurement.45.4 Preventing accidents in the physician’s office laboratory begin by observing all safety guideline including standard precautions, reporting all laboratory accidents in a timely manner, and maintaining appropriate housekeeping in the lab setting.In Summary (cont.)45.5 The goal of a quality assurance program in a physician’s office laboratory is to monitor the quality of the patient care that a medical laboratory provides. 45.6 It is the medical assistant’s responsibility to ensure patients understand what is expected of them before a test. Providing clear pre-test instructions in both oral and written form is an essential part of the test procedure. In Summary (cont.)45.7 Accurate quality control documentation in a physician’s office laboratory includes a reference laboratory log and a daily workload log.End of Chapter 45Quality is not an act, it is a habit. ~ Aristotle