Introduction 45-1 Laboratory testing – integral part of patient care Medical assistant must know Common laboratory equipment Safety in the laboratory.
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Introduction
45-1
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
45-2
Role of Laboratory Testing (cont.)
45-3
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.)
45-4
Purpose of POLAccurate and timely processing of routine
testsReporting test results to physicianTests
Chemical analysisHematologic tests Microbiologic testsUrinalysis
Apply Your Knowledge
45-5
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
45-6
Medical Assistant’s Role (cont.)
45-7
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
Apply Your Knowledge
45-8
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
45-9
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
45-10
Use of Laboratory Equipment (cont.)
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
45-11
Use of Laboratory Equipment: Microscope
45-12
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.)
45-13
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
Use of Laboratory Equipment (cont.)
Using an optical microscopeOperate correctlyCare and maintenance
Clean after each useStore under plastic coverMove by holding arm and supporting the
base
45-15
Use of Laboratory Equipment (cont.)
45-16
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
Apply Your Knowledge
45-17
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.)
45-19
OSHA guidelinesStandard Precautions
Hazard communication standards
OSHA Bloodborne Pathogens Standard
Hazardous Waste Operations and Emergency
Response Final Rule
Needlestick Safety and Prevention Act
45-20
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
Safety in the Laboratory (cont.)
Hazard communication Biohazard labels
Material Safety Data Sheets (MSDS)
Hazard labelsName of materialHazardous effects
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Safety in the Laboratory (cont.)
OSHA Blood-borne Pathogens StandardWritten OSHA Exposure Control Plan
Training Bloodborne pathogensPPE Universal PrecautionsPrevention of exposure
Hepatitis B vaccination
45-22
Safety in the Laboratory (cont.)
45-23
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
Safety in the Laboratory (cont.)
45-24
Accident prevention guidelinesPhysical safety
Common sensePPEManufacturers’ guidelines
Fire and electrical safetyFire drillsFire extinguishersReduce electrical hazards
Safety in the Laboratory (cont.)
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Chemical safetyMSDSPPE
Biologic safetyStandard
PrecautionsDisinfection Waste disposal
Accident reportingOffice procedures
Ensure safety / first aid
Clean up
Safety in the Laboratory (cont.)
HousekeepingReduce risk of disease transmissionGuidelines
Written policies and proceduresClean up spills / splashes
immediatelyClean equipment after useDispose of waste correctly
45-26
Apply Your Knowledge
45-27
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
45-28
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.)
45-30
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
45-31
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
45-32
QA Programs: Quality Control and Maintenance (cont.)
45-33
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
45-34
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
45-35
QA Programs (cont.)
Requisition formsMedical assistant’s
responsibility
Complete information
Include with specimen or send with patient to laboratory
45-36
Apply Your Knowledge
45-37
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.)
45-39
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.)
45-41
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
45-42
Apply Your Knowledge
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!
45-43
While performing a test using a reagent test kit, you notice that the positive control yields a negative result. What action should you take?
45-44
What non-verbal communication techniques can you use when you are instructing patients during the specimen collection process?
In Summary
45-45
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
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