Transcript Chapter One - cvadultcma

CHAPTER 15
INTRODUCTION TO THE CLINICAL
LABORATORY
PRETEST
True or False
1.
When the body is in homeostasis, an imbalance
exists in the body.
2.
A routine test is performed to assist in the early
detection of disease.
3.
The laboratory request form provides the outside
laboratory with information needed to test the
specimen.
4.
The clinical diagnosis is indicated on a laboratory
request to correlate laboratory data with the needs
of the physician.
5.
The purpose of a laboratory report is to indicate the
patient's diagnosis.
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PRETEST, CONT.
True or False
6.
A patient who is fasting in preparation for a
laboratory test is permitted to drink diet soda.
7.
A small sample taken from the body to represent the
nature of the whole is known as a specimen.
8.
A laboratory report marked QNS means that the
patient did not prepare properly.
9.
Fecal occult blood testing is an example of a CLIAwaived test.
10. The purpose of quality control is to prevent
accidents in the laboratory.
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Content Outline
Introduction to Clinical Laboratory
1. Laboratory tests:
a. Used along with the health history and
physical examination to diagnose patient's
condition
b. Laboratory tests: Provide objective and
quantitative information regarding status of
body conditions and functions
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Introduction to Clinical Laboratory
2. Homeostasis: state in which body systems
are functioning normally
a. Internal environment of the body is in
equilibrium
b. Body is in a healthy state
3. Normal or reference range: An established
range within which laboratory test results of a
normal person are expected to fall
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Introduction to Clinical Laboratory,
cont.
4. Body in homeostasis:
a. Physical and chemical characteristics of
body substances fall within normal range
b. Body substances include:
•
Fluids
•
Secretions
•
Excretions
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Introduction to Clinical Laboratory,
cont.
5. Pathologic condition:
a. Alters the normal functioning of the body
•
Results in imbalance in the body
– Causes patient to experience symptoms of
that particular pathologic condition (e.g.,
iron-deficiency anemia)
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Introduction to Clinical Laboratory,
cont.
b. May cause alteration in body substances
•
Chemical content of blood or urine
•
Antibody level
•
Cell counts
•
Cellular morphology
c. May result in abnormal values laboratory
test results
•
Certain pathologic conditions cause abnormal
values for specific laboratory tests
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Introduction to Clinical Laboratory,
cont.
6. Abnormal value for a particular test: may
be seen with more than one pathologic
condition
a. Example: Decrease in hemoglobin levels
seen with:
•
Iron-deficiency anemia
•
Hyperthyroidism
•
Cirrhosis of the liver
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Introduction to Clinical Laboratory,
cont.
b. Physician cannot rely solely on laboratory
tests to make a final diagnosis
•
Must use a combination of data from:
– Health history
– Physical examination
– Laboratory/diagnostic test results
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Laboratory Tests
1. Number of tests ordered: depends on
physician's clinical findings (health
history and physical examination)
a. May only need to order one test (e.g., urine
culture for a urinary tract infection)
b. May need to order a series of tests to
diagnose a condition
•
Many diseases have more than one alteration in:
– Physical and chemical characteristics of
body substances
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Laboratory Tests, cont.
2. Not all pathologic conditions require use
of laboratory tests to arrive at a final
diagnosis
a. Diagnosis can be made from patient's
symptoms and physical examination (e.g.,
otitis media)
3. MA should have knowledge of laboratory
tests performed most often
a. Purpose of tests
b. Normal value or range
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Laboratory Tests, cont.
c. Advance patient preparation or special
instructions
d. Any substances that might interfere with
accurate test results
•
Food
•
Medication
4. Make sure physician is alerted to
abnormal results on laboratory tests as
soon as possible
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Purpose of Laboratory Testing
1. Assist in diagnosis of pathologic conditions:
most frequent use of laboratory tests
a. Confirm clinical diagnosis
•
Clinical diagnosis: A tentative diagnosis of a
patient's condition obtained through evaluation of the:
–
Health history
–
Physical examination
•
Patient's symptoms may provide strong clinical
diagnosis (e.g., diabetes)
•
Laboratory tests are used to confirm that diagnosis
(glucose tolerance test)
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Purpose of Laboratory Testing,
cont.
b. Assist in differential diagnosis
•
Two or more diseases may have similar
symptoms
•
Laboratory tests ordered to determine which
disease is present
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Purpose of Laboratory Testing,
cont.
c. Obtain information regarding patient's
condition
•
May not be enough evidence to support a
clinical diagnosis
•
Patient may be exhibiting vague symptoms
– Example: Nonspecific abdominal pain
•
Series of laboratory and diagnostic tests
ordered to pinpoint cause of patient's problems
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Purpose of Laboratory Testing,
cont.
2. Evaluate patient's progress and to regulate
treatment: after making the final diagnosis
a. Based on laboratory results: therapy may need to be
adjusted or further treatment prescribed
•
Examples:
–
Complete blood count on patient with irondeficiency anemia to assess response to iron
therapy
–
Adjusting Coumadin therapy based on results on
physical therapy (PT) test
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Purpose of Laboratory Testing,
cont.
3. Establish patient's baseline
a. Age, gender, race, geographic location:
cause individuals to have different normal
levels within established normal range
b. Laboratory tests establish each patient's
baseline against which future results can
be compared
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Purpose of Laboratory Testing,
cont.
4. Prevent or reduce the severity of
disease by early detection of abnormal
findings (e.g., hyperlipidemia, anemia,
diabetes)
a. Known as a routine test: a test performed
on a routine basis on apparently healthy
patients to assist in the early detection of
disease
•
Easy to perform
•
Usually part of general physical examination
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Purpose of Laboratory Testing,
cont.
b. Common routine tests
•
Urinalysis
•
Complete blood count
(CBC)
•
Cholesterol
•
Routine blood chemistries
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Purpose of Laboratory Testing,
cont.
5. Requirement by state law
a. Example: Statutes of most states require
gonorrhea and syphilis tests be performed
on pregnant women
•
Purpose: to protect mother and fetus from harm
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Types of Clinical Laboratories
1. Medical office may use outside
laboratory or have its own laboratory
(physician's office laboratory)
a. Most offices use a combination of both
Physician's Office Laboratory (POL)
1. For tests that are convenient to perform
and commonly required (e.g., glucose,
urinalysis)
2. Time-consuming and expensive to
perform complex tests in the office
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Outside Laboratories
1. MA works closely with outside
laboratory
2. Outside laboratories include:
a. Hospital laboratories
b. Privately owned commercial laboratories
3. Laboratory provides office with supplies
and forms to collect and prepare
specimens for transport
4. MA responsible for checking and
reordering supplies
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Laboratory Directory
1. Reference source for proper collection
and handling of specimens
2. Provided to office by outside laboratory
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Laboratory Directory, cont.
3. Information included:
a. Names of tests performed by laboratory
b. Normal range for each test
c. Instructions on completion of forms (e.g.,
laboratory request)
d. Patient preparation required for each test
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Laboratory Directory, cont.
e. Supplies required for collection of each
specimen
f. Amount and type of specimen required for
each test
g. Techniques for collection of specimen
h. Proper handling and storage of specimen
i. Instructions for transporting specimen
4. If MA has any questions: Call laboratory
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Laboratory Directory
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Collection and Testing Categories
1. Categories:
a. Specimen collected and tested at office
b. Specimen collected at office and
transferred to outside laboratory
c. Patient given laboratory request to have
specimen collected and tested at outside
laboratory
2. Responsibilities of MA depend on which
method is used
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Laboratory Requests
Purpose
1. Laboratory request: Printed form containing
a list of most frequently ordered laboratory
tests
a. Can be completed manually
•
MA writes in all required information
b. Can be completed on a computer
screen
•
MA enters information on a keyboard
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Laboratory Requests, cont.
2. Required when a specimen is:
a. Collected at office and sent to outside
laboratory for testing
b. Collected and tested at an outside
laboratory
•
Request given to patient at office to take to
laboratory
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Laboratory Requests, cont.
3. Provides laboratory with information for:
a. Accurate testing
b. Reporting of results
c. Billing
4. Format of laboratory requests varies
depending on laboratory
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Laboratory Request Form
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Parts of a Laboratory Request Form
1. Physician's name and address
a. Facilitates reporting of results to physician
b. May be preprinted on form
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Parts of a Laboratory Request
Form, cont.
2. Patient's name and address
a. Needed for:
•
Identifying report
•
Billing purposes
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Parts of a Laboratory Request
Form, cont.
3. Patient's age and gender
a. Normal ranges for some tests vary based
on age and gender
•
Example: Hemoglobin
– Female: 12 to 16 g/dL
– Male: 14 to 18 g/dL
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Parts of a Laboratory Request
Form, cont.
4. Date and time of collection of specimen
a. Date:
•
Indicates number of days that have passed
since specimen was collected
•
Provides information regarding freshness of
specimen
•
Too long of a time lapse can result in inaccurate
results
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Parts of a Laboratory Request
Form, cont.
b. Time:
•
Normal range for some tests vary based on
whether test is an AM or a PM specimen
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Parts of a Laboratory Request
Form, cont.
5. Laboratory tests desired
a. Usually indicated by marking a box
adjacent to tests
•
Mark box clearly
b. Space designated for additional tests is
provided
•
Use to specify a test not listed on request form
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Parts of a Laboratory Request
Form, cont.
c. Profile: contains many laboratory tests
•
Profiles performed by laboratory and tests
included in each: listed in laboratory directory
• Specific profile: all tests relate to specific
organ
– Used when physician has a good idea of
what organ is involved in patient's condition
– Example: Hepatic profile tests assist in
diagnosis of liver conditions
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Parts of a Laboratory Request
Form, cont.
• General profile: contains routine laboratory
tests
– Used for routine health screens or when
patient's symptoms are vague
– Example: comprehensive metabolic profile
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Laboratory Profiles
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Laboratory Profiles
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Parts of a Laboratory Request
Form, cont.
6. Source of specimen (e.g., throat, wound,
ear, eye, urine, vagina)
a. Tells laboratory where specimen came from
•
May not be possible to determine by looking at
specimen
b. Method laboratory uses to test specimen:
based on source of specimen
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Parts of a Laboratory Request
Form, cont.
7. Physician's clinical diagnosis
a. Assists the laboratory in correlating clinical
laboratory data with the needs of physician
•
Further testing may be needed if one test
method proves inconclusive
b. Alerts laboratory to possibility of presence
of a dangerous pathogen (e.g., hepatitis)
c. Required for billing
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Parts of a Laboratory Request
Form, cont.
8. Medications
a. Certain medications may interfere with
accuracy and validity of test results
b. Must be indicated on request to inform
laboratory
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Parts of a Laboratory Request
Form, cont.
9. STAT
a. Performed as soon as possible
b. Results telephoned or faxed to office
10.Place completed request form with
specimen for transport to laboratory
a. Without request: laboratory does not have
info to carry out orders
•
Results in delay in completing tests and
reporting results
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Laboratory Reports
1. Purpose
a. Relay laboratory test results to physician
2. May be:
a. Preprinted form:
•
Results are printed on form by computer
b. Computer report
•
Entire report (tests and results) are printed by
the computer
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Laboratory Report
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Laboratory Reports, cont.
3. Includes:
a. Name, address, and telephone number of
laboratory
b. Physician's name and address
c. Patient's name, age, and gender
d. Patient's accession number
•
Provides positive identification of each
specimen and access to patient's laboratory
records
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Laboratory Reports, cont.
e. Date specimen received by laboratory
f. Date results reported by laboratory
g. Names of tests performed
h. Results of tests
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Laboratory Reports, cont.
i. Normal range for each test performed
•
A single value cannot be used because of
individual differences among general population
(age, gender, race, geographic location)
•
Normal range varies slightly from one laboratory
to another depending on:
– Test method used
– Equipment used
– Reagents used
•
Important to compare test results with normal
range supplied by laboratory performing the
test
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Laboratory Reports, cont.
4. Reports are relayed to office:
a. Hand-delivered
b. Sent electronically (by computer)
c. Faxed
d. Mailed to office
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Laboratory Reports, cont.
5. Abnormal results posing a threat to
patient's health or STAT reports:
a. Telephoned as soon as possible
b. Written results will follow
6. MA responsible for reviewing reports as
they are received
a. Notify physician of abnormal results
b. Most reports flag abnormal results
–
If not: MA should circle abnormal results with
red pen
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Laboratory Reports, cont.
7. Reports reviewed by physician:
correlates with info from health history
and physical examination
a. Physician initials laboratory report after
reviewing it
8. MA files report in patient's chart
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Patient Preparation and Instructions
1. Factors may affect results of certain
laboratory tests:
a. Food consumption
b. Medication
c. Activity
d. Time of day
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Patient Preparation and
Instructions, cont.
2. Advance patient preparation may be
required to obtain a quality specimen
a. Inaccurate results may occur if patient
does not prepare properly
3. MA responsible for instructing patient in
advance preparation
a. Explain reason for preparation: patient will
be more likely to comply
•
To ensure accurate test results
•
To avoid having to collect specimen again
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Patient Preparation and
Instructions, cont.
b. Check to make sure
patient completely
understands instructions
c. Written instruction sheet
may be provided
•
Patient can refer to it at
home
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Patient Preparation and
Instructions, cont.
4. Some tests may require patient to
remain at site for specified period of
time (e.g., glucose tolerance test)
a. Patient should be told in advance of time
requirement
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Patient Preparation and
Instructions, cont.
5. Patient may collect specimen at home
(e.g., first-voided urine specimen)
a. MA should:
•
Explain instructions on proper technique for
collection
•
Provide appropriate specimen container
•
Instruct patient on proper handling and storage
of specimen
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Patient Preparation and
Instructions, cont.
6. Type of preparation: depends on test
ordered and method used to run test
a. Outside laboratory testing: preparation
required listed in laboratory directory
b. POL testing: preparation listed in
manufacturer's instructions
c. Advance preparation usually in form of:
•
Fasting
•
Medication restriction
•
Diet modification
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Fasting
1. Required for some venous blood
specimens
a. Composition of blood is altered by
consumption of food
b. Example: Food intake results in falsely high
results for:
•
Fasting blood sugar (FBS)
•
Glucose tolerance test (GTT)
•
Triglycerides
c. Must also fast for any profile including a test
that requires fasting (e.g., lipid profile)
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Fasting, cont.
2. Fasting: abstaining from food and fluids
(except water) for a specified amount of
time (usually 12 to 14 hours)
3. Specimen collected in the morning
a. Food from evening meal completely
digested and absorbed
b. Least amount of inconvenience to patient
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Fasting, cont.
4. MA responsible for relaying instructions
to patient
a. Make sure patient understands to abstain
from both food and fluid (except water)
•
Advisable to drink water:
– To prevent dehydration: can alter certain
test results
– In case a urine specimen is required as part
of the test
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Fasting, cont.
b. When to start fasting
•
Indicate the specific time to
start fasting (e.g., 6 PM)
c. What time to report for
collection of specimen
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Medication Restrictions
1. Many medications affect physical and
chemical characteristics of body
substances
a. May lead to inaccurate test results
b. Example: antibiotic therapy before
collection of throat specimen for strep
testing may cause falsely negative results
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Medication Restrictions, cont.
2. Patient told not to take medications
before collection (if does not cause
health threat or serious discomfort to
patient)
3. Medications discontinued:
a. 48 to 72 hours: before urine collection
b. 4 to 24 hours: before blood collection
•
Medications more likely to interfere with urine
results than blood test results
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Medication Restrictions, cont.
4. If patient cannot be taken off
medications:
a. Medications being taken should be
recorded on laboratory request
b. Laboratory may be able to use alternate
method of testing
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Medication Restrictions, cont.
5. If test performed in medical office:
a. MA should consult manufacturer's
instructions for medications that interfere
with test
6. Physician determines what medications
to discontinue
a. MA ensure patient understands medication
restrictions
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Collecting, Handling, and
Transporting Specimens
1. Specimen: small sample or part taken
from the body to represent the nature of
the whole
2. Majority of laboratory tests performed
on specimens that are easily obtained:
a. Blood
b. Urine
c. Feces
d. Sputum
e. Cervical and vaginal scraping of cells
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Collecting a Blood Specimen
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Collecting, Handling, and
Transporting Specimens, cont.
f. Sample of secretion or discharge for
microbiologic analysis:
•
Nose
•
Throat
•
Wound
•
Ear and eye
•
Vagina
•
Urethra
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Collecting, Handling, and
Transporting Specimens, cont.
3. Other specimens not as easy to obtain
a. Gastric juices
b. Cerebrospinal fluid
c. Pleural fluid
d. Peritoneal fluid
e. Synovial fluid
f. Tissue specimens for biopsy
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Collecting, Handling, and
Transporting Specimens, cont.
4. Source of specimen: may not be
indicative of pathologic condition
a. Example: Thyroid tests are performed on
blood serum
5. MA responsible for collection of majority
of specimens
a. Most common specimens collected by MA:
blood and urine
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Collecting, Handling, and
Transporting Specimens, cont.
6. Certain specimens must be collected by
the physician
a. Examples:
•
Vaginal discharge
•
Urethral discharge
•
Tissue specimen
b. MA assists with collection
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Collecting a Tissue Specimen
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Collecting, Handling, and
Transporting Specimens, cont.
7. Handle specimen properly: to maintain
in vivo characteristics
a. In vivo: Occurring in the living body
b. If handled improperly: may cause
inaccurate test results
•
May interfere with accurate diagnosis and
treatment
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Guidelines for Specimen Collection
1. Review and follow OSHA Bloodborne
Pathogens Standard
2. Review requirements for collection and
handling of the specimen
a. Collection materials required
b. Type of specimen required (e.g., serum,
plasma, whole blood, urine)
c. Amount of specimen required
d. Procedure for collecting specimen
e. Proper handling and storage of specimen
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Guidelines for Specimen Collection,
cont.
3. Assemble equipment and supplies
a. Use only appropriate specimen containers
•
Substituting containers may affect test results
•
Container should be sterile:
– To prevent contamination of specimen: may
affect accuracy of test results
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Guidelines for Specimen Collection,
cont.
•
MA should check each container before using:
to make sure it is not broken, chipped, cracked,
or otherwise damaged
– Discard damaged containers
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Guidelines for Specimen Collection,
cont.
b. Label each tube and container:
•
Patient's
name
•
Date
•
MA initials
•
Any other
information
required by
laboratory
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Guidelines for Specimen Collection,
cont.
4. Identify the patient by full name and date
of birth
a. Avoids collecting from wrong patient
•
Could lead to invalid test results
– May affect patient's diagnosis and treatment
b. Explaining procedure helps relax and
reassure patient
•
Gains patient's confidence and cooperation
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Identify the Patient
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Guidelines for Specimen Collection,
cont.
5. Determine if pt has prepared
properly
a. Improper preparation may lead to
inaccurate test results
•
Example: FBS: If patient does not fast, results will be
falsely high
•
Inform physician if patient failed to prepare
–
Physician may want patient to prepare properly
and return
–
Physician may have MA collect specimen anyway
1) Alert laboratory to situation on request form
•
Example: Nonfasting specimen
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Guidelines for Specimen Collection,
cont.
6. Explain the procedure
a. Helps relax and reassure patient
b. Gains patient’s confidence and cooperation
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Guidelines for Specimen Collection,
cont.
7. Collection of the
specimen
a. Involves medical
and surgical
asepsis
b. Collect specimen
using proper
technique
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Guidelines for Specimen Collection,
cont.
c. Collect proper type of specimen
d. Collect proper amount of specimen
•
Refer to appropriate
reference material
– If specimen
transported to
outside laboratory:
refer to laboratory
directory
– If specimen tested
in office: refer to
manufacturer's
instructions
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Guidelines for Specimen Collection,
cont.
•
If proper amount not collected: laboratory
unable to perform test
•
Laboratory request will be returned marked
QNS (quantity not sufficient)
•
Patient must be called back for another
collection
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Guidelines for Specimen Collection,
cont.
e. Once collected, MA records in chart:
•
Date and time of collection
•
Laboratory tests ordered
•
Type of specimen
•
Source of specimen
•
If transferred to outside laboratory: date
specimen was collected should be recorded (if
different from date of collection)
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Recording Specimen Collection
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Guidelines for Specimen Collection,
cont.
8. Properly handle and store the specimen:
to preserve in vivo qualities
a. Best to perform laboratory
tests on fresh specimens
(within 1 hour after
collection)
•
Yield most reliable test
results
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Guidelines for Specimen Collection,
cont.
b. If specimen awaiting
laboratory pick-up:
properly preserve
specimen to
maintain in vivo
physical and
chemical
characteristics
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What Would You Do?
What Would You Not Do?
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What Would You Do?
What Would You Not Do?
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Clinical Laboratory Improvement
Amendments (CLIA)
Purpose of CLIA 1988
1. To improve the quality of laboratory testing in the
United States
2. Consists of federal regulations governing all
facilities that perform laboratory tests for means
of:
a. Health assessment
b. Diagnosis, prevention, or treatment of disease
3. Health Care Financing Administration (HCF)
(division of Department of Health and Human
Services): responsible for monitoring compliance
with CLIA regulations
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Categories of Laboratory Testing
Categories of laboratory testing based on
complexity of testing methods
1. Waived tests
a. Simple procedures including procedures that are
easy to perform
–
Include procedures that patients can perform at
home
b. Laboratories must apply for certificate of waiver from
HCFA
•
Exempts laboratory from many CLIA requirements
•
Must still adhere to good laboratory practices
–
Includes: following manufacturer's instructions
for each product or testing kit
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Categories of Laboratory Testing,
cont.
c. Examples of Waived Tests:
•
Dipstick or tablet reagent urinalysis
•
Fecal occult blood testing
•
Ovulation testing
•
Urine pregnancy testing
•
Erythrocyte sedimentation rate (nonautomated)
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Categories of Laboratory Testing,
cont.
•
Hemoglobin using a CLIA-waived analyzer
•
Spun microhematocrit
•
Blood glucose determination (using an FDAapproved blood glucose monitor)
•
Rapid strep testing
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Categories of Laboratory Testing,
cont.
2. Moderate-complexity tests
a. Account for 75% of estimated 10,000
laboratory tests performed in United States
b. Examples:
•
Hematology and blood chemistry tests
performed on automated blood analyzer (that
are not CLIA-waived)
•
Microscopic analysis of urine sediment
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Categories of Laboratory Testing,
cont.
3. High-complexity tests
a. Include:
•
Cytogenetics
•
Histopathology
•
Histocompatibility
•
Cytology (e.g., Pap test)
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Requirements for Moderate- and
High-Complexity Testing
1. Must meet CLIA regulations
2. Subject to unannounced inspections
every 2 years by HCFA
3. Patient test management
a. System to maintain optimal integrity and
identification of specimens
b. System to ensure accurate reporting of
results
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Requirements for Moderate- and
High-Complexity Testing, cont.
4. Quality control: to ensure accurate and
reliable test results
a. Each laboratory must establish and follow
written procedures
•
That monitor and evaluate quality of each
testing process
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Requirements for Moderate- and
High-Complexity Testing, cont.
b. Includes:
•
Developing laboratory procedure manual
•
Following manufacturer's instructions
•
Performing calibration procedure every 6
months and documenting results
•
Performing two levels of controls daily and
documenting results
•
Performing and documenting actions taken
when problems or errors occur
•
Documenting all quality control activities
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Requirements for Moderate- and
High-Complexity Testing, cont.
5. Quality assurance
a. Must establish and follow written policies
and procedures:
•
To monitor and evaluate the overall quality of
the total testing process
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Requirements for Moderate- and
High-Complexity Testing, cont.
6. Proficiency testing (PT)
a. Form of external quality control
b. Laboratory specimens prepared by an
approved PT agency
c. Unknown specimens shipped to POL
d. POL tests specimens and reports results to
PT agency for evaluation
e. Done 3 times per year
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Requirements for Moderate- and
High-Complexity Testing, cont.
7. Personnel requirements
a. CLIA specifies education and training
qualifications and responsibilities for:
•
Laboratory directors
•
Technical consultants
•
Clinical consultants
•
Testing personnel
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The Physician's Office Laboratory
1. MA may be responsible for performing
laboratory tests and recording results
2. Laboratory tests can be classified into
categories:
a. Hematology: Examination of blood for the
detection of abnormalities
•
Includes:
– Blood cell counts
– Cellular morphology
– Clotting ability of blood
– Identification of cell types
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The Physician's Office Laboratory,
cont.
b. Clinical chemistry: Determining the amount
of chemical substances present in body
fluids, excreta, and tissues
•
Largest area in clinical chemistry: blood
chemistry
c. Serology and blood banking: Studying
antigen-antibody reactions to assess the
presence of a substance and/or to
determine the presence of disease
d. Urinalysis: Physical, chemical, and
microscopic analysis of urine
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The Physician's Office Laboratory,
cont.
e. Microbiology: Identification of pathogens
present in specimens taken from the body
•
Examples of specimens:
-Urine
- Wound
-Blood
-Urethra
-Throat
-Vagina
-Sputum
-Cerebrospinal fluid
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The Physician's Office Laboratory,
cont.
f. Parasitology: Detection of the presence of
disease-producing human parasites or
eggs present in specimens taken from the
body
•
Examples of specimens:
– Stool
– Vaginal
– Blood
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The Physician's Office Laboratory,
cont.
g. Cytology: Detection of the presence of
abnormal cells
h. Histology: Detection of diseased tissue
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Categories of Laboratory Tests
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Categories of Laboratory Tests,
cont.
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The Physician's Office Laboratory,
cont.
3. Specimens can be analyzed by either
manual or automated method
4. Steps for testing specimen
a. Specific amount of specimen required:
measured from specimen sample
b. Chemical reagents are combined with
specimen
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The Physician's Office Laboratory,
cont.
c. Specimen/reagents
may require further
processing (e.g.,
centrifuging,
incubation)
d. Substance is manually
or automatically
measured or identified
e. Results obtained from
direct readout or by
mathematic calculation
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The Physician's Office Laboratory,
cont.
f. Results are recorded on laboratory report
form or in patient's chart:
•
Patient's name (not needed if recording in chart)
•
Date
•
Time
•
Name of laboratory test(s)
•
Results of laboratory test(s)
•
Name of individual performing test(s)
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Recording Laboratory Test Results
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Manual Method
1. Involves performing a series of steps by
hand
2. Testing kits available to speed up
process
a. Examples of testing kits:
-Urinalysis
-Strep testing
-Mono testing
-Urine pregnancy testing
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Manual Method, cont.
1. Requires a thorough knowledge of
testing procedure
a. Must be careful to avoid errors
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Automated Analyzers
1. Automated
analyzers designed
for use in medical
office
a. Permit processing
of specimens in a
short period of
time
b. Provide greater
precision than
manual method
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Automated Analyzers, cont.
2. Tests results by direct readout (digital or
printed)
3. Must be able to recognize signs that
indicate analyzer is malfunctioning
a. May lead to inaccurate test results
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Automated Analyzers, cont.
4. Numerous automated systems available
a. Operating manual with each that includes
information needed to:
•
Collect specimen
•
Handle specimen
•
Perform quality control procedures
•
Test specimen
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Automated Analyzers, cont.
b. Personnel available for on-site training and
service
c. Examples of automated analyzers:
•
QBC hematology analyzer
•
Reflotron blood chemistry analyzer
•
Clinitek urine analyzer
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Quality Control
1. Must make sure laboratory test is
accurately measuring what it is
supposed to measure
a. Encompasses every aspect of:
•
Patient preparation
•
Specimen collection
•
Handling
•
Transport
•
Testing
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Quality Control, cont.
2. Quality control: the application of methods
and means to ensure that test results are
reliable and valid and that errors that may
interfere with obtaining accurate test results
are detected and eliminated
3. Quality control methods
a. Use standards and controls:
•
To check the precision and accuracy of
laboratory equipment
•
To detect errors in technique
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Quality Control, cont.
b. Discard outdated reagents
c. Follow the procedure exactly to test
specimen
d. Perform tests in duplicate
e. Periodically check the accuracy of test
results with reference laboratory
f. Maintain equipment by having it checked
periodically
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Laboratory Safety
1. Carefully handle and store glassware:
a. Arrange in storage cabinets to prevent
breakage
b. Carefully remove from storage cabinets
c. If breakage occurs: dispose in punctureresistant container
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Laboratory Safety, cont.
2. Handle chemical reagents carefully
a. Reagent container should be clearly
labeled
b. If label becomes loose, reattach
c. Recap container immediately after using
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Laboratory Safety, cont.
3. Laboratory specimens should
be handled carefully:
a. Follow OSHA Bloodborne
Pathogens Standard
b. Wash hands immediately
if accidentally touch
specimen
c. Avoid hand-to-mouth
contact
d. Immediately clean up any
spill
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Laboratory Safety, cont.
e. Properly dispose of all contaminated
materials
f. Cover any break in the skin
g. Make sure specimen containers are tightly
capped
h. Handle all laboratory equipment and
supplies properly
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POSTTEST
True or False
1.
2.
3.
4.
5.
Laboratory tests are most frequently ordered by the
physician to assist in the diagnosis of pathologic
conditions.
A laboratory directory indicates the patient
preparation required for laboratory tests.
Laboratory tests termed profiles contain a number of
different tests.
A lipid profile includes a test for glucose.
The purpose of patient preparation for a laboratory
test is to ensure the test results fall within normal
range.
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POSTTEST, CONT.
True or False
6.
A comprehensive metabolic profile requires that the
patient fast.
7. Antibiotics taken by the patient prior to the
collection of a throat specimen for culture may result
in a false-positive result.
8. The purpose of CLIA is to prevent exposure of
employees to bloodborne pathogens.
9. If a POL is performing moderate-complexity tests,
CLIA requires that two levels of controls be run daily.
10. The study of blood and blood-forming tissues is
known as serology.
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