Lecture Clinical procedures for medical assisting (4/e): Chapter 14 – Booth, Whicker, Wyman

Chapter 14 - Laboratory and equipment safety. After you have mastered the material in this chapter, you will be able to: Describe the purpose of the physician’s office laboratory, list the medical assistant’s duties in the physician’s office laboratory, identify important pieces of laboratory equipment, operate a microscope,...

Laboratory and

Equipment Safety

Learning Outcomes

14.1 Describe the purpose of the physician’s office

laboratory.

14.2 List the medical assistant’s duties in the

physician’s office laboratory.

14.3 Identify important pieces of laboratory

equipment.

14.4 Operate a microscope.

Learning Outcomes (cont.)

14.5 Identify the regulatory controls governing

procedures completed in the physician’s office laboratory.

14.6 Identify measures to prevent accidents.

14.7 Describe the goal of a quality assurance

program in a physician’s office laboratory.

Learning Outcomes (cont.)

14.8 Identify the medical assistant’s

record-keeping responsibilities.

14.9 Describe correct waste disposal procedures.

14.10 Describe the need for quality assurance and

quality control programs.

Learning Outcomes (cont.)

14.11 Maintain accurate documentation, including

all logs related to quality control.

14.12 List common reference materials to consult

for information on procedures performed in the physician’s office laboratory.

14.13 Communicate with patients regarding test

preparation and follow-up.

• CLIA ’88 – impact on laboratory setting

– Quality assurance

– Quality control procedures

– Required record keeping

Role of Laboratory Testing in Patient Care

• Analysis 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

Role of Laboratory Testing (cont.)

• Have technological resources beyond the POL

– POL

• Quicker turnaround

• Eliminates 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.)

• Purpose of POL

– Accurate and timely processing of routine

tests – Reporting test results to physician

Apply Your Knowledge

Compare 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 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 POL

– Preparing the patient

– Collecting the sample

– Completing the test

– Reporting the results

– Communicating information about the

test

Medical Assistant’s Role (cont.)

• Additional

responsibilities

– Understand

regulations– Accident prevention

– Screen and follow-up results

Apply Your Knowledge

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

• You may routinely

use the following:

Use of Laboratory Equipment (cont.)

• Autoclave – sterilizes surfaces of

instruments and equipment

• Centrifuge – spins and separates

specimen into its component parts

Use of Laboratory Equipment (cont.)

• Optical microscope

– Uses 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

• Objectives

– Contain another magnifying lens – Moved under ocular when needed

– Three objectives

• Two dry

• One oil-immersion

Microscope

to focus the object

• Light source

– Under stage and

substage– Adjustable intensity

• Stage and substage

– Stage – platform for slide

– Substage – condenser

• Specimen slides/

coverslip

Microscope

Parts of the Microscope

Eyepieces

Nosepiec

eObjectivesSlide

Clips

StageCondenserIris

Light Source

Use of Laboratory Equipment (cont.)

• Using an optical microscope

–Operate correctly

–Care and maintenance

• Clean after each use

• Store under plastic cover

• Move by holding arm and supporting the base

Use of Laboratory Equipment (cont.)

• Electronic equipment

and software

– Used to create and

maintain clinical data

– More accurate, safer,

and more efficient than

Apply Your Knowledge

Matching:

_ Condenser to concentrate light E Ocular

_ Move body tube up and down F Substage

Safety in the Laboratory

• Workplace free from recognized hazards

– Enforces guidelines from CDC

OSHA Guidelines

• Standard Precautions

• Hazard communication standards

• OSHA Bloodborne Pathogens Standard

• Hazardous Waste Operations and

Emergency Response Final Rule

• Needlestick Safety and Prevention Act

Standard Precautions

• Assume that all blood, blood

products, human tissue, and body

fluids are contaminated

• PPE guidelines

– Gloves

– Eye protection

• Use equipment appropriately

• Proper biohazard disposal

Safety in the Laboratory (cont.)

• OSHA Bloodborne Pathogens

Safety in the Laboratory (cont.)

– Location of

containers – Reduce spillage

• Needlestick Safety and Prevention Act

– Revision of Bloodborne Pathogen Standard

– Use of devices to reduce risk

Accident Prevention Guidelines

Safety in the Laboratory (cont.)

first aid – Clean up

Safety in the Laboratory (cont.)

• Clean equipment after use

• Dispose of waste correctly

Apply Your Knowledge

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

• Monitor the quality of

Amendments (CLIA)

– Regulation of laboratories– Test categories

• Certificate of Waiver

• Moderate complexity

• High complexity

• Certificate of Waiver Tests

performed or interpreted incorrectly

results is minimal

• High-complexity tests

– Tests for specialties and subspecialties – Qualified laboratory personnel

– Random inspections

Components of Quality Assurance

– Adherence to procedures

– Careful documentation

• Instrument and equipment maintenance

• Proficiency testing

• Training and continuing education

• Standard operating procedures

documentation

Quality Control and Maintenance

• Ensure accuracy in test results by

carefully monitoring test procedures

• Procedures

– Equipment calibration

– Use control samples

– Perform reagent controls

– Maintain equipment

– Documentation of above procedures

Quality Control and Maintenance (cont.)

– Quality control log

– Reagent control log

– Equipment

maintenance log

– Reference laboratory log

– Daily workload log

Proficiency Testing

• Proficiency testing program

– Accuracy of test results

– Adherence to standard operating procedures

• Control sample, documentation sent to

proficiency testing organization

– Pass – continue performing test

– Fail – discontinue performing tests

• Manufacturers’ user or reference guides

• Clinical Lab Technical Procedure Manuals

• Regulatory documentation (OSHA, CLIA

’88)

• Maintenance and housekeeping schedules

Apply Your Knowledge

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.

Quality Answer!

Communicating with the Patient

• Before testing

– Patient preparation

– Verification of patient preparation

• During specimen collection

– Proper patient identification

– Verbal and nonverbal

• After specimen collection

– Postprocedure instructions

– Schedule for further testing, if needed

Communicating with the Patient (cont.)

• Test results

– Report to physician for interpretation

– Report to patient, if instructed to by the

physician – Patient questions

• Answer if within your scope

• Refer to physician

Record Keeping (cont.)

• Patient records

– Identify unusual

findings – Follow office

procedures

• Specimen identification

– Patient information – Person who

collected specimen – Physician

Patient: Jason Jones

DOB: 10/22/0000

Date / time: 04/14/0000 @ 9:00 AM

Collected by: shf

Physician: M Welby

Apply Your Knowledge

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.

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.

In Summary

14.1 The physician’s office laboratory (POL) is responsible

for accurate and timely processing of routine tests and for reporting test results to the physician

14.2 The medical assistant’s duties in an 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 to the patient

14.3 Common laboratory equipment includes autoclaves,

centrifuges, microscopes, electronic equipment and software, and equipment used for measurement

In Summary (cont.)

14.4 Follow specific steps for operating a microscope,

including plugging it in, cleaning the lenses, placing the slide on the stage, adjusting the focus, examining the image, and cleaning the lens before storage

14.5 Regulatory controls governing the physician’s office

laboratory include Standard Precautions, Hazard Communication Standard, OSHA Bloodborne

Pathogens Standard, Hazardous Waste Operations and Emergency Response Final Rule, and the

Needlestick Safety and Prevention Act

In Summary (cont.)

14.6 Preventing accidents in the physician’s office

laboratory should include physical, fire and electrical, chemical, and biologic safety measures

14.7 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

14.8 The medical assistant might be responsible for

recording information about quality control and equipment maintenance, inventory control, test results

in patient records, and tracking every specimen that

he or she handles

In Summary (cont.)

14.9 Hazardous waste must be disposed of in properly

constructed and labeled containers Containers for sharps must be puncture-proof, leak-resistant, and rigid, and needles should be dropped into the sharps container without bending, breaking, or recapping them

14.10 Quality assurance and quality control programs

serve to reduce testing errors and provide for the safety of laboratory personnel

14.11 Accurate quality control documentation in a

physician’s office laboratory includes a reference laboratory log and a daily workload log

In Summary (cont.)

14.12 Common reference materials used while performing

procedures in a physician’s office laboratory include Material Safety Data Sheets, standard operating

procedures, safety manuals, equipment manufacturers’ user or reference guides, Clinical Laboratory Technical Procedure Manuals, regulatory documentation, and maintenance and housekeeping schedules

14.13 It is the medical assistant’s responsibility to ensure

that patients understand what is expected of them before a test Providing clear pretest instructions in both oral and written form is an essential part of the test procedure

End of Chapter 14

Quality is not an act, it

is a habit.

~ Aristotle