Medical assisting Administrative and clinical procedures (5e) Chapter 45 Orientation to the lab

After studying this chapter you will be able to: Describe the purpose of the physician’s office laboratory, identify the medical assistant’s duties in the physician’s office laboratory, identify important pieces of laboratory equipment, illustrate measures to prevent accidents,...

Orientation to

the Lab

45.1 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

Role of Laboratory Testing in Patient Care

• Analysis of blood, urine, and other body

fluids

– Identify diseases or other problems

– Confirm or contradict initial diagnosis

– Determine and monitor dosage of a

medication

Role of Laboratory Testing in

Patient Care (cont.)

• Frees staff for patient care duties

Some managed care companies require

their subscribers to use a specific

reference laboratory.

The Purpose of the POL

• Accurate and timely processing of routine

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 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 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 include

– Understand regulations

– Accident prevention

– Waste disposal

– Housekeeping and maintenance

– Quality assurance and control

Medical Assistant’s Role (cont.)

• Additional responsibilities include

– Record 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 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

• Equipment used in a POL

Use of Laboratory Equipment (cont.)

• Autoclave – sterilizes surfaces of

instruments and equipment

• Centrifuge – spins and

separates specimen into

its component parts

• Most often used in a POL

• Onsite blood smear evaluation

• Provider performed microscopy procedures

must be CLIA-approved

Microscope (cont.)

• Objectives

– Contain another magnifying lens

– Moved under ocular when needed

– Three objectives

• Two dry

• One oil-immersion

Microscope

– Located on the arm

– Used to focus the

object

Microscope

• Stage – platform for slide

• Substage

– Condenser – Iris

Microscope (cont.)

• Using an optical microscope

– Operate correctly

– Artifacts

– Care and maintenance

• Clean after each use

• Store under plastic cover

• Move by holding arm and supporting the base

Electronic Equipment and Software

• Used to create and maintain

clinical data

• More accurate, safer, and

more efficient than manual

methods

• Photometer – measures light

intensity

Equipment used for measurement

• Precise measurement is critical in the POL

Apply Your Knowledge

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

Safety in the Laboratory

• Use Standard Precautions

• Guidelines

– Wear gloves and change between patients

– Wash hand after removing gloves

– Use PPE

– Avoid sharps injuries

– Use only recommended instruments and

equipment

Safety in the Laboratory (cont.)

• Guidelines (cont.)

– Prevent spills and splashes

– Disinfect areas contaminated by spills /

splashes

– Dispose of waste correctly

– Remove protective gear before leaving

laboratory

Safety in the Laboratory (cont.)

• Biologic safety

– Treat all specimens as if contaminated

– Follow Standard Precautions

• Accident Reporting

– Refer to office policy

– OSHA requirements

• Reduce risk of contamination

• Guidelines

– Refer to office policies and procedures

– Clean up spills immediately

– Clean equipment after use

– Dispose of waste correctly

– Take care with sharps

Apply Your Knowledge

List some guidelines for maintaining safety in a

POL?

ANSWER:

• Wear gloves and change between patients

• Wash hand after removing gloves

• Use PPE

• Avoid sharps injuries

• Use only recommended instruments and equipment

• Prevent spills and splashes

• Disinfect areas contaminated by spills / splashes

• Dispose of waste correctly

• Remove protective gear before leaving laboratory

Quality Assurance Programs

• Monitor the quality

Clinical Laboratory Improvement

Amendments (CLIA)

• Enacted in 1988 and updated in 1992

• Federal regulation of all laboratory facilities

CLIA (cont.)

• Certificate of Waiver Tests

– Pose insignificant risk to the patient if

performed or interpreted incorrectly

– Simple and accurate

– Approved by the FDA for

home use

CLIA (cont.)

• Moderate-complexity tests

– 75% of tests

– Qualified laboratory personnel

– Quality assurance program

– Random inspections

CLIA (cont.)

• High-complexity tests

– Tests for specialties and subspecialties

– Qualified laboratory personnel

– Quality assurance programs

– Random inspections

Components of Quality Assurance

• Quality control

• Instrument and equipment maintenance

• Proficiency testing

• Training and continuing education

• Standard operating procedures

documentation

Quality Control and Maintenance

– Qualitative test response

– Quantitative test results

Quality Control and Maintenance (cont.)

Quality Control and Maintenance (cont.)

result accuracy

– Adherence to

standard operating procedures

Training, Continuing Education, and

Documentation

• Employer provides

– Opportunities for training and continuing

education

– Written reference materials and

documentation procedures for POL

• Employee

– Consult reference materials

– Take part in available training

Filling Out a Laboratory Requisition Form

• Medical assistant responsibility

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 instructions

– Verify patient’s preparation

• During specimen collection

– Identify patient

– Instruct patient

– Provide reassurance

Communicating with the Patient

• After specimen collection

Apply Your Knowledge

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.

Good Job!

Good Job!

Record Keeping (cont.)

• Specimen identification

– Patient information

– Person who collected the specimen

– Date and time collected

– Physician

• Unidentified or

misidentified specimens

Apply Your Knowledge

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

In Summary

45.1 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 45

Quality is not an act, it

is a habit.

~ Aristotle