Chapter 45 Laboratory and Equipment Safety Medical Assisting PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

Learning Outcomes 45.1 Describe the purpose of the physician’s office laboratory. 45.2 List the medical assistant’s duties in the physician’s office laboratory. 45.3 Identify important pieces of laboratory equipment. 45.4 Operate a microscope.

Learning Outcomes (cont.) 45.5 Identify the regulatory controls governing procedures completed in the physician’s office laboratory. 45.6 Identify measures to prevent accidents. 45.7 Describe the goal of a quality assurance program in a physician’s office laboratory.

Learning Outcomes (cont.) 45.8 Identify the medical assistant’s record-keeping responsibilities. 45.9 Describe correct waste disposal procedures. 45.10 Describe the need for quality assurance and quality control programs.

Learning Outcomes (cont.) 45.11 Maintain accurate documentation, including all logs related to quality control. 45.12 List common reference materials to consult for information on procedures performed in the physician’s office laboratory. 45.13 Communicate with patients regarding test preparation and follow-up.

Introduction 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 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.) Kinds of laboratories Reference laboratory Owned and operated by an organization outside the practice 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 Tests Chemical analysis Hematologic tests Microbiologic tests Urinalysis

Super! Apply Your Knowledge 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 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 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 Very Good! 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. Very Good!

Use of Laboratory Equipment You may routinely use the following: Autoclave Centrifuge Microscope Electronic equipment Equipment used for measurement

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

Use of Laboratory Equipment: Microscope Oculars Eyepieces Monocular Binocular Contain a magnifying lens – magnify image 10 times (10X lens) Objectives Contain another magnifying lens Moved under ocular when needed Three objectives Two dry One oil-immersion Microscope

Use of Laboratory Equipment: Microscope (cont.) Arm and focus controls Arm – attaches oculars and objectives to body Focus controls – used 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 5. Eyepieces 6. Nosepiece 7. Objectives 1. Arm 8. Slide Clips 9. Stage 10. Condenser 11. Iris 2. Fine Adjustment 3. Coarse Adjustment 12. Light Source 4. Base Back

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 manual methods Photometer – measures light intensity Equipment used for measurement Pipettes Flasks or beakers Hemocytometer Thermometers

Nice Job! 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 ANSWER: D C E G Nice Job! F A B

Safety in the Laboratory Primary concern OSHA Protection of employees in the workplace Specific guidelines General duty clause If no specific guidelines Workplace free from recognized hazards Enforces guidelines from CDC

Safety in the Laboratory (cont.) OSHA guidelines Standard Precautions Hazard communication standards OSHA Bloodborne Pathogens Standard Hazardous Waste Operations and Emergency Response Final Rule Needlestick Safety and Prevention Act

Safety in the Laboratory (cont.) 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.) Hazard communication Biohazard labels Material Safety Data Sheets (MSDS) Hazard labels Name of material Hazardous effects

Safety in the Laboratory (cont.) OSHA Blood-borne Pathogens Standard Written OSHA Exposure Control Plan Training Bloodborne pathogens PPE Universal Precautions Prevention of exposure Hepatitis B vaccination

Safety in the Laboratory (cont.) Hazardous waste Dispose in proper containers Sharps Other biohazardous waste Location of containers Reduce spillage Needlestick Safety and Prevention Act Revision of Bloodborne Pathogen Standard Use of devices to reduce risk

Safety in the Laboratory (cont.) Accident prevention guidelines Physical safety Common sense PPE Manufacturers’ guidelines Fire and electrical safety Fire drills Fire extinguishers Reduce electrical hazards

Safety in the Laboratory (cont.) Chemical safety MSDS PPE Biologic safety Standard Precautions Disinfection Waste disposal Accident reporting Office procedures Ensure safety / first aid Clean up

Safety in the Laboratory (cont.) Housekeeping Reduce risk of disease transmission Guidelines Written policies and procedures Clean up spills / splashes immediately Clean equipment after use Dispose of waste correctly

Apply Your Knowledge What information must be included on the MSDS? E X C L N T ! 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 patient care Ensure safety of workers Assess the quality of tests performed CLIA Regulation of laboratories Test categories Certificate of Waiver Moderate complexity High complexity

QA Programs: Certificate of Waiver Tests Pose insignificant risk to the patient if they are performed or interpreted incorrectly Simple and accurate, so the risk of obtaining incorrect results is minimal Approved by the FDA for home use Office must apply for a Certificate of Waiver Exempt from CLIA ’88 standards May be randomly inspected

QA Programs (cont.) Moderate-complexity tests High-complexity tests 75% of tests Qualified laboratory personnel Random inspections High-complexity tests Tests for specialties and subspecialties Qualified laboratory personnel Random inspections

QA Programs (cont.) Components Quality control program Adherence to procedures Careful documentation Instrument and equipment maintenance Proficiency testing Training and continuing education Standard operating procedures documentation

QA Programs: 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

QA Programs: Quality Control and Maintenance (cont.) Equipment maintenance Manufacturer’s guidelines Troubleshooting a problem – investigating the cause using a systematic approach Documentation Quality control log Reagent control log Equipment maintenance log Reference laboratory log Daily workload log

QA Programs: 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

QA Programs (cont.) Training, continuing education, and documentation Employer responsibility Reference material MSDS / safety manuals / SOPs Manufacturers’ user or reference guides Clinical Lab Technical Procedure Manuals Regulatory documentation (OSHA, CLIA ’88) Maintenance and housekeeping schedules

QA Programs (cont.) Requisition forms Medical assistant’s responsibility Complete information Include with specimen or send with patient to laboratory

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 Post-procedure 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 Quality control and equipment maintenance Inventory control Record test results in patient records Tracking of specimens

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 Bravo! 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. 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 Medical assistant and the POL Maintain and improve technical skills Keep up on technological, legislative, and regulatory developments Prevent transmission of disease and occurrence of accidents Seek ways to improve quality of patient care Perform tests efficiently and accurately Maintain equipment properly

End of Chapter 45 Quality is not an act, it is a habit. ~ Aristotle