2. 1 PowerPoint ® to accompany Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 45

3. 2 Objectives: 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. 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 correct waste disposal procedures. Laboratory Equipment and Safety

4. 3 Objectives (cont.) 45-8 Describe the need for quality assurance and quality control programs. 45-9 Maintain accurate documentation, including all logs related to quality control. 45-10List common reference materials to consult for information on procedures performed in the physician’s office laboratory. 45-11Communicate with patients regarding test preparation and follow-up. 45-12 Identify the medical assistant’s record-keeping responsibilities. Laboratory Equipment and Safety

5. 4 Introduction  Laboratory testing  Laboratory testing is an integral component of patient care.  You will learn safety in the laboratory mandated by OSHA and steps to aid in preventing accidents. You must understand quality assurance, quality control procedures and required record keeping.

6. 5 Role of Laboratory Testing in Patient Care  Regular monitor for normal results  Specific tests for diagnosis  To determine and monitor medications Analysis of blood, urine, or other body fluids and substances provides three kinds of information

7. 6 Kinds of Laboratories Reference Laboratory  Owned and operated by an organization outside the practice  Have technological resources beyond the (POL) Physician’s Office Laboratory (POL)  Laboratory that is operated from the physician’s office  Processing tests in the POL produces quicker turnaround  No need for patient to travel to other test sites. Some managed care companies have contracts with laboratory companies requiring their subscriber to use a specific reference laboratory.

8. 7 Medical Assistant’s Role  Preparing the patient for the test  Collecting the sample  Completing the tests  Reporting the results  Telling the results to the patient You may be responsible for processing tests done in the POL:

9. 8 Use of Laboratory Equipment Learn by on the job or formal training. You may routinely use the following:  Autoclave  Centrifuge  Microscope  Electronic equipment  Equipment used for measurement

10. 9 Parts of the Microscope Eyepieces Nosepiece Objectives Slide Clips Stage Condenser Iris Light Source Fine Adjustment Coarse Adjustment Base Arm 5. 6. 7. 8. 9. 10. 11. 12. 2. 3. 4. 1. Name the parts of this MICROSCOPE. Click the Page Down button to see answers.

11. 10 Safety in the Laboratory  You must always be aware of and observe guidelines for laboratory safety.  OSHA guidelines Universal precautions Hazard communication standards OSHA Bloodborne pathogens standard Hazardous Waste Operations and Emergency Response Final Rule

12. 11 Universal Precautions Follow these guidelines;  Wear gloves when handling body fluids, secretions and excretions  Change gloves every time you move from patient to patient  Wash hands after removing gloves

13. 12 Hazard Communication Standard  Biohazard labels  Material Safety Data Sheets (MSDS)  Hazard labels

14. 13 OSHA Blood-borne Pathogens Standards  Written OSHA Exposure Control Plan must be created and updated annually  Training must be provided to all employees as mandated by the standard that includes use of PPE.  Employees must take hepatitis B vaccine or decline in writing.

15. 14 Hazardous Waste Operation & Emergency Response Final Rule Hazardous waste products include Hazardous waste products include :  Blood and blood products  Body fluids and tissue  Cultures  Vaccines  Sharps  Gloves  Specula  Inoculating loops  Paper product contaminated with body fluids

16. 15 Accident Prevention Guidelines  Physical safety  Fire and electrical safety  Chemical safety  Biologic safety

17. 16 Apply Your Knowledge How are each of the following pieces of equipment used in the POL? 1.Autoclave 2.Microscope 3.Centrifuge

18. 17 Answer Apply Your Knowledge – Answer 1.Autoclave – sterilize or eradicate all microorganisms 2.Microscope – examination of blood smears and identification of microorganisms 3.Centrifuge – spinning a specimen to separate its component parts How are each of the following pieces of equipment used in the POL?

19. 18 Responding to an Accident  You should be able to deal with most emergencies  There should be a written procedure to follow in the event of an accident.  Ensure safety for you, your colleagues and patients.

20. 19 Responding to an Accident (cont.)  Administer first aid  Take steps to get help  Use appropriate cleaning products for spilled chemicals  Do not touch broken glass, use tongs or broom and dustpan

21. 20 Housekeeping  Designed to reduce the risk of disease transmission  Guidelines for good operation procedures and reduce the risk of infections  Written policies and procedures  Immediately clean up skills or splashes or contaminated materials

22. 21 Quality Assurance Programs  Design to monitor the quality of the patient care a medical lab provides  Clinical laboratory improvement amendments (CLIA)  Labs under Health Care Financing Administration (HCFA) and CDC regulations

23. 22 Certificate of Waiver Tests  Tests pose insignificant risk to the patient if they are performed or interpreted incorrectly  Procedures involved are simple and accurate to such a degree that risk of obtaining incorrect results is minimal  Tests have been approved by the Food and Drug Administration for use by patients at home.

24. 23 Quality Assurance Program Must include :  Quality control  Instrument and equipment maintenance  Proficiency testing  Training and continuing education  Standard operating procedures documentation

25. 24 Quality Control  Calibration regularly of all equipment  Control samples serves as a check on the accuracy of the test  Reagent Control formulated to react in specific ways when exposed to special conditions Focus is to ensure accuracy in test results by carefully monitoring test procedures. Must follow these procedures:

26. 25 Quality Maintenance  Testing instruments and equipments must be properly maintained and procedures documented Documentation includes:  Careful adherence to procedures to identify problems  Careful documentation of all procedures.

27. 26 Proficiency Testing  A passing mark indicates that your laboratory can continue to perform that particular test  Failing mark means that your laboratory must stop the test and possibly other tests as well. Measures accuracy of test results and adherence to standard operating procedures

28. 27 Training, Continuing Education & Documentation Must provide training, written reference materials and procedures conducted in the POL.  MSDS  Standard operating procedures  Safety manuals  Equipment manufacturers’ user or reference guides  Clinical Lab Technical Procedure Manuals  OSHA standards  Maintenance and housekeeping schedules

29. 28 Communicating With the Patient  Before the patient submits samples for lab tests  During the specimen collection procedures  After the interpreted lab results have been given to the patient

30. 29 Record Keeping Keep Records on:  Inventory control  Patient records  Specimen identification “If it is not written down, it was not done” Accurate and complete record keeping can be summed up: “If it is not written down, it was not done”

31. 30 Apply Your Knowledge Congress placed all laboratory facilities under what federal agencies?

32. 31 Answer Apply Your Knowledge - Answer Health Care Financing Administration (HCFA) and CDC regulations Congress placed all laboratory facilities under what federal agencies?

33. 32 Apply Your Knowledge #2 When you arrive at work one morning you notice a fellow medical assistant putting on some lip balm in the POL. What should you do?

34. 33 Answer Apply Your Knowledge #2 - Answer Lip balm should not be put on in the POL. You may want to remind your fellow employee that it is for her safety not to put on make-up in the laboratory. When you arrive at work one morning you notice a fellow medical assistant putting on some lip balm in the POL. What should you do?

35. 34 Summary Medical Assistant The physician’s office lab offers many opportunities for interesting and satisfying work in your role as a medical assistant. Keeping a level head and applying common sense will go a long way toward making your work in the lab efficient and accurate.

36. 35 End of Chapter