2. CHAPTER © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45 Orientation to the Lab

3. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-2 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.)

4. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-3 Learning Outcomes (cont.) 45.5 Describe the goal of a quality assurance program in a physician’s office laboratory. 45.6Carry out communication with patients regarding test preparation and follow-up. 45.7 Carry out accurate documentation, including all logs related to quality control.

5. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-4 Introduction Medical assistant must know –Common laboratory equipment –Safety in the laboratory –Steps to prevent accidents Impact of CLIA ’88 –Quality assurance –Quality control procedures –Record keeping

6. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-5 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

7. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-6 Role of Laboratory Testing in Patient Care (cont.) Kinds of laboratories –Reference laboratory Outside the practice Technological resources Frees staff for patient care duties –Physician’s office laboratory (POL) Quicker turnaround Eliminates need for patient travel Some managed care companies require their subscribers to use a specific reference laboratory.

8. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-7 The Purpose of the POL Accurate and timely processing of routine tests Tests –Chemical analysis –Hematologic tests –Microbiologic tests –Urinalysis

9. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-8 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!

10. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-9 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

11. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-10 Medical Assistant’s Role (cont.) Additional responsibilities include –Understand regulations –Accident prevention –Waste disposal –Housekeeping and maintenance –Quality assurance and control

12. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-11 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

13. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-12 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.

14. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-13 Use of Laboratory Equipment Equipment used in a POL –Autoclave –Centrifuge –Microscope –Electronic equipment –Equipment used for measurement

15. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-14 Use of Laboratory Equipment (cont.) Autoclave – sterilizes surfaces of instruments and equipment Centrifuge – spins and separates specimen into its component parts

16. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-15 Microscope Most often used in a POL Onsite blood smear evaluation Provider performed microscopy procedures must be CLIA-approved

17. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-16 Microscope (cont.) Optical microscope –Uses light to project an image –Compound microscope ~ two lenses magnify the image

18. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-17 Microscope (cont.) Oculars – eyepieces –Monocular –Binocular –Magnifying lens ~ (10x lens) Microscope

19. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-18 Microscope (cont.) Objectives –Contain another magnifying lens –Moved under ocular when needed –Three objectives Two dry One oil-immersion Microscope

20. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-19 Microscope (cont.) Arm ~ attaches oculars and objectives to body Focus controls –Located on the arm –Used to focus the object Microscope Stage – platform for slide Substage –Condenser –Iris

21. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-20 Microscope (cont.) Light source –Under stage and substage –Adjustable intensity Specimen slides/ coverslip Microscope

22. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-21 Oculars (eyepieces) Revolving nosepiece Objectives Stage Arm Slide clips Condenser Iris Light source Fine Coarse Focus controls Base Microscope (cont.) Back

23. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-22 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

24. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-23 Electronic Equipment and Software Used to create and maintain clinical data More accurate, safer, and more efficient than manual methods Photometer – measures light intensity

25. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-24 Equipment used for measurement Precise measurement is critical in the POL Equipment includes –Pipettes –Flasks or beakers –Hemocytometer –Thermometers

26. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-25 Apply Your Knowledge Matching: ___ Measures light intensity A.Focus controls ___ Platform for slideB.Hemocytometer ___ Contains magnifying lensC.Stage ___ One is an oil-immersion D.Photometer ___ Condenser to concentrate lightE.Ocular ___ Move body tube up and downF.Substage ___ Calibrated to count cellsG.Objective ANSWER: G F E D C B A Nice Job!

27. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-26 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

28. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-27 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

29. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-28 Safety in the Laboratory (cont.) Biologic safety –Treat all specimens as if contaminated –Follow Standard Precautions Accident Reporting –Refer to office policy –OSHA requirements

30. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-29 Housekeeping 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

31. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-30 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

32. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-31 Quality Assurance Programs Monitor the quality of patient care Ensure safety of workers Assess the quality of tests performed Quality is #1

33. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-32 Clinical Laboratory Improvement Amendments (CLIA) Enacted in 1988 and updated in 1992 Federal regulation of all laboratory facilities Standards apply to –Standards – depend on test –Fees –Enforcement –Accreditation programs

34. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-33 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

35. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-34 CLIA (cont.) Moderate-complexity tests –75% of tests –Qualified laboratory personnel –Quality assurance program –Random inspections

36. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-35 CLIA (cont.) High-complexity tests –Tests for specialties and subspecialties –Qualified laboratory personnel –Quality assurance programs –Random inspections

37. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-36 Components of Quality Assurance Quality control Instrument and equipment maintenance Proficiency testing Training and continuing education Standard operating procedures documentation

38. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-37 Quality Control and Maintenance Calibration –Ensures equipment is operating correctly –Standards Control samples –Known values –Used each time a patient sample is processes –Qualitative test response –Quantitative test results

39. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-38 Quality Control and Maintenance (cont.) Reagent control –Reagents –Keep a reagent control log Maintain equipment –Follow manufacturer’s guidelines –Troubleshoot problems –Keep a maintenance log

40. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-39 Quality Control and Maintenance (cont.) Documentation –Quality control –Reagent control –Equipment maintenance –Reference laboratory –Daily workload Proficiency Testing Programs –Measure test result accuracy –Adherence to standard operating procedures

41. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-40 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

42. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-41 Filling Out a Laboratory Requisition Form Medical assistant responsibility Complete properly –Patient information –Insurance information –Physician information –Specimen information –Test(s) requested –Preliminary diagnosis

43. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-42 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!

44. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-43 Communicating with the Patient Before testing –Patient instructions –Verify patient’s preparation During specimen collection –Identify patient –Instruct patient –Provide reassurance

45. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-44 Communicating with the Patient After specimen collection –Post-test instructions –Schedule for further testing Test results –Report to physician for interpretation –Report to patient –Answer patient questions

46. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-45 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!

47. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-46 Record Keeping Inventory control –List of items routinely used –Reorder systematically Patient records – identify unusual findings

48. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-47 Record Keeping (cont.) Specimen identification –Patient information –Person who collected the specimen –Date and time collected –Physician Unidentified or misidentified specimens

49. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-48 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. Bravo!

50. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-49 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.

51. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-50 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.

52. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-51 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.

53. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-52 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.

54. © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45-53 End of Chapter 45 Quality is not an act, it is a habit. ~ Aristotle