CHAPTER
45
Orientation to
the Lab
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45-2
Learning Outcomes (cont.)
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.
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45-3
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.
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45-4
Introduction
• Medical assistant
must know
– Common laboratory
equipment
– Safety in the
laboratory
• Impact of CLIA ’88
– Quality assurance
– Quality control
procedures
– Record keeping
– Steps to prevent
accidents
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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
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45-6
Role of Laboratory Testing in
Patient Care (cont.)
• Kinds of laboratories
– Reference
laboratory
– Physician’s office
laboratory (POL)
• Outside the practice
• Quicker turnaround
• Technological
resources
• Eliminates need for
patient travel
• Frees staff for patient
care duties
Some managed care companies require
their subscribers to use a specific
reference laboratory.
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45-7
The Purpose of the POL
• Accurate and timely processing of routine
tests
• Tests
– Chemical analysis
– Hematologic tests
– Microbiologic tests
– Urinalysis
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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!
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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
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45-10
Medical Assistant’s Role (cont.)
• Additional responsibilities include
– Understand regulations
– Accident prevention
– Waste disposal
– Housekeeping and maintenance
– Quality assurance and control
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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
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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.
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45-13
Use of Laboratory Equipment
• Equipment used in a POL
– Autoclave
– Centrifuge
– Microscope
– Electronic equipment
– Equipment used for measurement
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45-14
Use of Laboratory Equipment (cont.)
• Autoclave – sterilizes surfaces of
instruments and equipment
• Centrifuge – spins and
separates specimen into
its component parts
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45-15
Microscope
• Most often used in a POL
• Onsite blood smear evaluation
• Provider performed microscopy
procedures must be CLIA-approved
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45-16
Microscope (cont.)
• Optical microscope
– Uses light to project an
image
– Compound microscope ~
two lenses magnify the
image
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45-17
Microscope (cont.)
• Oculars – eyepieces
– Monocular
– Binocular
– Magnifying lens ~ (10x lens)
Microscope
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45-18
Microscope (cont.)
• Objectives
– Contain another magnifying lens
– Moved under ocular when needed
– Three objectives
• Two dry
• One oil-immersion
Microscope
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45-19
Microscope (cont.)
• Arm ~ attaches
oculars and
objectives to body
• Stage – platform
for slide
• Focus controls
• Substage
– Located on the arm
– Used to focus the
object
– Condenser
– Iris
Microscope
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45-20
Microscope (cont.)
• Light source
– Under stage and
substage
• Specimen slides/
coverslip
– Adjustable intensity
Microscope
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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
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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
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45-24
Equipment used for measurement
• Precise measurement is critical in the POL
• Equipment includes
– Pipettes
– Flasks or beakers
– Hemocytometer
– Thermometers
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45-25
Apply Your Knowledge
Matching: ANSWER:
D Measures light intensity
___
A. Focus controls
C Platform for slide
___
B. Hemocytometer
E Contains magnifying lens
___
C. Stage
___
G One is an oil-immersion
D. Photometer
___
F Condenser to concentrate light E. Ocular
A Move body tube up and down
___
B Calibrated to count cells
___
Nice
F. Substage
G. Objective Job!
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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
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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
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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
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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
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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
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45-31
Quality Assurance Programs
• Monitor the quality of
patient care
• Ensure safety of
workers
Quality
is #1
• Assess the quality of
tests performed
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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
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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
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45-34
CLIA (cont.)
• Moderate-complexity tests
– 75% of tests
– Qualified laboratory personnel
– Quality assurance program
– Random inspections
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45-35
CLIA (cont.)
• High-complexity tests
– Tests for specialties and subspecialties
– Qualified laboratory personnel
– Quality assurance programs
– Random inspections
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45-36
Components of Quality Assurance
• Quality control
• Instrument and equipment maintenance
• Proficiency testing
• Training and continuing education
• Standard operating procedures
documentation
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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
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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
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45-39
Quality Control and Maintenance (cont.)
• Documentation
– Quality control
– Reagent control
– Equipment
maintenance
– Reference laboratory
• Proficiency
Testing Programs
– Measure test result
accuracy
– Adherence to
standard operating
procedures
– Daily workload
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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
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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
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45-42
4542
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!
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45-43
Communicating with the Patient
• Before testing
– Patient instructions
– Verify patient’s preparation
• During specimen collection
– Identify patient
– Instruct patient
– Provide reassurance
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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
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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!
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45-46
Record Keeping
• Inventory control
– List of items routinely used
– Reorder systematically
• Patient records – identify
unusual findings
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45-47
Record Keeping (cont.)
• Specimen identification
– Patient information
– Person who collected the specimen
– Date and time collected
– Physician
• Unidentified or
misidentified specimens
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45-48
Apply Your Knowledge
Bravo!
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.
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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.
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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.
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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.
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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.
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45-53
End of Chapter 45
Quality is
not an act, it
is a habit.
~ Aristotle
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.