CHAPTER
45
Laboratory and
Equipment Safety
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45-2
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.
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45-3
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.
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45-4
Learning Outcomes (cont.)
45.8 Identify the medical assistant’s recordkeeping responsibilities.
45.9 Describe correct waste disposal procedures.
45.10 Describe the need for quality assurance and
quality control programs.
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45-5
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.
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45-6
Introduction
• Laboratory testing –
integral part of patient
care
• Medical assistant
must know
– Common laboratory
equipment
– Safety in the
laboratory
• CLIA ’88 – impact on
laboratory setting
– Quality assurance
– Quality control
procedures
– Required record
keeping
– Steps to prevent
accidents
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45-7
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
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45-8
Role of Laboratory Testing (cont.)
• Kinds of
laboratories
– Reference
laboratory
• Owned and operated
by an organization
outside the practice
– POL
• Quicker turnaround
• Eliminates need for
patient travel to other
test location
• Have technological
resources beyond the
POL
Some managed care companies require their
subscribers to use a specific reference laboratory.
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45-9
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
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45-10
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 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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45-11
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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45-12
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
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45-13
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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45-14
Use of Laboratory Equipment
• You may routinely
use the following:
–
–
–
–
–
Autoclave
Centrifuge
Microscope
Electronic equipment
Equipment used for
measurement
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45-15
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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45-16
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
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45-17
Microscope
• Oculars
• Objectives
– Eyepieces
• Monocular
• Binocular
– Contain a
magnifying lens –
magnify image 10
times (10X lens)
– Contain another
magnifying lens
– Moved under
ocular when
needed
– Three objectives
• Two dry
• One oil-immersion
Microscope
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45-18
Microscope (cont.)
• Arm and focus
controls
– Arm – attaches
oculars and objectives
to body
– Focus controls – used
to focus the object
• Stage and substage
– Stage – platform for
slide
– Substage – condenser
• Specimen slides/
coverslip
• Light source
– Under stage and
substage
– Adjustable intensity
Microscope
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45-20
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
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45-21
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
• Equipment used for
measurement
–
–
–
–
Pipettes
Flasks or beakers
Hemocytometer
Thermometers
– Photometer –
measures light
intensity
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45-22
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 F. Substage
___
B Calibrated to count cells
___
G. Objective
Nice
Job!
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45-23
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
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45-24
OSHA Guidelines
• Standard Precautions
• Hazard communication standards
• OSHA Bloodborne Pathogens Standard
• Hazardous Waste Operations and
Emergency Response Final Rule
• Needlestick Safety and Prevention Act
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45-25
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
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45-26
Hazard Communication
• Biohazard labels
• Material Safety Data Sheets
(MSDS)
• Hazard labels
– Name of material
– Hazardous effects
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45-27
Safety in the Laboratory (cont.)
• OSHA Bloodborne Pathogens
Standard
– Written OSHA Exposure Control Plan
– Training
• Blood-borne pathogens
• PPE
• Universal Precautions
• Prevention of exposure
– Hepatitis B vaccination
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45-28
Safety in the Laboratory (cont.)
• Hazardous waste
– Dispose in proper
containers
• Needlestick Safety
and Prevention Act
• Sharps
– Revision of
Bloodborne Pathogen
Standard
• Other biohazardous
waste
– Use of devices to
reduce risk
– Location of
containers
– Reduce spillage
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45-29
Accident Prevention Guidelines
• Physical safety
– Common sense
– PPE
– Manufacturers’ guidelines
• Fire and electrical safety
– Fire drills
– Fire extinguishers
– Reduce electrical hazards
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45-30
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
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45-31
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
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45-32
Apply Your Knowledge
What information must be included on the
MSDS?
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
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45-33
Quality Assurance Programs
• Monitor the quality of
patient care
– Ensure safety of
workers
– Assess the quality of
tests performed
• Clinical Laboratory
Improvement
Amendments (CLIA)
– Regulation of
laboratories
– Test categories
• Certificate of Waiver
• Moderate complexity
• High complexity
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45-34
CLIA
• 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
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45-35
CLIA (cont.)
• Moderate-complexity
tests
– 75% of tests
– Qualified laboratory
personnel
– Random inspections
• High-complexity tests
– Tests for specialties
and subspecialties
– Qualified laboratory
personnel
– Random inspections
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45-36
Components of Quality Assurance
• Quality control program
– Adherence to procedures
– Careful documentation
•
•
•
•
Instrument and equipment maintenance
Proficiency testing
Training and continuing education
Standard operating procedures
documentation
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45-37
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
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45-38
Quality Control and Maintenance (cont.)
• Equipment maintenance
– Manufacturer’s guidelines
– Troubleshooting a problem –
investigating the cause using a
systematic approach
• Documentation
– Reference laboratory
– Quality control log
log
– Reagent control log
– Daily workload log
– Equipment
maintenance log
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45-39
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
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45-40
QA Programs
• 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
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45-41
QA Programs (cont.)
• Requisition forms
– Medical assistant’s responsibility
– Complete information
– Include with specimen or send with
patient to laboratory
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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!
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45-43
Communicating with the Patient
• Before testing
– Patient preparation
– Verification of patient preparation
• During specimen collection
– Proper patient identification
– Verbal and nonverbal
• After specimen collection
– Postprocedure instructions
– Schedule for further testing, if needed
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45-44
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
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45-45
Record Keeping
• Quality control and equipment
maintenance
• Inventory control
• Record test results in patient records
• Tracking of specimens
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45-46
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
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45-47
Apply Your Knowledge
Bravo!
1. 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.
2. 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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45-48
In Summary
45.1 The physician’s office laboratory (POL) is responsible
for accurate and timely processing of routine tests
and for reporting test results to the physician.
45.2 The medical assistant’s duties in an 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 to the patient.
45.3 Common laboratory equipment includes autoclaves,
centrifuges, microscopes, electronic equipment and
software, and equipment used for measurement.
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45-49
In Summary (cont.)
45.4 Follow specific steps for operating a microscope,
including plugging it in, cleaning the lenses, placing
the slide on the stage, adjusting the focus, examining
the image, and cleaning the lens before storage.
45.5 Regulatory controls governing the physician’s office
laboratory include Standard Precautions, Hazard
Communication Standard, OSHA Bloodborne
Pathogens Standard, Hazardous Waste Operations
and Emergency Response Final Rule, and the
Needlestick Safety and Prevention Act.
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45-50
In Summary (cont.)
45.6 Preventing accidents in the physician’s office
laboratory should include physical, fire and electrical,
chemical, and biologic safety measures.
45.7 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.
45.8 The medical assistant might be responsible for
recording information about quality control and
equipment maintenance, inventory control, test
results in patient records, and tracking every
specimen that he or she handles.
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45-51
In Summary (cont.)
45.9 Hazardous waste must be disposed of in properly
constructed and labeled containers. Containers for
sharps must be puncture-proof, leak-resistant, and
rigid, and needles should be dropped into the sharps
container without bending, breaking, or recapping
them.
45.10 Quality assurance and quality control programs
serve to reduce testing errors and provide for the
safety of laboratory personnel.
45.11 Accurate quality control documentation in a
physician’s office laboratory includes a reference
laboratory log and a daily workload log.
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45-52
In Summary (cont.)
45.12 Common reference materials used while performing
procedures in a physician’s office laboratory include
Material Safety Data Sheets, standard operating
procedures, safety manuals, equipment
manufacturers’ user or reference guides, Clinical
Laboratory Technical Procedure Manuals, regulatory
documentation, and maintenance and housekeeping
schedules.
45.13 It is the medical assistant’s responsibility to ensure
that patients understand what is expected of them
before a test. Providing clear pretest instructions in
both oral and written form is an essential part of the
test procedure.
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45-53
End of Chapter 45
Quality is
not an act, it
is a habit.
~ Aristotle
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.