Standard 22B
Instructional Areas
Recommended Materials
• Guide to Accreditation
• NAACLS Glossary of Terms
•
Standard 22B
The standard states:
– The curriculum must include:
1. Scientific content (either prerequisite or as an integral part of the
curriculum) to encompass areas such as anatomy/physiology,
immunology, genetics/molecular biology, microbiology,
organic/biochemistry, and statistics.
2. Pre-analytical, analytical, and post-analytical components of
laboratory services, such as hematology, hemostasis, chemistry,
microbiology, urinalysis, body fluids, molecular diagnostics,
immunology, phlebotomy, and immunohematology. This includes
principles and methodologies, performance of assays, problem-solving,
troubleshooting, techniques, interpretation of clinical procedures and
results, statistical approaches to data evaluation, and continuous
assessment of laboratory services for all major areas practiced in the
contemporary clinical laboratory.
Standard 22B is continued on next slide.
•
Standard 22B
The standard states (continued):
– The curriculum must include:
3. Principles and practices of quality assurance/quality improvement as applied to the pre-analytical,
analytical, and post-analytical components of laboratory services.
4. Application of safety and governmental regulations and standards as applied to laboratory practice.
5. Principles of interpersonal and interdisciplinary communication and team-building skills.
6. Principles and application of ethics and professionalism to address ongoing professional career
development.
7. Education techniques and terminology sufficient to train/educate users and providers of laboratory
services.
8. Knowledge of research design/practice sufficient to evaluate published studies as an informed
consumer.
9. Concepts and principles of laboratory operations must include:
a. Critical pathways and clinical decision making;
b. Performance improvement;
c. Dynamics of healthcare delivery systems as they affect laboratory service;
d. Human resource management to include position description, performance evaluation,
utilization of personnel, and analysis of workflow and staffing patterns, and;
e. Financial management: profit and loss, cost/benefit, reimbursement requirements,
materials/inventory management.
Standard 22B
Learning Outcomes
Upon completion of this unit of instruction
and review of additional resources, the
learner shall be able to:
1. Identify the scientific content required for the MLS
curriculum as defined by the NAACLS standards
2. Classify a topic/task as a pre-analytical, analytical or
post-analytical laboratory component
3. Categorize examples of curriculum
topics/experiences into the appropriate
instructional areas for MLS
Standard 22B.1
• Standard 22B.1
– The program must insure the scientific content of
courses such as anatomy/physiology, immunology,
genetics/molecular biology, microbiology,
organic/biochemistry and statistics is either:
• Taught as part of the MLS program curriculum
Or
• Taught as a prerequisite university/college course prior
to entry into the MLS program
Standard 22B.1
• A matrix, unique to each discipline, is available
in section IV of the “New Guide for
Accreditation” at
http://naacls.org/accreditation/newguide_acc
reditation.asp
• The matrix helps the program document
where the required scientific content is
provided
Standard 22B.2
• Across the curriculum, the program must insure
the pre-analytical, analytical and post-analytical
components are taught.
– Pre-analytical – all aspects of specimen integrity from
the time the physician places the laboratory orders to
the time the specimen is received in the laboratory
– Analytical – all processes associated with specimen
testing once received in the clinical laboratory
– Post-analytical – all processes involved with result
reporting and delivery
Standard 22B.2
• For all major areas of the clinical laboratory,
the program must insure the curriculum
includes:
– Principles and methodologies
– Performance of assays
– Problem solving and trouble-shooting
– Techniques
– Interpretation of clinical procedures and results
– Statistical approaches to data evaluation
– Continuous assessment of laboratory services
Standard 22B.2
• Two areas within Standard 22B.2 that are
often difficult to grasp include:
– Statistical approaches to data evaluation
•
Opportunities or examples in the clinical laboratory:
–
–
–
–
–
–
–
Sensitivity
Specificity
Confidence interval
Positive and negative predictive values
Delta checks
Trends
Standard deviation
Standard 22B.2
– Continuous assessment of laboratory services
• Opportunities or examples:
– Reflexive testing
– Algorithms and practice guidelines
– Test and instrument evaluation
» Costs versus benefit
» Sensitivity and specificity
» Value provided for physician and patient
» Turn around time
» Training and proficiency testing required
» Screen versus confirmatory results
» Effect on length of stay
– Test evaluation and validation
– Test utilization by physicians
– Use of evidence based medicine
– Benchmark against best practices
Standard 22B.3-9
• While some of the instructional areas described in
Standard 22B.3-9 can be taught throughout the
curriculum, others may be better approached as
topics within a separate course such as management.
• Writing behavioral objectives for these topic areas tend to lend
themselves better to taxonomy levels I and II.
– Level III taxonomy levels may be more difficult to achieve if time is
a limiting factor for the program
• Measurable objectives are required to document achievement of the
appropriate knowledge and skills for each topic area
• These topics can be reinforced by having the student participate in
various projects, such as writing a procedure, during applied education
where many of the examples provided occur each day.
• The opportunities or examples provided are designed to stimulate
ideas for potential inclusion in the curriculum and are not required
specifically by the NAACLS MLS standards.
Standard 22B.3
• Principles and practices of quality assurance/quality
improvement as applied to the pre-analytical, analytical and
post-analytical components of laboratory services
– Opportunities or examples:
• Review of quality control for a clinical area and resolution of
outliers
• Review and assess the quality assurance monitors in the clinical
laboratory
• Attend a laboratory quality committee meeting
• Determine how the laboratory fits into the hospital quality
improvement (QI) program
• Review QI monitors that cross over into other non-laboratory
departments
• Using the CAP accreditation checklist, review the quality
management system of a laboratory
• Review of proficiency testing data
Standard 22B.4
• Application of safety and governmental
regulations and standards as applied to
laboratory practice
– Opportunities or examples:
• Discussion of Accreditation
–
–
–
–
–
–
Clinical Laboratory Improvement Amendments (CLIA)
The Joint Commission (TJC formerly JCAHO)
College of American Pathologists (CAP)
American Association of Blood Banks (AABB)
NAACLS
Others
• Occupational Safety and Health Administration (OSHA)
• Environmental Protection Agency (EPA)
Standard 22B.4
• Opportunities or examples (continued)
• Department of Transportation (DOT)
• Nuclear Regulatory Commission (NRC)
– Compliance
• Health Insurance Portability and Accountability Act (HIPAA)
• Stark and anti-kickback laws
– Medicare/Medicaid reimbursement
•
•
•
•
•
CPT coding
Medical necessity
Advanced beneficiary notice
ICD9 coding soon to transition to ICD10
Fraud and abuse
Standard 22B.5
• Principles of interpersonal and
interdisciplinary communication and teambuilding skills
– Opportunities or examples:
• Conflict management skills
• Verbal, nonverbal and paraverbal (tone, pitch, pace and
inflection of voice) communication
• Telephone etiquette
• Customer service
• Business communication such as an email, memo,
proposal, etc.
• Team building exercises
Standard 22B.6
• Principles and application of ethics and
professionalism to address ongoing
professional career development
– Opportunities or examples:
• Introduction to professional organizations
– ASCP, ASCLS, CLMA, ASM, AACC, others
– Attendance of a national, state or local professional
meetings
• Continuing education
– Journals, seminars, workshops, webinars,
professional meetings, formal academic training,
etc.
– Certification and continuing education maintenance
Standard 22B.6
• Opportunities or examples (continued):
–
–
–
–
Networking
Mentoring
Presentation at a professional meeting
Participation in a professional organization
• Committees, board of directors, officers, student representative
–
–
–
–
–
Specialist examinations
Professional ethics
Hospital medical ethics committee
Program policies such as plagiarism and honesty
Licensure
Standard 22B.7
• Education techniques and terminology
sufficient to train/educate users and providers
of laboratory services
– Opportunities or examples:
• Create and present an in-service for the clinical laboratory
personnel
• Critique the objectives and evaluations for a course within the MLS
program
• Create and present a recruitment session for a grade school, high
school or college
• Develop competency assessment tools
• Create an educational poster presentation for non-laboratory
personnel or the public
Standard 22B.8
• Knowledge of research design/practice
sufficient to evaluate published studies as an
informed consumer
– Opportunities or examples:
• Using a procedure, review the reference(s) cited and
then research for possible updates
• Perform a literature search
• Develop a hypothesis and perform a literature review
• Research a new instrument or test and develop a
proposal for or against its use
• Review a research paper to insure its validity
Standard 22B.9
• Concepts and principles of laboratory
operations must include:
a. Critical pathways and clinical decision making
–
Opportunities and examples:
» Review the laboratory test menu and use tools
available to determine testing overuse, misuse and
underuse by physicians
» Using evidence based research, make suggestions for
changes to the test menu
» Research benchmarks for current best practices
» Review order sets, care pathways and algorithms in
place
» Review reflexive testing available
Standard 22B.9
b. Performance improvement
–
Opportunities and examples:
» Review performance measures in place and note trends
» Attend a quality oversight laboratory or hospital
meeting
» Review quality methodologies such as Six Sigma, LEAN
or ISO
» Identify changes made due to quality indicators in place
and note the effect of the changes
» Review the CAP accreditation guidelines as they relate
to performance improvement
Standard 22B.9
c.
Dynamics of healthcare delivery systems as they
affect laboratory service
–
Opportunities and examples:
»
»
»
»
»
»
»
»
»
Review the laboratory’s mission, vision and value and
strategic plan and determine how it supports those of the
hospital
Review the laboratory’s business plan
Develop an advertising campaign for promotion of laboratory
services
Review data from survey tools related to customer service
Spend the day in the laboratory’s customer service area
Visit an outreach clinic and reference laboratory
Propose ways to work with other departments or facilities to
expand services
Review policies for continuity of operation during a disaster
Investigate the effect of standardization of testing across a
system of hospitals
Standard 22B.9
d. Human resource management to include position
description, performance evaluation, utilization of
personnel, and analysis of workflow and staffing patterns
–
Opportunities or examples:
»
»
»
»
»
»
»
»
Attend a new co-worker orientation
Review the laboratory units of service, operating and capital
budgets with the laboratory director/manager
Examine laboratory job descriptions and performance
evaluation tools
Review training and competency assessments
Create a resume
Work with a supervisor to build a department work schedule
Set up a mock interview for a laboratory position
Given the laboratory’s test ordering pattern, determine the
number of co-workers needed each shift
Standard 22B.9
e. Financial management: profit and loss, cost/benefit,
reimbursement requirements, materials/inventory
management.
–
Opportunities or examples:
» Review a laboratory capital and operating budget
» Review CPT coding for the laboratory test menu
» Review a laboratory test order requisition for
compliance issues
» Review a laboratory budget for variance(s) or trends
» Examine a vendor equipment or supplies contract
» With a supervisor or manager, review the processing of
costing out a test
» Select a new test to add to the laboratory menu and
determine the potential impact to workload volume
» Assist with ordering supplies for a laboratory area
Standard 22B
• While not required specifically by NAACLS,
additional topics/experiences for inclusion in a
management course might include:
– Write a procedure using Clinical and Laboratory Standards Institute
format
– Laboratory information management and technology
– Steps in the critical thinking and problem-solving process
– Time management skills
– MLS in a consultative role in the hospital
– Shadow a laboratory manager or director for a day
– Perform a mock CAP inspection of a clinical laboratory area
– Capstone project or professional portfolio
– Volunteerism and community service
– Professional advocacy
Assessment
Based on the NAACLS MLS standards, which of
the following is considered required
curriculum?
a.
b.
c.
d.
Physics
Statistics
Ecology
College algebra
Assessment
Screening an expectorated sputum specimen
for the presence of squamous epithelial cells
is considered a/an __________ component of
the total testing process.
a. Pre-analytical
b. Analytical
c. Post-analytical
Assessment
Providing MLS students education on the
sensitivity and specificity of the rapid Group A
Streptococcus throat screen would help meet
the NAACLS MLS curricular requirement for
__________ in Microbiology.
a.
b.
c.
d.
Continuous assessment of laboratory services
Performance of assays
Principles and methodologies
Statistical approaches to data evaluation
Assessment
MLS students are provided the opportunity to
meet with a clinical laboratory pathologist and
discuss physician utilization of laboratory
testing. This is an example of education in the
curricular area of:
a.
b.
c.
d.
Problem-solving and trouble-shooting
Financial management
Critical pathways and clinical decision making
Performance improvement
Assessment
A clinical laboratory is considering implementing
LEAN/Six Sigma principles at the facility where
MLS students complete their chemistry clinical
rotation. The Six Sigma black belt instructor
offers to present a lecture to the students on
LEAN and Six Sigma. This would be a example of
curriculum in the area of:
a.
b.
c.
d.
Process improvement
Human resource management
Principles and methodologies
Application of safety and governmental regulations