© 2009 The McGraw-Hill Companies, Inc. All rights reserved Laboratory and Equipment Safety...

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Laboratory and Equipment SafetyLaboratory and Equipment SafetyPowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson


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.


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.


45-4


45.8 Identify the medical assistant’s record-keeping responsibilities.

45.9 Describe correct waste disposal procedures.

45.10 Describe the need for quality assurance and quality

control programs.


45-5


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.


45-6

Introduction Laboratory testing –

integral part of patient care

Medical assistant must know Common laboratory

equipment

Safety in the laboratory

Steps to prevent accidents

CLIA ’88 – impact on laboratory setting Quality assurance

Quality control procedures

Required record-keeping


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


45-8

Role of Laboratory Testing (cont.) Kinds of laboratories

Reference laboratory Owned and operated

by an organization outside the practice

Have technological resources beyond the POL

POL Quicker turnaround Eliminates need for

patient travel to other test location

Some managed care companies require their subscribers to use a specific reference laboratory.


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


45-10

Apply Your Knowledge

Compare a reference laboratory and the POL.

ANSWER: A reference laboratory is 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!


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


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


45-13


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.


45-14

Use of Laboratory Equipment You may routinely use the

following: Autoclave Centrifuge Microscope Electronic equipment Equipment used for

measurement


45-15

Use of Laboratory Equipment (cont.)

Autoclave - sterilizes surfaces of instruments and equipment

Centrifuge – spins and separates specimen into its component parts


45-16


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


45-17

Use of Laboratory Equipment: Microscope Oculars

Eyepieces Monocular Binocular

Contain a magnifying lens – magnify image 10 times (10X lens)

Objectives Contain another

magnifying lens Moved under ocular

when needed Three objectives

Two dry One oil-immersion

Microscope


45-18

Arm and focus controls Arm – attaches oculars

and objectives to body Focus controls – used

to focus the object

Light source Under stage and

substage Adjustable intensity

Stage and substage Stage – platform for

slide Substage – condenser

Specimen slides / coverslip

Microscope

Use of Laboratory Equipment: Microscope (cont.)


45-20


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


45-21


Electronic equipment and software Used to create and

maintain clinical data

More accurate, safer, and more efficient than manual methods

Photometer – measures light intensity

Equipment used for measurement Pipettes Flasks or beakers Hemocytometer Thermometers


45-22


Matching:

___ Measures light intensity A. Focus controls

___ Platform for slide B. Hemocytometer

___ Contains magnifying lens C. Stage

___ One is an oil-immersion D. Photometer

___ Condenser to concentrate light E. Ocular

___ Move body tube up and down F. Substage

___ Calibrated to count cells G. Objective

ANSWER:

G

F

E

D

C

B

ANice Job!


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


45-24

Safety in the Laboratory (cont.)

OSHA guidelines

Standard Precautions

Hazard communication standards

OSHA Bloodborne Pathogens Standard

Hazardous Waste Operations and Emergency

Response Final Rule

Needlestick Safety and Prevention Act


45-25

Safety in the Laboratory (cont.) 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


45-26


Hazard communication Biohazard labels

Material Safety Data Sheets (MSDS)

Hazard labels Name of material Hazardous effects


45-27


OSHA Blood-borne Pathogens Standard Written OSHA Exposure Control Plan

Training Bloodborne pathogens PPE Universal Precautions Prevention of exposure

Hepatitis B vaccination


45-28


Hazardous waste Dispose in proper

containers Sharps Other biohazardous

waste

Location of containers

Reduce spillage

Needlestick Safety and Prevention Act Revision of Bloodborne

Pathogen Standard Use of devices to

reduce risk


45-29


Accident prevention guidelines Physical safety

Common sense PPE Manufacturers’ guidelines

Fire and electrical safety Fire drills Fire extinguishers Reduce electrical hazards


45-30


Chemical safety MSDS PPE

Biologic safety Standard

Precautions Disinfection Waste disposal

Accident reporting Office procedures Ensure safety /

first aid Clean up


45-31


Housekeeping Reduce risk of disease transmission Guidelines

Written policies and procedures Clean up spills / splashes

immediately Clean equipment after use Dispose of waste correctly


45-32


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


45-33

Quality Assurance Programs Monitor the quality

of patient care Ensure safety of

workers Assess the quality

of tests performed

CLIA Regulation of

laboratories Test categories

Certificate of Waiver Moderate complexity High complexity


45-34

QA Programs: Certificate of Waiver Tests

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

Office must apply for a Certificate of Waiver Exempt from CLIA ’88 standards May be randomly inspected


45-35

QA Programs (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


45-36

QA Programs (cont.)

Components Quality control program

Adherence to procedures Careful documentation

Instrument and equipment maintenance Proficiency testing Training and continuing education Standard operating procedures documentation


45-37

QA Programs: 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


45-38

Equipment maintenance Manufacturer’s guidelines Troubleshooting a problem – investigating the

cause using a systematic approach Documentation

Quality control log Reagent control log Equipment

maintenance log

Reference laboratory log

Daily workload log

QA Programs: Quality Control and Maintenance (cont.)


45-39

QA Programs: 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


45-40

QA Programs (cont.)

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


45-41

QA Programs (cont.)

Requisition forms Medical assistant’s

responsibility

Complete information

Include with specimen or send with patient to laboratory


45-42


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.

QualityAnswer!


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 Post-procedure instructions Schedule for further testing, if needed


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


45-45

Record-Keeping Quality control and equipment

maintenance

Inventory control

Record test results in patient records

Tracking of specimens


45-46

Record-Keeping (cont.)

Patient records Identify unusual

findings Follow office

procedures

Specimen identification Patient information Person who

collected specimen Physician

Patient: Jason JonesDOB: 10/22/0000Date / time: 04/14/0000 @ 9:00 AMCollected by: shf Physician: M. Welby


45-47


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.

Bravo!


45-48

In Summary Medical assistant and the POL

Maintain and improve technical skills Keep up on technological, legislative, and

regulatory developments Prevent transmission of disease and occurrence of

accidents Seek ways to improve quality of patient care Perform tests efficiently and accurately Maintain equipment properly


45-49

End of Chapter

Quality is not an

act, it is a habit.

~ Aristotle

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