© 2009 the mcgraw-hill companies, inc. all rights reserved laboratory and equipment safety...
TRANSCRIPT
© 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
© 2009 The McGraw-Hill Companies, Inc. All rights reserved
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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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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Learning Outcomes (cont.)
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.
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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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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
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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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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.
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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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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!
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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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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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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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Use of Laboratory Equipment You may routinely use the
following: Autoclave Centrifuge Microscope Electronic equipment Equipment used for
measurement
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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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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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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
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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.)
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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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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
Photometer – measures light intensity
Equipment used for measurement Pipettes Flasks or beakers Hemocytometer Thermometers
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Apply Your Knowledge
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!
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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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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
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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
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Safety in the Laboratory (cont.)
Hazard communication Biohazard labels
Material Safety Data Sheets (MSDS)
Hazard labels Name of material Hazardous effects
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Safety in the Laboratory (cont.)
OSHA Blood-borne Pathogens Standard Written OSHA Exposure Control Plan
Training Bloodborne pathogens PPE Universal Precautions Prevention of exposure
Hepatitis B vaccination
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Safety in the Laboratory (cont.)
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
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Safety in the Laboratory (cont.)
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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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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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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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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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
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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
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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
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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
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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
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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.)
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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
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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
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QA Programs (cont.)
Requisition forms Medical assistant’s
responsibility
Complete information
Include with specimen or send with patient to laboratory
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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.
QualityAnswer!
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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
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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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Record-Keeping Quality control and equipment
maintenance
Inventory control
Record test results in patient records
Tracking of specimens
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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
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Apply Your Knowledge
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!
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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
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End of Chapter
Quality is not an
act, it is a habit.
~ Aristotle