Laboratory and Equipment Safety

1. 45 Laboratory and Equipment Safety

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.

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.

4. 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.

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.

6. 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 Introduction

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

8. 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 Role of Laboratory Testing(cont.) Some managed care companies require their subscribers to use a specific reference laboratory.

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

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!

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

12. 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 Medical Assistant’s Role (cont.)

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. Very Good!

14. Use of Laboratory Equipment • You may routinely use the following: • Autoclave • Centrifuge • Microscope • Electronic equipment • Equipment used for measurement

15. Use of Laboratory Equipment(cont.) • Autoclave – sterilizes surfaces of instruments and equipment • Centrifuge– spins and separates specimen into its component parts

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

17. 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 Microscope

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 Microscope (cont.)

19. 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

20. 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 Use of Laboratory Equipment (cont.)

21. 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: D C E G Nice Job! F A B

22. 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

23. OSHA Guidelines • Standard Precautions • Hazard communication standards • OSHA Bloodborne Pathogens Standard • Hazardous Waste Operations and Emergency Response Final Rule • Needlestick Safety and Prevention Act

24. 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

25. Hazard Communication • Biohazard labels • Material Safety Data Sheets (MSDS) • Hazard labels • Name of material • Hazardous effects

26. 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

27. 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 Safety in the Laboratory (cont.)

28. Accident Prevention Guidelines • Physical safety • Common sense • PPE • Manufacturers’ guidelines • Fire and electrical safety • Fire drills • Fire extinguishers • Reduce electrical hazards

29. Chemical safety MSDS PPE Biologic safety Standard Precautions Disinfection Waste disposal Accident reporting Office procedures Ensure safety/first aid Clean up Safety in the Laboratory (cont.)

30. 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

31. Apply Your Knowledge What information must be included on the MSDS? E X C E L L E N T ! • 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

32. 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 Quality Assurance Programs

33. 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

34. Moderate-complexity tests 75% of tests Qualified laboratory personnel Random inspections High-complexity tests Tests for specialties and subspecialties Qualified laboratory personnel Random inspections CLIA (cont.)

35. Quality control program Adherence to procedures Careful documentation Instrument and equipment maintenance Proficiency testing Training and continuing education Standard operating procedures documentation Components of Quality Assurance

36. 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

37. Reference laboratory log Daily workload log Quality Control and Maintenance (cont.) • 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

38. 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

39. 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

40. QA Programs (cont.) • Requisition forms • Medical assistant’s responsibility • Complete information • Include with specimen or send with patient to laboratory

41. 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!

42. 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

43. 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

44. Record Keeping • Quality control and equipment maintenance • Inventory control • Record test results in patient records • Tracking of specimens

45. Patient records Identify unusual findings Follow office procedures Specimen identification Patient information Person who collected specimen Physician Record Keeping (cont.) Patient: Jason Jones DOB: 10/22/0000 Date / time: 04/14/0000 @ 9:00 AM Collected by: shf Physician: M. Welby

46. Apply Your Knowledge Bravo! • 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. • 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.

47. 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.

48. 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.

49. 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.

50. 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.