NHA chapter 11 Testing & Lab procedures

Clinical Laboratories Improvement Amendments (CLIA-waived tests)

have little chance of harm due to error; can be performed in a physician office

Random urine specimen

Pt. urinates in a clean, non sterile container. This specimen is used for screening purposes and does not require fasting and can be performed at anytime

first morning urine specimen

a urine specimen that is collected after a night's sleep; contains greater concentrations of substances that collect over time than specimens taken during the day and is used for pregnancy testing or when other analytes (protein, nitrites) need to be evaluated.

clean-catch midstream urine specimen

Pts. performs perineal cleaning using moist wipes, begins to urinate, and then collects the specimen midstream in a sterile urine container. This is used for cultures or when a non contaminated specimen is desired.

24-hour Urine

this method uses a container with preservatives. The pt. discards the first morning specimen and collects all specimens for the next 24 hours, including the first void of the second day. This type of collection is important in quantitative analysis of the components such as proteins when analyzing kidney function

Catheterized Urine collection

Nurse or provider inserts a sterile tube through the urethra into the bladder and the CCMA preps Pt and assists provider during procedure.

fecal occult blood test

lab test performed to detect blood in the feces which can indicate a disease process or G.I.Bleed. To prevent a false positive instructions on medications and foods to avoid for 3 days prior to testing and the pt is to collect three separate specimens on the filter paper.

tape test for pinworms

Typically collectd on small children. provide Parents with a slide with a piece of tape on it. The tape is placed over child's anus before getting up in the morning and then back on the side and brought back to provider for analysis.

Stool samples for O & P, ova & parasite collection

Stool samples can be collected for parasites and or to evaluate for bacterial infections. Give pt special container and directions for collection at home

sputum culture

microbial test used to identify disease-causing organisms of the lower respiratory tract, especially those that cause pneumonias Pt should produce a deep,productive cough. Pts should avoid mouthwashes prior to sputum collection

collecting culture specimens

Always collected in a sterile container and precautions should be taken not to touch inside of container or lids and swabs which could contaminate the specimen.

Reminders for specimen collections

Collect specimen at the right time, Use the right site of suspected infection, minimize transport time to a reference lab, collect the appropriate quantity, use the appropriate containers and label accordingly.

FDA (Food and Drug Administration)

requires all testing to meet federal guidelines and determines the complexity of the tests performed in the Lab. Ambulatory care centers perform CLIA waived tests.

Point-of-care-testing (POCT)

A mode of testing in which the analysis is performed at the site where healthcare is provided

pregnancy test

blood or urine test to detect the presence of hCG

Rapid Streptococcus testing

Throat swabs are obtained to screen for Group A streptococcus

dipstick urinalysis

involves dipping a type of chemical analysis strip into a sample or urine and reading the colors of the squares that measure the specific gravity, acidity (pH), glucose, ketones, blood, leukocytes, nitrites, bilirubin, and urobilinogen levels in the sample

Hemoglobin machine

Is measured using machine to screen for oxygen-carrying protein in whole blood, performed using capillary blood from a finger stick (capillary puncture).

Spun hematocrit

Fingerstick collection of blood in microcapillary tubes is centrifuged and evaluated for the percentage of red blood cells

blood glucose levels

Whole blood is analyzed in a glucometer for a quantitative glucose level and is a screening test for diabetes, performed using capillary blood from a finger stick(capillary puncture)

Hemoglobin A1c

A test that measures the level of hemoglobin A1c in the blood as a means of determining the average blood sugar concentrations for over approximately three month period

cholesterol testing

Lipids are evaluated using capillary blood

Helicobacter pylori (H. pylori)

a blood test to determine the presence of H. pylori antibodies, which indicate infection with the bacteria; H. pylori is also found in the lining of the stomach and causes duodenal ulcers

Mononucleosis screening

This screening tool tests for the presence of the Epstein-Barr virus in capillary blood

Nasal smear for influenza types A and B

This screening is a qualitative test for influenza antigens using a swab that is inserted into the nostril

Drug Testing

urine, blood screening, or hair analysis used to identify those who may be using drugs

fecal occult blood test

test to detect hidden occult blood in feces

CLIA regulations

Established in 1988 to ensure quality of diagnostic testing through lab regulations. There are three designations for lab testing based on complexity.

CLIA-waived tests

most common designation for ambulatory care and its lowest level of complexity and can be done at home or office

moderate to high complexity and not under the scope of MA

considered non-waived. Labs performing these tests have CLIA waived Certificate and undergo inspections to ensure standards are met. typically performed in reference or hospital labs

Commission on office Laboratory Accreditations (COLA)

is a independent accreditor for labs and focuses on meeting CLIA regulations with a goal of providing the best care to the patient.

Quality Assurance (QA)

is comprehensive and relates to policies and procedures that must be implemented for reliability of the test results(exp putting newest urine test strips in back of older urine strip containers)

Quality Control (QC)

is included in quality assurance but is more specific; it is related to test reliability and accuracy while attempting to uncover errors and eliminate them(reviewing expiration dates on urine mult-sticks)

quality assurance

Policies and procedures to maximize pt safety and ensure reliability related to lab testing.(the policy of checking Lab refrigerator temp and documenting it in a log and making sure the temp is maintained between 39 and 41 degree F)

Controls

specific tools used in lab with a known result, used to compare with results of a pt sample to confirm validity of the test and specimen using a quantitative result range or qualitative descriptor

Quality control procedures

Testing specimens, quality control samples are tested to ensure pt. samples are accurate. example. (exp. if using a fecal occult slide a control strip turns blue if the developer is effective. if the control strip does not turn blue than the developer is not working or the slide is not valid and the test will not be accurate.)

quantitative Urinalysis results

glucose-neg, spec gravity-1.020., pH- 6.1, protein-neg, ketones-neg, WBC's-neg, bilirubin-neg, blood-neg, nitrate-neg, urobilinogen- neg,

Qualitative Urinalysis

urine dip-Clarity-clear, color- amber

Specimen collection containers

containers should be labeled with pt information at the time of collection. The labels should then be verified against the pt chart and lab order before sending the specimen to the lab for processing

MACRA

Medicare Access and CHIP Reauthorization Act of 2015(deals with payment for health care under the direction of the CMS

CMS

Centers for Medicare and Medicaid Services

CMS-1500 form

the standard form used by health-care providers to bill for services, including disease state management services.

CPOE (Computerized Physician Order Entry)

An order entry and decision support system that allows direct entry of orders into Epic. Only Certified(Credentialed) CCMA's are authorized to enter orders including Pharmacy orders

patient demographic information

Patient name, Address, Date of birth, gender, age, Telephone number, Insurance information,Provider information, Diagnostic or indications for testing, last menstrual period if performing a Pregnancy confirmation test and Order date.

The ICD-10 coding Information

Lab Requisition slips are already populated with the appropriate ICD-10 codes. Lab testing is strictly coded from the provider's reason for ordering the test. To appropriately assign codes ensure that complete diagnosis info is included on form.

Testing information

Each test is individually checked unless a panel of tests are required;example Lipid panel testing for liver issues. Validate that the tests on the requisition match the provider's orders in the medical record. If pregnancy test is ordered then add date of last menstrual period.

SPECIMEN LABELS SHOULD INCLUDE

patients full name and date of birth
the date and time of collection and initials of person collecting the specimen
the type of specimen
Providers name

fasting blood sugar (FBS)

goes to Chemistry Lab for processing

white blood cell count (WBC)

goes to Hematology for processing

culture and sensitivity (C&S)

goes to Microbiology for processing

type and crossmatch for blood typing

goes to the Blood Bank for processing

Pap smear test

Papanicolaou (smear or test) is sent to cytology for processing

Nitrate

sent to Urinalysis for processing

The chain of custody is used for what purposes?

Retaining evidence integrity by identifying people coming into contact with evidence especially for a court subpoena to prevent specimen tampering

Bilirubin

a urine test that requires testing for bilirubin needs special handling to protect the specimen from light which would affect the accuracy of the testing is required. A dark container is required for the specimen

processing non-blood specimens

swabbed specimens needs to be kept moist by breaking the fluid chamber within the specimen container
urine specimens for microscopic analysis can require centrifuging prior to transport with the supernatant fluid removed

storing nonblood specimens

Urine should be refrigerated if testing is not immediately performed. Urine left at room temp will have ph changes and be considered unfit for testing,.
Swabs for std testing can be destroyed if they are cooled and should remain at room temperature

transporting nonblood specimens

padding and protection is needed if specimen has the potential to break, and specimens should be put into a biohazard bag with a biohazard label on the outside of shipping packages to warn handlers of potential hazards

proper disposal of nonblood specimens

red biohazard waste bags are sufficient for specimen containers that are not breakable, Use sharps containers for anything that could splinter or break . A designated sink is often adequate for disposal of urine samples. ALWAYS follow the policies and procedures outlined by the facility and adhere to OSHA standards

Hemoglobin(Hgb) Range

Male: 13 - 18 g/dL
Female: 12 - 16 g/dL
Infant: 14 - 22 g/dL

Hematocrit (Hct) Range

Male:42% to 52%
Females: 36% to 48%

fasting blood glucose(FBS)

60 to 110 mg/dL

Total cholesterol levels

Less than <200 mg/dL

low-density lipoprotein (LDL)

Bad cholesterol less than 130 mg/dL

High-density lipoprotein (HDL)

good cholesterol greater than 40mg/dL

Triglycerides

<150 mg/dL

erythrocyte sedimentation rate (ESR, sed rate)

blood test that measures rate at which red blood cells settle out of blood to form sediment in bottom of test tube; indicates presence of inflammatory disease
0 to 20 mm/hr males
0 to 30 mm/hr females

International Normalized Ratio (INR)

Blood coagulation test; commonly performed on patients taking anticoagulants (i.e. coumadin/warfarin)
range 0.8-1.2

Prothrombin Time (PT)

test of the ability of blood to clot
range 10.4 to 15.7 seconds

Urine pH range

4.5

Specific gravity of urine

1.005-1.030

Urobilinogen in urine

Norm- 0.1-1.0; Abn.- absent-biliary obstruction; increasd- early sign of liver or hemolytic disease; reduced- reaction to antibiotic medication

EMR (electronic medical record) Pt lab results

Make sure Dr has signed off on lab results before you release any lab results to pt portal or to pt. Verify correct address before mailing results and verify identification before releasing Lab results by phone to pt.(HIPAA regulations)

abnormal or critical lab values(outside of the established reference range)

CLIA requires rapid communication of critical lab values If CMA takes a call from the reporting lab on a critical Lab value the CMA should ensure accuracy by repeating the lab values back to the laboratory personnel

Hyperopia (farsightedness)

Condition in which a person can see things in the distance but has trouble seeing at close range.

Myopia (nearsightedness)

Condition in which a person can see things close up but has trouble seeing at a distance.

Presbyopia is:

the gradual loss of power to focus on near objects due to the aging process

near vision test(presbyopia or hyperopia)

patient holds card 14 to 16 inches from the eye and reads the chart - without glasses on. Test each eye separately and then both together. This test is for patients with poor eye sight. Test results should read "14/14" (Jaeger card is used)

Distance vision(myopia) should be tested at how many feet?

20 feet- Pt can test with corrective lenses. eyes are tested separately and then together, pt can miss one item and still pass that line. vision is recorded in a fraction, with 20/20 representing normal vision

color vision tests

use of multicolored charts to determine ability of patient to recognize color. screening tests is an 11 plates within the Ishihara book. if pt misses four or more there might be a color deficiency and further testing is warranted

visual field testing (perimetry)

Extent of range of vision in each direction. Sensitivity of vision to a given light stimulus is important in diagnosis of glaucoma. May be affected by eye disease, stroke, space-occupying lesions, trauma, etc.

Tympanometry measures

middle ear function. tests record movement of the tympanic membrane which can be affected by increased pressure in the middle ear.

tympanogram

record of middle ear function (presented in graph form)

abnormal tympanogram

will produce a flat line

audiometry

the use of an audiometer to measure hearing acuity. CMA's can perform audiometry
testing if pts can respond to directions of pushing or raising a hand to acknowledge when various tones are heard through headphones(adults should hear at 25 decibels, child at 15 decibles

Tuning forks to diagnose hearing loss

Sensorineural hearing loss: hears better through the air than through the bone via vibration

Conductive hearing loss: hears better through the bone (vibration) than through the air
vibrating tuning fork is placed on top of the head or on the mastoid process to tst hearing

skin testing for allergies

- apply antigen to non-hairy skin
- scratch skin
- may produce anaphylactic reaction so have epinephrine handy to cause rapid bronchodilation and vasoconstriction so provider needs to conduct testing

scratch test

type of allergy testing in which body is exposed to allergens through a light scratch in skin, If a wheal occurs within 15 minutes the allergist can identify the substance as a possible allergen

Intradermal testing

a diluted allergen is injected ID and the pt is observed. if the wheal becomes inflamed with induration (raised, hard area ) the substance can be identified as an allergen

RAST testing

test blood for specific antibodies that could indicate an allergy. safer regarding avoiding a potential allergic reaction but requires a blood draw.

food challenge testing

used to detect specific food allergies. Not first choice but could be prescribed if scratch test or Intradermal test is positive. Pt is given increased amounts of food suspected of causing an allergy (peanut butter) Environment must be controlled where medication and treatments are available

Peak flow testing

Used to measure a patients ability to exhale, (forced expiratory volume) which indicates the effectiveness of airflow out of lungs diagnosis of asthma

peak flow testing instructions

wear non restrictive clothing -begin with marker at the bottom of the scale on the meter-in a upright sitting or standing position, take deep breath and forcefully blow out of the mouth- record number where the marker is located at the end of the testometry -repeat the test two to three times and record the results

Spirometry measures

lung capacity

Spirometry testing

automated test that produces a graphic result, pt should wear loose clothing, sit in upright or standing position, and breath through mouth, pursing lips around the mouthpiece, CMA applies clip to pt's nose to avoid nose-breathing during procedures. pt should lift the chin slightly and extend the neck a little during test to reduce breathing resistance

pre-test pt instruction prior to spirometry rest

no large meals 2 hours prior to test, no smoking 1 hour prior to test, and discontinuing the use of bronchodilators or other breathing therapies (Inhalers,Nebulizers) for at least 6 hours before the test.