NHA Module 7 - Point of Care Testing and Laboratory Procedures

Medical laboratories

Commonly found in hospitals, ambulatory care facilities, public health departments, health maintenance organizations, and referral laboratories.

Roles in clinical laboratories

Director, certified medical technologists (MTs), medical laboratory technicians (MLTs), medical laboratory assistants (MLAs), certified clinical medical assistants (CCMAs), and phlebotomists.

Role of medical assistants (MAs)

Collect specimens that are sent to outside reference laboratories for testing.

Purposes of laboratory tests

To document health, screen for diseases, aid in diagnosis, determine appropriate treatment, and monitor treatment effects and disease progression.

Lab requisitions

Necessary when sending specimens to an outside laboratory for testing.

Consequences of inaccurate lab requisition

The specimen may be rejected, leading to patient dissatisfaction and delayed treatment.

Specimen label information

Patient's name, date of birth, date and time of collection, and the medical assistant's initials.

Labeling specimen containers

Specimen containers should be labeled instead of the lid to prevent mix-ups, as lids can be mistakenly placed on different containers.

Verification before sending specimens

The labels should be checked against the patient's health record and the lab order.

Patient information in lab requisition

Patient demographics, provider's signature or authentication, and specific tests ordered.

Organization of tests on requisition

Based on the clinical laboratory department that will perform the test.

Additional information on lab requisition

The source of the specimen, date and time of collection, and diagnosis code related to medical necessity.

Urinalysis department examination

Examines the physical, chemical, and microscopic properties of urine.

Hematology department analysis

Analyzes blood cell counts, including RBCs, WBCs, and platelets.

Tests in the chemistry department

Conducts blood, cerebrospinal fluid, urine, joint fluid analysis, lipid profiles, and fasting glucose.

Microbiology department study

Studies bacteria, fungi, parasites, yeasts, and viruses from specimens such as urine, blood, sputum, cerebrospinal fluid, stool, and wound material.

Cytology department focus

Focuses on the microscopic examination of cells for diagnostic purposes.

Function of the blood bank

Processes and stores blood and blood products for transfusion and blood disorder treatments.

Selecting laboratory tests

Based on the provider's orders.

Documentation for urine screenings

The urine temperature at the time of specimen collection.

Confirmation before fasting blood test

That they have fasted and not consumed food or liquids if required.

Importance of demographic accuracy

Ensures proper billing and patient identification.

Demographic information on requisition form

Patient name, address, date of birth, sex, telephone number, insurance information, provider information, diagnosis code, and order date.

Purpose of pregnancy testing

To screen for human chorionic gonadotropin (hCG) in urine or blood.

Rapid streptococcus test

Screens for Group A streptococcus using a throat swab.

Dipstick, tablet, or multi-stick urinalysis

Tests for various analytes excreted in urine, such as glucose, protein, bilirubin, nitrite, blood, leukocytes, pH, and specific gravity.

Analytes in urine

Various analytes excreted in urine, such as glucose, protein, bilirubin, nitrite, blood, leukocytes, pH, and specific gravity.

Hemoglobin testing in point-of-care

Using capillary blood from a fingerstick to screen for the oxygen-carrying protein in whole blood.

Spun hematocrit test

A test where blood from a capillary puncture is collected in microcapillary tubes, centrifuged, and evaluated for red blood cell percentage.

Blood glucose test

Whole blood is tested using a glucometer for a quantitative glucose level, often for diabetes screening.

Hemoglobin A1C test

It determines blood glucose control over a 3-month period using capillary blood.

Cholesterol testing

Lipids in a capillary blood sample using a reagent strip and a cholesterol testing machine.

Helicobacter pylori detection

Through a whole blood sample screening for H. pylori antibodies.

Mononucleosis screening

To test for the Epstein-Barr virus in a capillary blood sample.

Nasopharyngeal swab specimen

Influenza Types A and B using a qualitative antigen test.

Drug testing

The presence of recreational drugs and medications in urine or blood samples.

Fecal occult blood test

To screen for hidden blood in the stool using a fecal occult blood testing kit.

FDA requirements for testing

The FDA requires all testing to meet federal guidelines and determines the complexity of tests performed in laboratories.

CLIA-waived testing

CLIA-waived testing is the simplest form of laboratory testing, commonly performed in ambulatory care centers, with minimal risk of incorrect results.

Trained personnel for CLIA-waived testing

Medical assistants are trained to perform CLIA-waived testing under a provider's request.

CLIA

CLIA stands for the Clinical Laboratory Improvement Amendments, established in 1988 to ensure quality diagnostic testing.

Laboratory testing designations under CLIA

The three designations are CLIA-waived (low complexity), moderate-complexity, and high-complexity tests.

Facilities performing CLIA-waived tests

Ambulatory care centers and home environments commonly perform CLIA-waived tests.

Requirements for moderate- and high-complexity tests

They must have a CLIA certificate and undergo inspections to ensure compliance with regulations.

Provider-performed microscopy (PPM)

PPM is a form of moderate-complexity testing that allows providers to screen some specimens, such as urine or body excretions, microscopically to aid in preliminary diagnosis and treatment.

Quality assurance (QA) in laboratory testing

QA ensures reliability and accuracy of test results by implementing policies and procedures.

Quality control (QC) in laboratory testing

QC is a part of QA that focuses on maintaining test reliability and accuracy by identifying and eliminating errors.

Quality control measure example

Checking the expiration date of urine reagent strips before use.

Quality assurance measure example

Rotating stock so that the newest containers are placed in the back of the storage area.

Laboratory refrigerator temperature range

2° C to 8° C (35° F to 46° F).

Specimen Collection Guidelines

Collect at the appropriate time, Collect from the suspected infection site, Minimize transport time, Collect the correct quantity, Use proper containers and labeling

Importance of matching specimens

Mismatching specimens can delay diagnosis, treatment, and cause laboratory errors.

Most commonly tested specimen in ambulatory care

Urine

Random urine specimen

A random urine specimen can be collected at any time and is used for screening purposes. It is collected in a clean, non sterile container.

First-morning urine specimen for pregnancy testing

It is more concentrated and provides a more accurate analysis of analytes like hCG (pregnancy hormone), protein, or nitrites.

Clean-catch midstream urine collection

The patient must cleanse the genitalia using antiseptic wipes, start urinating in the toilet, pause, and then collect the remaining urine in a sterile container. This method helps prevent contamination and is used for cultures.

24-hour urine sample

A 24-hour urine sample collects all urine over a full day, except for the first void, which is discarded. It is used for quantitative analysis of kidney function and substances released sporadically.

Catheterized urine collection

When a sterile urine sample is needed or if the patient cannot provide a specimen on their own. A catheter is inserted through the urethra into the bladder to collect the sample.

Fecal occult blood test (FOBT)

It detects hidden blood in stool, which may indicate gastrointestinal bleeding or disease.

Dietary and medication restrictions before FOBT

Avoid red meats, foods with dyes, aspirin, vitamin C, and iron supplements for three days before testing to prevent false-positive results.

Specimen collection for cultures

In sterile containers, avoiding contact with the inside of lids, swabs, or containers to prevent contamination.

Importance of proper specimen collection for cultures

Improper collection can lead to contamination, preventing the identification of the causative agent and delaying proper treatment.

Role of a medical assistant in specimen handling

To obtain, process, and prepare the specimen for transportation while following standard precautions to prevent contamination and infection.

Consideration of specimens as potentially infectious

To protect the medical assistant, patient, and others from exposure to disease-causing microorganisms.

Most effective way to prevent the spread of infection when handling specimens

Handwashing.

Common types of specimens in ambulatory care

Blood, urine, and swab samples.

Patient identifiers to verify before processing a specimen

Name, assigned identification number, date of birth, phone number, and address.

Necessity of proper specimen processing before transport

To maintain the integrity of the specimen and ensure accurate test results.

Example of a specimen processing technique

Ensuring a swabbed specimen is moist by breaking the fluid chamber within the specimen container.

Centrifugation of urine specimen before transport

To remove the supernatant fluid for microscopic analysis.

Handling of urine sample for bilirubin testing

It should be stored in a dark container to protect it from light, which could affect test accuracy.

Time limit for urine sample before refrigeration

One hour; otherwise, bacteria growth may lead to inaccurate test results.

Packaging of specimens for transport

Specimens should be packaged appropriately to prevent contamination and ensure safe transport.

Specimen packaging

In a clear plastic bag with a zip closure and dual pockets to separate the specimen from the lab requisition.

Safety measures for breakable specimen containers

Wrap them in absorbent material and place them in a biohazard bag.

Biohazard identification requirement

To alert handlers of the potentially infectious nature of the package.

Chain of custody

A documented process ensuring a specimen's integrity, particularly for legal drug and alcohol tests.

Chain of custody form signing

To confirm proper handling and prevent tampering.

Donor requirements for urine specimen

Sign a consent form explaining the test's purpose and giving permission for specimen collection and transport.

Donor listing for drug or alcohol testing

Any prescription or nonprescription substances taken in the last 30 days.

Disposal method for breakable specimen containers

In a sharps container.

Disposal method for non-breakable specimen containers

Red biohazard waste bags.

Urine specimen disposal

A designated sink.

Guidelines for handling specimens

Facility policies, OSHA standards, and laboratory reference manuals.

Importance of knowing test result values

To recognize abnormal results, notify the provider when necessary, and educate patients as directed.

Impact of electronic medical records (EMRs)

EMRs expedite communication through the provider portal, eliminating the need for faxed or printed results.

Medical assistant's action during lab result review

Note the date of the review, the action taken, and ensure results are accessible to patients if possible.

Releasing lab results to a patient

Ensure the provider has reviewed and signed off on the results.

Importance of accurate communication of lab results

Miscommunication can have significant and adverse effects on patients.

CLIA requirement for critical laboratory values

Rapid communication of critical values to the provider.

Action on receiving critical test result call

Repeat the test results back to ensure accuracy, notify the provider immediately, and document the communication.

Normal reference range for hemoglobin (Hgb) in males

13.5 to 17.5 g/dL.

Normal reference range for hemoglobin (Hgb) in females

12 to 16 g/dL.

Normal hematocrit (Hct) range for males

41% to 53%.

Normal hematocrit (Hct) range for females

36% to 46%.

Normal range for white blood cell (WBC) count

4,500 to 11,000/mm³.

Normal red blood cell (RBC) count for males

4.5 to 5.9 million/mm³.

Normal red blood cell (RBC) count for females

4 to 5.5 million/mm³.

Normal platelet count

150,000 to 400,000/mm³.

Percentage of white blood cells that should be granulocytes

50% to 70%.