New CCMA Module 7: Point of Care Testing and Laboratory Procedures

Clinical Laboratories

Facilities found in hospitals, ambulatory care centers, public health departments, etc., staffed by medical professionals to perform tests for patient health.

Lab Personnel

Includes directors, medical technologists, medical laboratory technicians, medical laboratory assistants, clinical medical assistants, and phlebotomists.

Specimen Collection

The process of properly collecting and labeling patient specimens for testing at outside reference laboratories, crucial for accurate test results.

Lab Requisitions

Forms required when sending specimens to outside laboratories, containing patient demographic info, provider's signature, specific tests ordered, specimen source, and diagnosis code.

Clinical Laboratory Departments

Includes urinalysis, hematology, chemistry, microbiology, cytology, and blood bank, each specializing in different types of specimen examination.

Urinalysis

Includes the physical, chemical, and microscopic examination of urine

Hematology

Blood cell counts that determine RBC's, WBC's, and platelets of a blood specimen

Chemistry

chemicals found in blood, cerebrospinal fluid, urine, joint fluis, lipid profiles (triglycerides, total cholesterol, HDL, LDL), and fasting glucose

Microbiology

studying bacteria, fungi, parasites, yeasts, and viruses, specimens can include urine, blood, cerebrospinal fluid, stool, and wound material

Cytology

Microscope examination of cells for diagnostic purposes

Blood Bank

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

Point-of-Care Tests

CLIA-waived tests easily performed in provider office laboratories, including pregnancy testing, rapid streptococcus testing, urinalysis, hemoglobin screening, and more.

CLIA-Waived Testing

Designation for the simplest form of laboratory testing, commonly performed in ambulatory care centers and medical offices with minimal risk of incorrect results.

Pregnancy Test

Urine or blood is screened to detect the presence of human chorionic gonadotropin (HCG)

Rapid Streptococcus Testing

Throat swabs are obtained to screen for Group A streptococcus. Both sides of the posterior throat/tonsil area are swabbed and tested for the presence of the group A antigen

Dipstick, Tablet, or Multistick Urinalysis

The urinalysis is a screening tool for analytes that are excreted in the urine, the urine sample is performed with a reagent strip

Hemoglobin

A machine is used to screen for the oxygen-carrying protein in whole blood, performed using a capillary blood from a fingerstick (capillary puncture)

Spun Hematocrit

Fingerstick collection of blood is obtained in a microcapillary tubes, which are centrifuged and evaluated for the percentage of RBC's

Blood Glucose

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 fingerstick

Hemoglobin A1C

Capillary blood test deterimes the approximate control of blood glucose over an approximate 3 month period

Cholesterol Testing

Lipids are evaluated from a capillary blood sample. The sample is placed on a reagent strip and analyzed in a cholesterol testing machine.

Helicobactor pylori (H. pylori)

A whole blood sample can screen for the presence of H.pylori (bacteria can infect the stomach, causes ulcers)

Mononucleosis Testing

Tests for the presence of the Epstein-Barr virus in capillary blood sample

Influenza type A and B Testing

A qualitative test for multiple influenza antigens using a swab that is inserted into the nostril to obtain the specimen

Drug Testing

Testing for substances such as recreational drugs and medications can be detected in urine and blood samples

Fecul Occult Blood Test

performed to screen for hidden blood in the stool

Moderate- and High-Complexity Tests

Nonwaived tests that are considered more complex and carry a higher risk of incorrect results compared to CLIA-waived tests.

Nonwaived tests

Moderate- and high-complexity tests requiring CLIA certificate and lab inspections.

CLIA certificate

Certificate required for labs performing moderate- and high-complexity tests.

Reference laboratory

Lab where moderate- and high-complexity tests are typically performed.

Provider-performed microscopy procedures

Microscopic screening of specimens like urine, approved by CLIA for preliminary diagnosis.

Quality assurance (QA)

Comprehensive policies and procedures for test result reliability.

Quality control (QC)

Specific measures for test reliability, e.g., reviewing expiration dates.

Specimen collection

Process of collecting, handling, and transporting specimens for testing.

Specimen Collection Techniques and requirements

Collect the specimen at the right time, from the site of suspected infection, minimize transport time, collect the appropriate quantity, use the appropriate containers and label them accordingly

Random urine

Urine sample collected at any time of day for screening purposes. The patient urinates in a clean, nonsterile, container.

First morning specimen

Patient collects their first urine specimen of the morning in a clean container. It is more concentrated and used for specific tests like pregnancy testing or for checking protein and nitrites

Clean-catch midstream

Urine collected after cleansing genitalia area using 3 moist antiseptic wipes. The pt. will begin by urinating in the toilet, then pause and collect the rest of the urine in a sterile cup. used for cultures or noncontaminated specimens are required

24-hour sample

Use a large container with perservatives. The pt. discards their 1st morning urine specimen and collects all remaining urine for the next 24 hrs., including the 1st morning void of the second day. important for quantitative analysis of components such as protein when analyzing kidney function. Also used to analyze substances that are sporadically released into urine over 24 hr. period

Catheterized collection

Insertion of a sterile tube for urine collection when sterile sample is needed or pt. is unable to provide a specimen on their own. The MA preps the patient and assists the nurse or provider as needed.

Fecal occult blood test (FOBT)

Test requiring stool specimen collection to screen for hidden blood. Can indicate the presence of disease or GI bleeding

The MA should instruct pt's to avoid what medications and food for 3 days prior to obtaining a fecal occult blood test because they could cause a false positive

red meats or dyes, aspirin or aspirin products, vit. C, and iron supplements

Sterile containers

Containers used for collecting specimens for cultures to avoid contamination. Use precautions to avoid touching the inside of lids, swabs, or containers.

Which category of tests is most often offered in a laboratory at a provider's office

CLIA- waived

How many antiseptic wipes will a MA provide a female patient when instructing them to collect a clean catch midstream urine

3

Standard precautions

Precautions to protect against exposure to infectious micro-organisms when handling specimens.

Patient identifiers

Information like name, ID number, date of birth, etc., crucial for accurate testing.

Handwashing

Most effective means of preventing the spread of infection when handling specimens.

Centrifuging

Process of separating components in a specimen by spinning at high speed.

Supernatant fluid

The liquid lying above a solid residue after centrifugation.

Refrigeration

Preservation method to prevent bacterial growth in specimens like urine.

Specimen transport packaging

Appropriate packaging for transporting specimens to maintain integrity.

Specimen Transport

The process of packaging and transporting specimens, including the use of clear plastic bags with zip closures, padding for breakable containers, and biohazard identification for mail transport.

A MA is obtaining a urine specimen that is being tested for bilirubin. What kind of container should they use

Dark container. Light affects the accuracy of the test

Urine samples need to be tested within what amount of time?

1 hour. If it has been 1 hr urine should be refrigerated to prevent bacteria from growing

Legal Specimen

A specimen, such as a urine sample for drug and alcohol analysis, that may be used in a court of law and requires careful handling and documentation. Sample must be put in a specimen bag that is permanently sealed until it is opened for analysis

Chain of Custody

A documented process of handling a specimen, including signatures from everyone who handles it, to ensure its integrity and prevent tampering.

Biohazard Waste Disposal

The proper disposal of specimens to prevent the spread of infection, using red biohazard waste bags for non-breakable containers and sharps containers for breakable items.

Expected Values

The normal ranges and values of test results that a medical assistant should be familiar with when performing office laboratory testing.

Electronic Medical Records (EMRs)

A digital version of a patient's paper chart, providing immediate access to information and facilitating the communication of laboratory test results.

HIPAA Compliance

Adherence to the Health Insurance Portability and Accountability Act regulations when communicating patient information, including verifying identity when sharing results over the phone.

CLIA

The Clinical Laboratory Improvement Amendments, which require rapid communication of critical laboratory values and the implementation of quality control measures in laboratory testing.

Quality Assurance (QA) in Laboratory

The process of ensuring accuracy and reliability in laboratory testing, involving three stages: preanalytical, analytic, and postanalytical phases.

Preanalytical Phase

The stage of laboratory testing that includes test ordering, specimen collection, labeling, and transportation, with potential errors such as misidentification of the patient or inadequate sample collection.

Analytic Phase

The stage of laboratory testing involving instrument maintenance, specimen testing, result comparison, and documentation, with potential errors like equipment malfunctions or sample mix-up.

Postanalytical Phase

The final stage of laboratory testing, including proper specimen disposal, quality control analysis, result interpretation, patient notification, and documentation, with potential errors like failure to report or excessive turnaround time.

Data Entry

Accurate recording, a key responsibility of the medical assistant

Turnaround Time

The time taken to complete a process or task

Specialty Tests

Tests performed in the medical office, excluding point-of-care and CLIA-waived tests

Screening Tests

Tests frequently conducted in ambulatory care to guide treatments or referrals

Vision Testing

Noninvasive screening to detect visual abnormalities, using a Snellen chart for distance vision and Jaeger eye chart for near vision

Snellen Chart

Used to test distance vision to evaluate for myopia

Myopia

nearsightedness

Instructions for vision testing using the Snellen chart

Adults stand 20 feet away and children stand 10 feet away

Each eye is tested individually and then both together

Patients are allowed to wear prescription glasses

The last line they can clearly read is the screening result

Patient can miss one item on the line and still pass

presbyopia

a refractive disorder that occurs with aging

Hyperopia

farsightedness

Chart used for near vision testing

Jaeger eye chart

Instructions for the Jaeger eye chart

Patient is asked to read words at various sized prints on cards that are held 14 to 16 inches away from eyes

No corrective lenses

Each eye is tested individually then together

The level at which the patient can read the smallest printing clearly and accurately is the final result

The most common type of color defiency

red-green

Color Vision Testing

Screening for color deficiency using Ishihara test color-plate book. If the patient misses 4 or more there might be a color deficiency and further testing is warrented

Hearing Screenings

Valuable tool in detecting hearing loss, using an audiometer to measure hearing acuity

Tympanometry

Records movement of the tympanic membrane to detect fluid and potential infections in the middle ear.

Normal tympanogram has a peak on the gragh

Abnormal- flat line

Audiometry

Measures hearing level in decibels and frequency in hertz using headphones and various tones

Normal hearing results

Adult- hear tones below 25 decibels

Child- hear tones below 15 decibels

Allergy Testing

Skin testing to identify allergens, requiring patient education on preparation and discontinuation of antihistamines

Patient education for allergy testing

Discontinue the use of antihistamines 3 days prior to testing

Scrath Test

A diluted allergen is applied to a scratch or prick on the surface of the skin. If a wheel occurs in the first 15 minutes the allergist can identify the substance as a possible Allergen. The larger the wheal, the more significant the allergy

Intradermal Allergy Test

A diluted allergen is injected intradermally, and the patient is observed. An initial wheal is expected. If the wheal becomes inflamed with induration the substance is confirmed an allergen

Spirometry

Noninvasive test to detect lung function, comparing predicted respiratory values to measured values

Instructions for spirometry Test

Patient should wear loose clothing

Sitting or standing position

Breath through the mouth pursing lips around mouth piece

MA applies clip to nose to avoid nose breathing during test

Take the deepest breath possible

Blow as hard and fast as possible, blowing until you empty lungs

The procedure is repeated until there is 3 acceptable attempts

Pretest preparation for spirometry

No large meals 2 hours before the test

No smoking 1 hour before the test

Discontinuation of the use of bronchodilators or other breathing therapies 6 hours before the test

Peak Flow Meter

Measures forced expiratory volume to indicate airflow effectiveness, helpful for monitoring chronic respiratory diseases like asthma and COPD. Patient can do at home

Normal Peak flow rating

80% or better is considered well-controlled and does not require treatment

Patient instructions for Peak flow

Wear nonrestrictive clothing

Begin with the marker at the bottom of the scale on the meter

In an upright sitting or standing position, take a deep breath and forcefully blow out of the mouth

Record the number where the marker is located at the end of the test

Repeat the test 2 to 3 times and record results

Demonstrate the technique for the patient and let them practice

cytology

microscope examination of cells to identify a diagnosis

hematology

study of cause, prognosis, treatment, and prevention of diseases related to blood

microbiology

study of all living organisms that are too small to be visible by the naked eye

cholesterol

a waxy, fatlike substance made by the liver

human chorionic gonadotropin (hCG)

hormone secreted by the placenta during pregnancy

analytes

a substance or chemical that is being identified and measured