Outcome 4/5

Question 1

Explain how the path of workflow is divided.

Answer 1

The path of workflow for laboratory specimens begins with the test order and proceeds all the way to report, follow-ups, and disposal of the specimen. It is divided into three sections.

Preexamination, Examination, and postexamination.

Question 2

Pre-examination Phase

Answer 2

all the activities from the time the lab tests are ordered through the time specimens are processed and delivered to the examination location.

Question 3

Examination Phase

Answer 3

where specimen testing actually occurs. Usually divided based on the functional and physical space of the laboratory.

Question 4

Post-examination Phase

Answer 4

Review, release, reporting, and retention of results, as well as the retention, storage and disposal of specimens.

Question 5

List Activities in the Pre-examination phase

Answer 5

• Ordering
  The healthcare provider makes a request (verbal, written or electronic) for laboratory examination. The request must include information identifying the patient, requestor, priority and clinfo.
• Specimen collection
  The specimen must be collected either by lab or non-lab staff. Patient preparation, collection instructions, and labeling are all critical aspects of specimen collection.
• Specimen transport
  Information needs to be provided by the lab for any special preservation, handling, packaging, or shipping requirements.
• Specimen receipt, accessioning, and processing
  The specimen is received in the lab. The specimen will be evaluated for condition, and labeling requirements. Specimens that do not meet lab standards are handled according to SOP and the source location is made aware of the issue.

Question 6

List Activities in the examination phase

Answer 6

• Examination Method Selection
  The lab needs to consider customer expectations, and verify manufacturer instrument claims can be met within the lab’s environment. Policies, processes, and procedures are updated.
• Examination Performance
  Includes all the tests performed by the laboratory and processes that ensure proper performance of all automated and manual tests. Quality control is in his phase.
• Result Review and Follow Up
  The lab needs a process to correlate current examinations with previous examinations. QC review process. Processes for results above or below the verified limits of a method.
• Laboratory Results Interpretation
  Criteria for evaluation of results. Includes criteria to evaluate qualitative results, reference intervals, age-specific information, critical values, and any other information necessary to interpret test results.

Question 7

List Activities in the post-examination phase

Answer 7

Review, release, report, and retention of results, as well as the retention, storage and disposal of specimens.

Question 8

Explain how a lack of completeness or correctness along the path of workflow affects patient care.

Answer 8

Lack of completeness or correctness causes patient sample quality to decrease, which can cause increased TAT. This affects how quickly a patient can receive care and can have critical outcomes.

Question 9

Explain why patient instructions are important

Answer 9

The quality of the specimen directly impacts the quality of the result provided by the laboratory. Poor specimens may need to have additional steps done to them, or may incorrectly reflect the patients true values. Additionally, incorrectly collected samples can lead to recollection. All these factors increase the turn around time of the test lowering the quality patient care.

Question 10

Describe the collection requirements for: 24-hour urines

Answer 10

Determine what type of preservative and container is required for the test requested.

Label the container with: Patients name, PHN, location, Test request, Physician, Test start, test end.

At the time you start your 24-hour collection, empty your bladder into the toilet.

Collect every subsequent urination for the next 24 hour period, and store the container in a cool dry place.

Deliver the container to the laboratory the day the test is completed.

Question 11

Describe the collection requirements for: Semen

Answer 11

Specimens are collected following sexual abstinence of a minimum of three days, but no longer than five days.

The best specimen is collected by masturbation, as the greatest concentration of sperm is found in the first portion of the ejaculate.

Do not use any contraceptive devices (lubes, condoms, powders)

Specimens are collected in a sterile plastic container labelled with the patient’s name, PHN, and date/time of collection.

If the specimen is collected for fertility testing it must be kept at body temperature and delivered to the lab within one hour of collection. If the specimen is collected for post-vasectomy testing the sample does not need to be kept at room temperature.

Question 12

Describe the collection requirements for: FIT testing

Answer 12

Do not start collection if you have active bleeding (ex. menstruation)

Label the container with the patient’s name, and date and time of collection.

Deposit stool into a clean dry container or onto plastic wrap.
Scrape the surface of the stool with the collection stick

Close the collection container and do not reopen it. Place the container into the plastic bag and reseal it.

Dispose of the remaining stool.

Wash your hands.

Question 13

Describe the collection requirements for: Ova and Parasite

Answer 13

The SAF solution in the stool container is poisonous

Deposit stool into a clean dry container or onto plastic wrap.

Scoop stool into the SAF container, upt to the fill line.

Ensure specimen is well-mixed with the fixative

Ensure the container is labeled with the patient’s name and PHN.

`Patient history sheet is required.

Question 14

Describe the collection requirements for: Pinworm Collection

Answer 14

Label the container with the patient’s name, PHN

The best sample collection time is early in the morning

Do not wash or wipe the rectal area prior to collection

Press the sticky side of the paddle gently against the skin around the anus

Wash hands immediately after collection

Bring the specimen to the lab as soon as possible

Question 15

Explain the importance of labelling

Answer 15

Ensures the patient is protected from any mistakes resulting from improperly handled specimens.

Question 16

Describe the recommended methods of transport for optimum sample quality: Semen For Fertility Testing

Answer 16

Sample must remain at body temperature and be delivered to the lab within 1 hour of collection.

Question 17

Describe the recommended methods of transport for optimum sample quality: Semen Post-Vasectomy

Answer 17

Sample should arrive at the lab as soon as possible, the sample can arrive at room temperature as sperm motility is not being examined, only the presence of sperm will be noted.

Question 18

Describe the recommended methods of transport for optimum sample quality: 24 HR Urine

Answer 18

Sample should be transported to the lab the day the collection is finished. The urine may have a preservative.

Question 19

Describe the recommended methods of transport for optimum sample quality: FIT Testing

Answer 19

Should be returned to the lab ASAP. Specimens not received within 7 days will need to be recollected.

Question 20

Describe the recommended methods of transport for optimum sample quality: Ova and Parasite

Answer 20

Brought to the lab ASAP. If repeat specimens are ordered, a new container should be provided. Specimens can remain at room temperature or be refrigerated.

*3 specimens collected 2 days apart for no longer then 10 days is ideal

Question 21

Describe the recommended methods of transport for optimum sample quality: Pinworm

Answer 21

Brought to the lab ASAP.

Question 22

Explain the pre-examination processing requirements for: Semen

Answer 22

Examination should occur immediately upon arrival at the laboratory.

Fertility - Appearance, volume, viscosity, pH, sperm count, sperm motility, sperm morphology,

Post-vasectomy - Examination of a wet prep. A negative wet prep is centrifuged, and the pellet is examined.

Question 23

Explain the pre examination processing requirements for: 24 HR Urine

Answer 23

Check all information on the requistion and urine container label to ensure all the required data has been completed. The urine must be mixed well, and the total volume of urine is measured. Aliquot the urine for testing and storage.

Question 24

Explain the pre examination processing requirements for: FIT Testing

Answer 24

The specimens label is thoroughly checked and matched with the requisition. Then the sample is checked for leaks, and that it is under 7 days old.

Question 25

Explain the pre examination processing requirements for: Ova and Parasite

Answer 25

Check the specimen label and requisition for all required information, and that they have matching demographic information. The sample is then checked fro leaks, and that the correct container was used.

Question 26

Explain the pre examination processing requirements for: Pinworm Collection

Answer 26

Check the specimen label and requisition for all required information, and that they have matching demographic information.

Question 27

Explain the process for unsuitable specimens

Answer 27

Unsuitable specimens are generally rejected, and the ordering location is notified that the specimen was unsuitable and must be recollected. And RLS is submitted to explain the issue. If the sample canot be recollected a waiver from can be filled out by the collector so the sample can be used.

The POC/MOC can also be consulted with to see if any troubleshooting can be approved for the sample.

Question 28

What are the preservatives used in 24 hour urine collection

Answer 28

Refrigeration - Does not interfere with chemical or physical properties of the specimen. Inhibits bacterial growth.
Crystal growth can occur.

Formaldehyde - interferes with glucose, and is toxic. Fixes the formed elements in the urinary sediment.

Acidification - Formed elements are destroyed by HCL, and acids or corrosive and toxic. HCL is useful in the determination of steroids,

catecholamines, and VMA. Boric acid preserves chemical and formed elements.

Sodium benzoate - Used to preserve glucose. Used in C&S.

Urinary preservation tablets - Used by insurance companies, good for routine analyses and for formed elements.

Question 29

Explain how non-blood specimens should be transported safely.

Answer 29

Non-blood specimens should be transported in the primary container surrounded by a leak proof container (bag). If the specimen is being transported off site the sample should also be placed into a puncture proof container. Transport at room temperature, and as STAT.

Question 30

Differentiate between a traumatic tap and a haemorrhage

Answer 30

Traumatic tap: When the CSF collection is bloody, and blood runs into the tubes for collection, the level of blood will decrease from tubes 1-4. CSF may clot, and no hemosiderin or xanthochromia will be present.

Haemorrhage: The amount of blood stays the same in all collection tubes. CSF will not clot. Hemosiderin-laden macrophages and xanthochromia are present.

Question 31

Paracentesis

Answer 31

The percutaneous puncture of a body cavity for the aspiration of fluid.

Question 32

Ascites

Answer 32

An effusion specific to the peritoneal cavity.

Question 33

Chylous Effusion

Answer 33

Fluid resulting from chronic pleural effusion with breakdown of inflammatory cell membranes into cholesterol crystals. This fluid can appear iridescent.

Question 34

Pericardial Fluid

Answer 34

Fluid accumulated in the pericardium, the closed sac of tissue surrounding the heart, often due to inflammation or malignancy.

Question 35

Peritoneal Fluid

Answer 35

Fluid accumulated in the peritoneal cavity of the abdomen, often due to hepatic cirrhosis and less frequently due to malignancy or cardiac failure.

Question 36

Pleural Fluid

Answer 36

Fluid accumulated in the pleural cavity surrounding the lungs.

Question 37

Exudate

Answer 37

Accumulation due to inflammation and characterized by high protein and the presence of cells

Question 38

Transudate

Answer 38

Accumulation due to changes in hemodynamic pressures, typically paucicellular and low in protein; is often seen in congestive heart failure.

Question 39

Name the collection procedures for serous fluids.

Answer 39

Thoracentesis = Pleural Fluid
Pericardiocentesis = Pericardial Fluid
Paracentesis = Peritoneal Fluid

Question 40

What tubes do serous fluids need to be collected in

Answer 40

Heme - EDTA
Chemistry - Plain sterile or Sodium heparin
Micro - Sterile heparin

Question 41

List Amniotic fluid colours, and their significance.

Answer 41

Blood streaked - Traumatic tap, abdominal trauma, intra-amniotic haemorrhage.
Yellow - Bilirubin from HDN
Dark green - Meconium
Dark red-brown - Fetal death

Question 42

List Amniotic fluid tests, and their significance.

Answer 42

Cytogenetic Analysis - Congenital defects

Alpha-fetoprotein - Neural tube defects

Bilirubin levels - HDFN

Lecithin-sphingomyelin ratio, amniostat, lamellar body count - Fetal lung maturity

Question 43

List Amniotic fluid storage requires for different tests

Answer 43

Cell Cx, chromosomal studies, microbial or viral culture - room temperature and should be handled aseptically.

FLM testing - Refrigerated (2-8C)

Bilirubin levels - Protect from light and store refrigerated or frozen

Question 44

Describe labeling requirements for primary specimens received in the laboratory.

Answer 44

Specimen labels must have the unique ID of the patient, including two independent identifiers. Specimens should be labeled at the patient’s bedside, directly after collection.

Full name - top left-hand corner.
PHN
Patients DOB
Time and date of collection
Collector ID

Question 45

Describe how to handle situations where labeling requirements are not met for the laboratory.

Answer 45

Recollectable specimens are to be discarded and recollected. Specimens that are unable to be recollected should have attempts made to establish whether the patient can be identified.

Question 46

Explain how secondary labels should be applied and why this is important.

Answer 46

Secondary labels are generally LIS labels, these are placed on the primary sample and should be placed immediately below the name on the older label. Having two patient names positioned immediately next to each other reduces the possibility of a labeling error.

Each time an additional label is placed on a specimen, it is an opportunity for a mislabelling event.

Question 47

Describe how to label laboratory reagents, QC vials, and calibrators when put into use in the laboratory.

Answer 47

Reagents: Most are purchased commercially and will have a manufacturer label that shows the reagent, lot number, and expiry date.

Once in use, the date opened, the initials of who opened the reagent, and the expiry date must be recorded on the reagent.

Calibrators/QC: Must have the date and time it was opened, the initials of the person who opened it, and the new expiry date.

Question 48

Label Placement

Answer 48

Linearly along the collection container so the text is readable from left to left, and located as high as possible on the container.

Question 49

Labeling Aliquots

Answer 49

Each lab will have different specifications of aliquot labels, but one standard will always be held. The aliquot must be traceable back to the original specimen

Question 50

Core Laboratory Aliquots

Answer 50

All core lab aliquots must have the accession number to ensure it can be traced back to the original specimen. Additionally any alterations to the specimen when placed in the aliquot tube must be indicated on the tube.

Question 51

Histology Aliquots

Answer 51

Histology samples are assigned a unique identifier, multiple samples may be collected from a patient at the same date and time (ex. moles). These specimens must be tied together as coming from the same patient at the same time, but they must be differentiated according to body site. In these cases an additional identifier would be added.

S1234-1, S1234-2

Question 52

Microbiology Aliquots

Answer 52

Microbiology aliquots include all plated specimens. Any containers that are to have a patient sample added to them must be labeled before the specimen is added.