PCHA Laboratory Guide to Services
Contents
1. TEST SPECIMEN CONTAINER AMOUNT INSTRUCTIONS GLUCOSE TOLERANCE PLASMA NA HEPARIN 4ML TEST USE FOR SERUM RED TOP 4ML PREGNANT LADIES GLUCOSE TOLERANCE GTT LAB PLASMA NA HEPARIN 4ML TEST USE FOR SERUM RED TOP 4ML EVERYONE EXCEPT PREGNANT LADIES GLUCOSE CSF CSFALB LAB CSF FLUID STERILE TUBE GLUCOSE PLEURAL PLGLU LAB Fluid RED TOP 4ML FLUID 4ML GLUCOSE SYNOVIAL SYGLU LAB Fluid RED TOP 4ML FLUID 4ML GLUCOSE BODY FLUID BFGLU LAB Fluid RED TOP 4ML 4ML H PYLORI SERUM TESTING HYPA LAB SERUM RED TOP 4ML Hemoglobin A1C A1C LAB WHOLE EDTA 4ML GLYCOSYLATED BLOOD HEMOGLOBIN HEPATITIS B HEPSAB LAB SERUM RED TOP 10ML ANTIBODY 4ml HEPATITIS B ANTIGEN HEPBSAG LAB SERUM RED TOP 10ML IF POSITIVE SENT TO 4ml REFERRENCE LAB FOR CONFIRMATOR TESTING HEPATITIS C HEPC LAB SERUM RED TOP 10ML IF POSITIVE SENT TO 4ml REFERRENCE LAB FOR CONFIRMATOR TESTING HIV HIV LAB SERUM RED TOP 10ML IF POSITIVE SENT TO 4ml REFERRENCE LAB FOR CONFIRMATORY TESTING HCG HCGSQ LAB SERUM Red top 4ml Plasma Na heparin IGG IGG LAB SERUM RED TOP 4ML IGA IGA LAB SERUM RED TOP 4ML IGM IGM LAB SERUM RED TOP 4ML INR PT INR LAB PLASMA NA CITRATE 4 5ML IRON IRON LAB SERUM RED TOP 4ML LDH LDH LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML LH LH LAB SERUM GOLD TOP 4ML Red top 4ml LIPID LIPID LAB PLASMA NA HEPARIN 4ML Red top 4ml LITHIUM LI LAB PLASMA NA HEPARIN 4ML Time of LAST AND NEXT SERUM RED TOP 4ML DOSE REQUI2. UNITS AVAILABLE WILL BE HELD UNTIL sumus Pueus fo SERUM ON HOLD UNTIL DATE TIME Sunan 25 wemeszws UNIT NUMBER EXPIRY DATE ISSUED amp CHECKED BY LILIAN COMMENTS x j SRO0DCOLETOR Date OF COLLECTION PATIENT WITNESS TIME amp DATE OF WITNESS TECHNOLOGIST SIGNATURE DATE amp TIME REPORTED nmm 88 FORM NO 004 NOV 0S THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 Appendix D1 AUTHORIZATION TO PROCEED WITH TESTING Please fax completed and signed copy to Name Fax Date Dear Dr Please note that Laboratory policy requires that all specimens are labeled with two identifiers patient s full name Healthcare number or unique patient ID on both the specimen and requisition Your departmental office process and procedure for identification of specimens should be reviewed and revised to ensure this requirement is fulfilled An improperly labeled specimen was received from location After discussion with the personnel involved in the procurement of the specimen it has been determined that the specimen may be from patient name Labeling problem is Please provide the identifying information which is missing regarding this specimen and sign and date the statement below Verify Information Name Healthcare Nu
3. hes Pictou xal ealth LABORATORY GUIDE TO SERVICES THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 INTRODUCTION In producing this manual it was our hope that it might serve to assist primary care personnel in the selection of appropriate laboratory tests and in proper preparation of the patient before testing We also hope to provide information to care givers who collect primary samples on the proper procedures to be followed for collection labeling and transporting of samples to the laboratory Results are only as good as the original specimen In order for us to offer results that are of the highest quality it is important that the appropriate tests are selected and that the specimens are of high quality initially Please always keep in mind that an improperly collected specimen can lead to suspect or un interpretable results Our Laboratory has detailed policies to guide our staff in determining whether the specimen is suitable for processing As this is our first attempt at a document such as this if there are points which require further clarification or suggestions for improvement we would value your input Contacts are as listed below John O Donoghue Darlene Gilby Laboratory Manager Laboratory Standards Coordinator 752 7600ext 2830 752 7600ext4527 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISI
4. Confidentiality extends to everything hospital personnel learn hear see or observe in carrying out their duties This extends to include staff maintaining confidentiality of personal information and test results of people known to them such as family friends and other PCHA staff members REQUISITIONING OF LABORATORY TESTS A properly completed Laboratory Services Requisition Appendix C1 must accompany all labeled specimens The following information must appear on the request form Patient s full name Date of birth Location Sex Health Care number Family physician legible full name Ordering physician legible full name Diagnosis Test requested initials or signature of person who drew specimen date and time of collection of specimen all pertinent information as requested by lab zocoooc e The following additional information is required if the request is for MICROBIOLOGY HISTOLOGY tissue CYTOLOGY BLOOD BANK See Appendix C1 for See Appendix C4 for sample of requisition sample of requisition e source of specimen e type of tissue e type of tissue e type and volume e antibiotics currently e source of tissue e source of tissue of product in use or to be e patient s history patient s history required started operative findings operative findings date product clinical data if applicable if applicable required pertinent to e history of appropriate transfusions processing o
5. a soft sided outer container is acceptable 1 Ensure all caps are secure and seal all non Vacutainer type tubes containing liquids with Parafilm 2 Place a large plastic bag in cooler 3 Ensure an absorbent pad is in the bottom of the cooler 4 Stand test tube racks on the absorbent pad 5 Stand the specimen tubes or urine containers in the cooler Note For small shipments paper towels may be used as cushioning between sample tubes 6 Close the secondary container 7 Place all the requisitions in a separate plastic bag on top of closed secondary container 8 Close the cover on the outer container cooler Requisitions Do not wrap requisitions around specimens Do not tape specimens to requisitions Place in a separate plastic bag together with other requisitions for the same discipline May be folded to place in envelope Contamination e Avoid contaminating the outside of the container Clean with a disinfectant such as alcohol or diluted bleach if contamination occurs THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 ENTERING ELECTRONIC REQUESTS IN MEDITECH SYSTEM Staff with access to the Laboratory module of the HITS Meditech system shall enter patients as outlined in the Laboratory Registration Manual located in the Laboratory Outpatient department Specimens for Microbiology Cytology and Histology shall be entered as per departmental p
6. DATE August 16 2013 ABERDEEN LABORATORY DEPARTMENT PHONE NUMBERS 752 7600 DEPARTMENT EXTENSION Laboratory 1600 Laboratory Office 2860 Bacteriology amp Urinalysis 2810 Betty Parker 4522 Blood Bank 2800 Chemistry 2870 Collections wireless 1405 Collections wireless 1406 Core lab 2880 Core lab fax 2460 Cytology 2820 Darlene Gilby 4527 Histology 2825 Histology Basement 3025 Lab outpatients registration 4524 Specimen processing receiving 2890 John O Donoghue 2830 ABERDEEN LABORATORY FAX NUMBERS DEPARTMENT FAX NUMBER Laboratory Office Main Fax 752 1931 Laboratory outpatient 755 7327 Darlene Gilby 752 1310 SUTHERLAND HARRIS MEMORIAL HOSPITAL LABORATORY CONTACT INFORMATION AUTO ATTENDANT 485 5665 AREA NUMBER Central Registry 3139 Blood collection 2311 Fax 485 4049 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 HOURS OF OPERATION PICTOU COUNTY HEALTH AUTHORITY BLOOD COLLECTION CENTERS EAST RIVER ROAD SUTHERLAND HARRIS MEMORIAL BLOOD COLLECTION CLINIC Hours of operation Hours of operation Mon Fri 7 00am 2 30pm Mon Tue Thurs and Fri 7 30 10 30am Excluding Statutory Holidays Excluding Statutory Holidays OUTPATIENT BLOOD COLLECTION This is a walk in service where patients use a numbering system and wait their turn
7. STANDING ORDER THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 ADMINISTRATION AND TEAM LEADERS DEPARTMENT Laboratory Admistration NAME Laboratory Manager John O Donoghue CONTACT INFORMATION 752 7600 ext 2830 john o donoghue pcha nshealth ca Transfusion Medicine Senior Technologist 752 7600 ext 2800 Betty Parker betty parker pcha nshealth ca Microbiology Team Leader 752 7600 ext 2810 Gale Canning gale canning pcha nshealth ca Histology Team Leader 752 7600 ext 2810 Gale Canning gale canning pcha nshealth ca Cytology J Sheldon Hewey 752 7600 ext 2820 Hematology Team Leader 752 7600 ext 2880 Lois MacDonald lois macdonald pcha nshealth ca Chemistry Team Leader 752 7600 ext 2880 Edith Thomson edith thomson pcha nshealth ca Laboratory Information Team Leader 752 7600 ext 2880 System Team leader Edith Thomson edith thomson pcha nshealth ca Laboratory Standards Senior Technologist 752 7600 ext 4527 Coordinator Darlene Gilby Darlene gilby pcha nshealth ca Blood Collection Senior Technologist 752 7600 ext 4527 Darlene Gilby Darlene gilby pcha nshealth ca VP Corporate Services Alan Mongraw 752 7600 ext 4240 Medical Director Dr Leon Desormeau 752 7600 ext 2850 Thursday only THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION
8. is the required identifiers Bar coded labels are also to be marked as to be able to identify the collector This can be accomplished by writing the collectors Meditech user name on the large label and initials on each of the small labels Bar coded samples must also have the time that the sample was drawn recorded on the bar coded tube If collecting blood and you do not have a Meditech user name please place your full name on the Patient requisition and initials on the tube the receiving lab must be able to trace back to who performed the collection Specimens collected for use in the Blood Transfusion Department shall have 2 identifiers on the tube consisting of the patients name and at least one other unique identifier all labeling information on Blood Bank specimens should be completed by hand bar coded Meditech labels should not be placed on blood bank tubes The two unique identifiers placed on the tube must also be present on the requisition The Blood bank requisition must be signed and the date and time of collection stated by the collector If any of the preceding criteria are not met the Blood Transfusion Service will reject the specimen In the event of an improperly labeled irreplaceable specimen the ordering physician must issue an order to proceed as described on page 14 of this manual This will be done through use of a form that can be viewed in Appendix D1 of this manual Reports issued from the lab will contain a disclaimer
9. mother is Rh negative and baby is Rh positive Required Kleihauers should be performed and resulted within 48 hours of birth to allow time for report delivery and administration of Rh immune globulin within 72 hours of birth If 2 day weekend testing can be done on Saturday and then subsequently don t have to be done on Sunday If 3 day weekend Kleihauers can be done on Sunday then would not need to be done on Saturday or Monday of a long weekend Transfusion reaction perform initial investigation DAT hemolysis check and clerical check where symptoms suggest a critical situation such as hemolytic transfusion reaction or transfusion mix up may have occurred DAT s in cases with clinical symptoms of suspected increased red cell destruction e g hemolytic anemia s and other Autoimmune disorders etc SEROLOGY HIV Hepatitis B and C only done STAT in response to Blood Borne Pathogen Exposure by PCHA employees when source and employee specimen are both available Tests not on this list will not be carried out or reported on evenings weekends or statutory holidays except in cases where the physician has consulted the Laboratory Manager and received approval for the test to be carried out and reported When this occurs the Laboratory Manager must notify the Technologist of their approval of the requested order so that the Technologist on duty can arrange the workload as necessary and or arrang
10. placed in the Histology department refrigerator Specimens being delivered to the laboratory from inpatient units should be dropped off in Specimen Processing Monday Friday 7am to 3 30pm excluding holidays after regular business hours stat blood specimens should be delivered to the core lab Notify a staff member that you are leaving a specimen for processing Specimens for Microbiology or urinalysis testing from inpatient units should be delivered to the Bacteriology department between 3 30pm and 5pm After 5 pm please deliver specimens to the core laboratory and notify a staff member Cytology specimens should be taken to the Cytology department THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PHYSICIAN INSTRUCTIONS TO OUTPATIENTS WHEN ORDERING BLOOD WORK Patients must be properly prepared when arriving for certain testing provided by the lab It is recommended that Physicians consider this and provide the pertinent necessary information to their patient This helps to provide you with useful clinically relevant results that are often the cornerstone of diagnosis and treatment It also prevents the patient from being inconvenienced by having to return another day because they were not properly prepared for the test when arriving for blood work This section deals with frequently ordered tests that may require patient preparation before being performed TES
11. reporting results THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 TRANSPORTATION OF SPECIMENS All specimens should be delivered to the laboratory as soon after collection as possible In order to provide for the safety of the various people or businesses delivering specimens to our laboratory and to protect our own staff receiving them all specimen transport must comply with Transport of Dangerous Goods regulations The Transportation of Dangerous Goods TDG Act is a federal law created for the protection of humans animals and the environment Included under this law is the shipment of diagnostic laboratory samples such as blood urine etc either across the country or across a few blocks up the street All diagnostic samples including those collected in clinics doctor s offices etc must be packaged and transported in accordance with this law As the receiving laboratory we have a responsibility to accept only properly packaged samples and to inform individuals who do not comply with this law Failure to improve the situation will result in a formal report to a Federal Inspector who can impose significant fines The following information has been abstracted from the TDG Act and is provided as a guide to assist you in complying with this law This is the actual sample container blood tube urine container swab etc Always make sure the container lid cap is properly
12. to QEII aa ee Gore CENTRIFUGING D DIMER DD LAB WHOLE NACITRATE 4 5ML PERFORM BEFORE BLOOD PTINR APTT TESTING DIGOXIN DIG LAB SERUM RED TOP 4ML JUST PRIOR TO THE NEXT NA HEPARIN DOSE TROUGH OR AT LEAST 6 HOURS AFTER DOSE PEAK DRUG SCREEN UDR LAB URINE URINE 1ML ESH ESR LAB WHOLE BLACK 2ML BLOOD FERRITIN FER LAB SERUM RED TOP 4ML Gold top 3 5 ml FIBRINOGEN FIB LAB PLASMA NA CITRATE 4 5ML FOLATE SERUM FOL LAB SERUM RED TOP 4ML GOLD TOP 4ML FSH FSH LAB SERUM RED TOP 4ML GOLD TOP 4ML FT4 FT4 LAB SERUM RED TOP 4ML GOLD TOP 4ML GAMMA GT GGT LAB PLASMA NA HEPARIN 4ML SERUM Red top 4ML GENTAMICIN EXT GENTEXT LAB Plasma NA HEPARIN 4ML TAKE BLOOD 6 HOURS SERUM Red top BEFORE THE NEXT DOSE IS ADMINISTERED GENTAMICIN PRE GENTPRE LAB NA HEPARIN 4ML 30 MINUTES BEFORE NEXT Plasma Red top DOSE TROUGH SERUM GENTAMICIN POST GENTPOS LAB Plasma NA HEPARIN 4ML 30 MINUTES AFTER T SERUM Red top COMPLETION OF IV DOSE OR 60 MINUTES AFTER IM DOSE PEAK GLUCOSE 50g Trutol GTTLOAD LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML GLUCOSE AC GLUAC LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML GLUCOSE PC GLUPC LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML GLUCOSE RANDOM GLUR LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013
13. 5 Open front of section 1 Use one stick to collect a small sample Apply a thin smear covering Box A Collect second sample from a different part of the stool with the same stick Apply a thin smear covering Box B Discard stick in a waste container Do not flush it down the toilet E 7 Z 7 Z 6 Close and secure front flap Store card at room temperature until returned to the laboratory 7 Repeat steps 2 6 for the next two days using cards 2 and 3 After completing the last card return the specimen to the laboratory during regular business hours of Monday Friday 6am to 1 30pm excluding holidays 8 Remember to wash your hands well after collecting the specimen Keep the test kit at room temperature until you bring it back to the Laboratory Registration Area Bring labeled specimens to desk 3 at the laboratory Protect the kit from light Bring the completed test kit back to the laboratory as soon as possible The collected specimen is stable for up to 14 days After the specimen is collected you may resume your normal diet THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPENDIX Procedures relating to the collection of blood specimens and proper specimen processing technique are available in the Laboratory Collection areas and specimen processing area For document control the procedures will not be included in this manual SUMMARY The follo
14. AL GIVE RESULTS CONTACT AND DOCUMENT IN TO DR S OFFICE COMPUTER PHYSICIAN S OFFICE AND DOCUMENT IN COMPUTER ANSWERING MACHINE OFFICE IF LINEIS CONTINUALLY CLOSED CALL RESULTS TO BUSY OR NO ANSWER FOLLOW REFERING HOSPITAL AND DIRECTIONS THEY WILL CONTACT THE PHYSICIAN WHO ORDERED THE TESTING CALL PRIVATE NUMBER DOCUMENT IN COMPUTER s CALL SWITCHBOARD TO NO HAVE PHYSICAN PAGED COVERING DR INDICATED IF COVERING DOCTOR IS INDICATED CALL IF ABLE TO REACH DOCUMENT OFFICE OF COVERING IN COMPUTER TIME PHYSICAN DOCTOR WAS REACHED DOCUMENT IN COMPUTER IF UNABLE TO REACH WHEN COVERING DOCTOR PHYSICTAN REACHED CALL SWITCHBOARD TO FIND OUT NAME OF DOCTOR ON CALL CALL DOCTOR ON CALL WHEN THEY BEGIN CALL THIS MAY NOT BE UNTIL NOON OR 5PM DEPENDING ON THE DAY RECORD ALL INFORMATION IN COMPUTER THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PCHA Laborator Services Critical VALUES List Biochemistry Acetaminophen 4 hours gt 992 umol Liver damage post ingestion Acetaminophen 8 hours gt 330 Liver damage post ingestion lt 12 mmol l Complex interwoven gt 40 mmol l Complex Bicarbonate patterns with interwoven CO3 acid base and patterns with electrolyte balance acid base and electrolyte balance Serum Calcium lt 1 5 mmol L Tetany amp convulsions gt 3 25 mmol L Coma S
15. DIX C1 PCHA LABORATORY SERVICES OUTPATIENT REQUISITION PICTOU COUNTY HEALTH AUTHORITY LABORATORY REQUISITION Patient Name Gender HCN Exp Date DOB Requesting Provider PMB Copy to Date Requested Provider s Signature Indicate if requests are for uninsured services WCB Insurance DNO Corr Car Collected Date CHEMISTRY 2 Glucose AC ciuac 2 Glucose Tolerance GTT No food or drink except water after midnight or 8 hours prior to test Glucose Random GLUR A1C atc Creatinine CREAT BUN UREA Sodium NA Potassium K Chloride ct Calcium cA Phosphorus PHOS Magnesium MG Bilirubin BILT AST ast ALT ALT Alk Phos ALK Gamma GT Total Protein TP Albumin ALB LDH Lox CPK ck Amylase Amy Uric Acid uric Iron IRON 8 TIBC Lipids LIPID Chol Trig HDL LDL No food or drink except water 12 fast MISCELLANEOUS Ferritin FER TSH 5 Free 4 PSA PsA Folate serum FOL Vit B12 812 OCCULT BLOOD Date Collected 51081 STOB2 STOB3 U UU U U U UU U C UU UU UU U UU C U U U C U UU U U Collector Name HEMATOLOGY CBC No Diff ccnp CBC with Diff 080 INR PriNR Q PIT SEROLOGY Mono MONO ASOT Asor RA RAQ RA RPR rp Rubella Rus Hep B Surf Ag HEPBSAG Hep B Antibody HEPBSA3 Hep C Antibody HEPC HIV uv H pylor
16. Date last transfused O Crossmatch RC units Date Required DRUG MONITORING Last Dose Date Time Next Dose Time Q Digoxin Lithium uy Phenytoin Dilantin PNY Carbamazepine Tegretol care Any Other Tests Please Print Below Antibiotics PCHA Specimen Collection at Pictou SHMH available from 7 30 AM to 10 30AM each week day except for Wednesdays amp Holidays PCHA Specimen Collection at 678 East River Road available from 7 AM to 2 30 PM each week day except for Holidays 24 May 2013 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PiCTOU COUNTY HEALTH AUTHORITY BLOOD BANK LABORATORY LOCATION LABORATORY ACCESSION NO FULL NAME BB 03578 CLINICAL NOTE DIAGNOSIS HOSPITAL NO NSHCN DOB YY MM DD MEDICATIONS FAMILY PHSYCIAN CONSENT SIGNED ORDERING DOCTOR REQUISITION COMPLETED BY URGENT L ROUTINE STAT FOR LAB USE ONLY B PRENATAL EDC 0 PREOP SURGERY DATE Lamueam ANTIBODY SCREENING SCREEN amp HOLD SERUM p l TN PREVIOUS TRANSFUSION DATE reaction yes wo PREVIOUS PREGNANCIES DATE KNOWN ANTIBODIES DIRECT ANTIGLOBULIN TEST DAGT ANTIBODY IDENTIFICATION ITE BLOOD PRODUCTS acao BLOOD PRODUCTS LS X UNITS ROUTINE URGENT U STAT les asen Fosw
17. IMEN IDENTIFICATION _ N SUBMISSION OF CODED PATIENT SAMPLES _ REJECTION OF SPECIMENS A PROCESSING IRREPLACABLE SPECIMENS _ TRANSPORTATION OF SPECIMENS _ o ENTERING ELECTRONIC REQUESTS IN MEDITECH SYSTEM _ CLASSIFICATION OF LABORATORY ORDERS E DISTRIBUTION OF REPORTS lt REPORT INQUIRIES LABORATORY TESTS ELIGIBLE FOR STAT REQUEST N e PROCESS FOR NOTIFICATION OF CRITICAL LABORATORY VALUES N _ PCHA LABORATORY SERVICES CRITICAL VALUES LIST 24 26 PCHA RECORD AND SPECIMEN RETENTION TIMES N GENERAL LABORATORY TESTS AVAILABLE AT PCHA LABORATORY APPENDIX A A1 PAGE PATIENT PREPARATION AND COLLECTION INSTRUCTIONS 32 COLLECTION OF A MID STREAM URINE A2 33 COLLECTION OF A 24 HOUR URINE SAMPLES A3 34 OCCULT BLOOD TESTING A5 35 SEMINAL ANALYSIS PAGE IN HOUSE COLLECTION PROCEDURES APPENDIX B B1 36 Do s and Don ts of blood collection APPENDIX C PAGE SAMPLES OF LABORATORY REQUISITION FORMS C1 37 PCHA LABORATORY SERVICES OUTPATIENT REQUISITIONS C4 40 BLOOD TRANSFUSION SERVICES REQUISITION PAGE OTHER MISCELLANEOUS FORMS USED IN THE PROCESS OF LABORATORY TESTING APPENDIX D D1 41 AUTHORIZATION TO PROCEED WITH TESTING IRREPLACEABLE SPECIMENS D2 42 RENEWAL NOTICE
18. ODIUM 24 HR URINE U24NA LAB URINE 24HRURINE TOTAL CONTAINER VOLUME TEGRETOL CARB LAB PLASMA NAHEPARIN 4ML 6 18 HOURS AFTER LAST CARBAMEZAPINE SERUM RED TOP 4ML ORAL DOSE THEOPHYLLINE THEO LAB SERUM RED TOP 10 2 3 HOURS AFTER LAST ORAL DOSE OR 3 6 HOURS AFTER LAST DOSE OF SLOW Referred out RELEASE THEOPHYLLINE OR 15 MINUTES AFTER IV INJECTION TRIGLYCERIDE TRIG LAB PLASMA NAHEPARIN 4ML serum Red top 4ml TIBC TIBC LAB SERUM RED TOP 4ML ORDER IRON TOTAL CO2 602 LAB PLASMA NAHEPARIN 4ML SERUM RED TOP 4ML TOTAL PROTEIN TP LAB PLASMA NAHEPARIN 4ML SERUM RED TOP 4ML TROPONIN TROPI LAB PLASMA NAHEPARIN 4ML SERUM RED TOP 4ML TSH TSH LAB SERUM GOLD TOP 4ML URIC ACID URIC LAB PLASMA NAHEPARIN 4ML SERUM RED TOP 4ML URINALYSIS UA LAB URINE URINE 90 ml AUTOMATICALLY SENT FOR C amp S IF CONDITIONS INDICATE URINE C amp S URNC LAB URINE C amp S 90 ml PRESERVE 10 TUBE URINE DRUG SCREEN UDR LAB URINE URINE 10ML CONTAINER URINE HCG HCG LAB URINE URINE 10ML container THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 TEST L SPECIMEN CONTAINER AMOUNT INSTRUCTIONS VALPROIC ACID VALP PLASMA NA HEPARIN 4ML 1 3 HOURS AFTER LAST SERUM RED TOP 4ML DOSE OR IMMEDIATELY PRIOR TO NEXT DOSE VANCOMYCIN PRE VANPRE LAB PLASMA NA HEPARIN 4ML IMMEDIATELY PRIOR TO SERUM RED TO
19. ON DATE August 16 2013 RECORD OF CHANGES MADE TO LABORATORY USERS MANUAL PAGE SUMMARY OF CHANGES MADE DATE 2 5 6 Change in contact information for Dgilby and update Edith Thomson March 1 2012 7 T of Blood Collection Clinic operation March 1 2012 8 Removal of Priority Desk information March 1 2012 11 Addition of comment March 1 2012 Changes to critical value reporting list to match Meditech targets March 1 2012 13 Corrections to coded sample process March 5 2012 39 Appendix A 5 removed August 16 2013 31 35 Updated test list August 16 2013 Various Updated contact information August 16 2013 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PAGE INDEX SUBJECT INTRODUCTION REVISION LIST INDEX ADMINISTRATION AND TEAM LEADERS DEPARTMENT NUMBERS HOURS OF OPERATION PCHA BLOOD COLLECTION CENTRES HOURS OF OPERATION PCHA TESTING SERVICES PROVISION OF SERVICE TO AUTHORIZED REQUESTERS SURGICAL SPECIMEN DROP OFF AND INPATIENT SPECIMEN DROP OFF N N A ROIN PHYSICIAN INSTRUCTIONS TO PATIENTS WHEN ORDERING BLOODWORK _ REQUISITIONING OF LABORATORY TESTS _ VERBAL REQUEST FOR LAB TESTS RECURRING TESTS _ TECHNICAL AND CLINICAL LABORATORY CONSULTATION INFORMATION _ N SPEC
20. P 4ML DOSE VANCOMYCIN POST VANPOST LAB PLASMA NA HEPARIN 4ML 2 HOURS AFTER FINISH OF SERUM RED TOP 4ML DOSE VDRL RPR LAB SERUM RED TOP 4ML IF SENT TO REFERRENCE LAB FOR CONFIRMATORY TESTING VITAMIN B12 B12 LAB SERUM GOLD TOP 4ML MICROBIOLOGY TESTS Detailed information on collection storage and transport of Microbiology tests available through PCHA laboratories can be found in the PCHA LAB SERVICES MICROBIOLOGY USERS MANUAL issued by the PCHA Microbiology Department REFERRAL OF TESTS TO REFERENCE LABORATORIES Tests not included in the list above or when circumstances beyond our control warrant will be referred to a preapproved Reference Laboratory chosen by the referring Laboratory THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPENDIX A1 PATIENT INSTRUCTIONS Instructions for the Collection of a Mid Stream Urine Sample For specimens collected in the Lab The container Use a dry sterile container How to collect a mid stream urine e Wash your hands before urinating e Remove the cap of the sterile container s Do not touch inside the cap or the bottle e The urine must pass into the container without touching the skin Females should separate the labia and males should retract the foreskin e Pass a small amount of urine into the toilet Stop the flow and then begin urinating directly into the container until half full Stop the flow Fini
21. Patients must have a completed and signed requisition from their physician indicating the tests requested specimen priority and to whom the results should be reported Requisitions cannot be altered by the patient All patients must also have a current health card with them and be prepared to show it to the registration staff Physicians who require stat testing to be performed after regular operating hours must contact the laboratory to make arrangements for testing Phone 902 752 7600 2880 If cancellation of a scheduled clinic is necessary the Lab will attempt to post advanced notice as a reminder of the cancellation as early as possible If due to unforeseen circumstances the Laboratory Blood Collection service must close notification will be posted at the blood collection center and a public notice will be made on 94 1 East Coast FM HOURS OF TESTING PCHA Lab provides 24 hour coverage 7 days per week Full service is offered Monday Friday from 0700 1500 Minimal staff is available Monday Friday from 1500 0700 for STAT or URGENT requests only Minimal staff is available on weekends and holidays 24 hours for STAT or URGENT requests only THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PROVISION OF SERVICE TO AUTHORIZED REQUESTERS Laboratory Services of PCHA will perform Laboratory Tests and examinations of specimens at the request of authorized req
22. RED LYTES LYTES LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML MAGNESIUM MG LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML MICROALBUMIN UMALBR LAB URINE URINE 10ML MONO MONO LAB SERUM RED TOP 4ML OCCULT BLOOD STOOL STOB LAB STOOL OB CARD PHENOBARBITOL PHEN LAB SERUM Red top 10 ml 6 18 HOURS AFTER LAST ORAL DOSE THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March REVISION DATE Augu 1 2009 st 16 2013 TEST MNEUMONIC SPECIMEN CONTAINER AMOUNT INSTRUCTIONS PHENYTOIN PLASMA NAHEPARIN 4ML 4 8 HOURS AFTER LAST ORAL DOSE OR IMMEDIATELY BEFORE THE DILANTIN SERUM RED TOP 4ML NEXT DOSE PHOSPHORUS PHOS LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML PLATELET FUNCTION PFA LAB WHOLE NA CITRATE 4 5ML FASTING LIST ALL BLOOD PRESCRIBED AND ADALYA UNPRESCRIBED DRUGS DELIVER TO LAB IMMED PROLACTIN PROL LAB SERUM GOLD TOP 4ML POTASSIUM 24 HR URINE U24K LAB URINE 24HR URINE TOTAL CONTAINER VOLUME PSA PSA LAB SERUM RED TOP 4ML Gold top 3 5ml RA SCREEN RA LAB SERUM RED TOP 4ML RETIC RETIC LAB WHOLE EDTA 4ML BLOOD RUBELLA RUB LAB SERUM RED TOP 10ML SALICYLATE SAL LAB PLASMA NAHEPARIN 4ML ASA OR ASPIRIN SERUM RED TOP 4ML SEMINAL FLUID SA LAB SEMINAL URINE SEE SPECIAL PROCEDURE COMPLETE SEMINAL FLUID POST SAPV LAB SEMINAL URINE SEE SPECIAL PROCEDURE VAS SERUM FOLATE FOL LAB SERUM GOLD TOP 4ML S
23. RMED SERUM RED TOP 4ML AUTOMATICALLY IF T BILI IS OUTSIDE NORMAL RANGE BILI TOTAL BILT LAB PLASMA NA HEPARIN 4ML D BILI PERFORMED SERUM RED TOP 4ML AUTOMATICALLY IF T BILI IS OUTSIDE NORMAL RANGE BLOOD GAS ARTERIAL ABG LAB BLOOD HEPARINIZED 2ML DELIVER TO LAB ASAP ARTERIAL SYRINGE ON ICE BLOOD GAS ARTERIAL ACOBG LAB BLOOD HEPARINIZED 2ML DELIVER TO LAB ASAP CORD ARTERIAL SYRINGE ON CORD ICE BLOOD GAS CAPILLARY CBG LAB BLOOD HEPARINIZED 150UI DELIVER TO LAB ASAP CAPILLARY CAPILLARY ON ICE BONE MARROW BMW LAB MARROW MUST BE BOOKED WITH CORE LAB MONDAY FRIDAY BUN UREA LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML CALCIUM CA LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML CBC CBC LAB WHOLE EDTA 4ML BLOOD THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 CEA CEA LAB SERUM RED TOP 10ml Gold top 4ml CHOLESTEROL CHOL LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML CK CK LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML CKMB CKMB LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML COLD AGGLUTININS COLD LAB SERUM RED TOP 10ML CREATININE CREAT LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML CREATININE 24 HR U24CREA LAB URINE 24HR URINE TOTAL URINE T CONTAINER VOLUME hsCRP QUANTITATIVE HS CRP LAB PLASMA NA HEPARIN 4ML SERUM RED TOP CRYOGLOBULINS CRYOG LAB SERUM RED TOP 3 4ML ALLOW TO CLOT IN WATERBATH AT 37 C FOR referred out
24. T INSTRUCTIONS TO PATIENTS AC Glucose Patients should not have breakfast the morning of the test minimum of 8 hour fast Lipids Instruct patient to not eat or drink for a minimum of 12 hours before test Small amounts of water are acceptable if necessary PC Glucose Inform patient they will be returning to the lab for a second blood test after breakfast Glucose Tolerance No breakfast Testing pregnant or Inform patient that there will be more than one blood sample taken non pregnant Also inform patient that they will be given a concentrated glucose drink while at the Lab and have their blood drawn at different times Patients are expected to remain at the Blood Clinic during the waiting time between drink and blood collection 50 Gram Trutol or Inform patient that they will be given a concentrated glucose drink Glucose Load and be required to have their blood drawn 1 hour after finishing the drink Patients are expected to remain at the Blood Clinic during the waiting time between drink and blood collection Midstream Urine Early morning collection is best Keep urine refrigerated until coming to the lab Must be received by Lab within 2 hours of collection Instructions are included in this manual as APPENDIX A1 24 hour Urine Containers collection devices and patient instructions are available collections from the lab Instruct patient to bring the requisition to the lab when for any test picking up the bottle as
25. ach blood collection staff at the Aberdeen Hospital phone extension 1405 or 1406 DISTRIBUTION OF REPORTS Only the physicians or other authorized requesters whose names appear on the ordering requisition will receive copies of the report An exception to this policy will be made if the lab finding is such that it is required to be reported by law This is to ensure that copies of laboratory results are not distributed to any physician or caregiver other than the one ordering the test and or those approved by the patient The lab does not give results or copies of results directly to clients REPORT INQUIRIES All inquiries regarding reports should be directed through the laboratory office during regular full service hours This service is only intended for use when a report cannot be accessed on the patient s chart through the EMR patient enquiry system or in the physician s office If the requested test is currently in progress or if a question requires consultation with a technologist the call will be transferred to the appropriate laboratory department Please allow a minimum of three days for lab results to reach your office Tests referred to reference laboratories will require more time Please allow a minimum of five days for pathology reports LABORATORY TESTS ELIGIBLE FOR STAT REQUEST Only the tests listed below will be done on a STAT order basis The tests listed below are available on a STAT basis 24 hours a day 7 da
26. closed With the exception of Vacutainer type tubes where the seal remains intact all other tubes containing a liquid sample and or transport fluid must have the cap lid sealed Parafilm is ideal for this As an alternative to this primary sample containers can be placed inside plastic envelopes with each tube heat sealer individually Non liquid samples e g routine culture swabs do not require sealing This can be a plastic bag such as the lab transport bags or large plastic e g garbage bag Place around the primary container s inside the outer container Used to absorb fluids if the primary container should accidentally break Suggested materials include diapers absorbent pad e g Depends etc Absorbent pads may be used with larger samples such as urines or stools Place inside the secondary container Used to separate each test tube and or container containers should not touch one another this is especially important for liquid samples N collection areas may use a test tube rack to separate blood tubes Eor small shipments paper towels or newspaper may be used as cushioning between sample tubes Samples may be placed into individual zip lock plastic bags All outer containers must be clearly identified as containing biohazardous material Arigid container such as an insulated box A Cooler is ideal for routine diagnostic specimens Fortransportation of a small number of specimens
27. container Replace the cap and tighten it firmly Gently shake the container after each urine specimen is added Keep the urine container refrigerated during the collection period and until you bring it to the laboratory for testing DAY 2 Exactly 24 hours later for example 7 00 a m completely empty your bladder and add this specimen to the container This is the last specimen and completes your 24 hour collection Record the exact end time on the container If you have a requisition write the date and time on the requisition Replace the cap and tighten it firmly Refrigerate the specimen until you can bring it to the laboratory Bring specimens and doctors orders to the laboratory as soon as possible during business workday hours and not on weekends If you were on a special diet for this test you may resume your normal diet after the specimen is collected THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPENDIX A3 COLLECTION OF STOOL FOR OCCULT BLOOD HEMOCCULT 8 TEST The following collection instructions are intended to help you collect the correct specimen for the test your clinician has requested First read the instructions carefully make sure you are prepared and then follow each of the steps to ensure proper collection Notes The occult blood test looks for very small amounts of blood in your stool If you are bleeding from a condition such as hemor
28. ction e g 1600 Enter Collected By Care Area Y Labels will print on unit To print on unit enter Collected by Care Area Y Enter N if printed by Phlebotomy Printed by Phlebotomy Printed by Phlebotomy Notify Lab Staff of STAT collections If labels printed on the unit and Phlebotomy is required notify lab use site specific list below If Phlebotomy prints labels do not notify Do not notify Notify lab of timed collection Immediately As soon as possible Next routine Usually within 15 minutes of Sweep requested time Immediately after As soon as possible collection Blood after collection Blood Will be collector will transport collector will transport transported to Will be transported blood to Lab receiving blood to Lab Receiving the lab in to the lab as time area Notify receiving that STAT sample has been obtained STATS processed first area Notify Receiving that URGENT sample has been obtained Urgent processed ahead of Routine batches as time permits Processed in routine manner permits Processed based on Urgent or Routine priority Report printed to unit as complete Report broadcast to unit as soon as complete Report printed to unit at defined print time Reported based on Urgent or Routine priority THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 To re
29. d the result Note The physician is responsible for follow up with the patient Department of Health Public Health Notification e ln accordance with the Public Health Act the laboratory provides details of patients including the name of the submitting physician with laboratory evidence of certain diseases to the DOH A list is provided to all physicians and the current list from DOH is version issued August 2005 entitled It s the Law Reporting notifiable disease and conditions e Certain findings are considered critical from a Public Health standpoint and are reported immediately by phone and fax as the results become available all other results are provided by fax as obtained Critical Public Health Reports those communicated immediately Enteric pathogens e g Salmonella Shigella E coli 0157 etc Bordetella pertussis parapertussis Bacterial meningitis Neisseria meningitidis systemic and eye infections only Clusters of isolates suggesting a central source Others as circumstances suggest THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PROCESS FLOWCHART FOR NOTIFICATION OF CRITICAL LABORATORY VALUES CRITIAL RESULT WITHIN APPROXIMATELY 15 MINUTES OF VERIFICATION PHONING PROCESS MUST START IF INPATIENT OR IF OUTPATIENT CALL TO ER PATIENT REQUESTING PHYSICIAN IF RESULTS FROM A CALL NURSING REFERRING UNABLE TO UNIT WITH RESULTS HOSPIT
30. e for off duty technologist to be called back to perform the requested work as necessary For some tests in the Lab only a small number of Technologists are trained to perform these If the on duty Technologist is unable to perform the test or locate someone qualified to perform the test the test cannot be done at that time Testing will not be performed at any time by unqualified personnel PROCESS FOR NOTIFICATION OF CRITICAL LABORATORY VALUES Policy The medical laboratory technologist performing a test the result of which is a critical value as defined and listed below is responsible for ensuring that this information is communicated to the appropriate physician nurse practitioner and or unit in a timely within 15 minutes of completion and accurate manner The technologist must also document all information regarding this communication in the computer with the critical result s report THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 General Notes Critical Results e Critical results are entered and verified in the computer system as soon as they are available thus they may be viewed in the EMR or printed for the patient s chart e Using a variety of standard texts the name of the person receiving the information date time etc is documented in the computer by the technologist In Patients e Critical results are phoned to the appropriate nursing unit the
31. ed specimen depends on test required Incorrect type of specimen or specimen container Whole blood specimens that are clotted Specimens that are too old Specimens that did not receive specialized storage Microbiology specimens in non sterile container THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 PROCESSING IRREPLACEABLE SPECIMENS A specimen is deemed irreplaceable if e arepeat specimen is unattainable by recollection AND e not processing the specimen could result in the loss of information that will significantly affect the treatment of the patient Policy Improperly labeled irreplaceable specimens may be processed and reported as long as the required documentation has been completed by the ordering physician and has been received in the Laboratory An Authorization to Proceed with testing form is the required documentation to be in the Lab s possession before testing can be reported on improperly labeled irreplaceable specimens If the completed Authorization to Proceed with Testing form is not returned to the Laboratory no results will be reported on this The Manager or Senior Technologist or Team Leader or designate receiving the specimen shall Telephone the patient care area or appropriate healthcare provider and a explain the labeling problem b Determine whether or not the specimen is irreplaceable by discussion with the appropriate healt
32. erum Chloride lt 80 mmol L Complex interwoven gt 120 mmol L Complex patterns with interwoven acid base and patterns with electrolyte balance acid base and electrolyte balance Digoxin gt 2 56 nmol l Serum Glucose lt 3 0 mmol L Brain damage gt 20 0 mmol L Diabetic coma Magnesium lt 0 41 mmol l gt 1 93 mmol l Phenobarbital gt 215 Serum Phosphus 0 32 mmol L Seizures amp Coma 2 58 mmol l Serum Potassium 3 0 mmol L Muscle weakness 6 0 mmol L Cardio toxicity paralysis cardiac with arrhythmias arrhythmias Serum Salicylate None 2 17 mmol L Continuing untreated toxicity Serum Sodium 120 mmol L Extremes of 160 mmol L Extremes of dehydration vascular dehydration collapse or edema vascular hypovolemia collapse or hypervolemia heart edema failure hypovolemia heart failure THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 Hematology 0 18 Heart failure and 20 60 Hematocrit anoxemia 70 g L Heart failure and 200g L Venous Hemoglobin anoxemia stagnation thrombosis and embolization Platelets lt 40 x 107 L Hemorrhage 2 900 None gt 4 0 INR Hemorrhage PT INR resulted PTT Partial None gt 60 seconds Hemorrhage Thromboplastin Time Fibrinogen lt 1 0 g L Hemorrhage gt 8 0 g L Confirmed Hepatitis B antigen Infectious Disease Serology Faxed by QEII to Public Hea
33. f the and or specimen pregnancies e any known antibodies THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 VERBAL REQUEST FOR LAB TESTS Any Laboratory Personnel receiving verbal orders must obtain the following information o That he orders were a Verbal Request Date and time of request All necessary patient information Name with unique identifiers location The tests being requested Health Care practitioner placing the order also include name of designate placing the call if not the Health Care Practitioner themselves o Name of Laboratory staff taking the order O OOO All verbal request for tests require that the tests ordered be read back to confirm the entire order STAFF ARE NEVER PERMITED TO PERFORM ANALYSIS FOR CLIENTS INCLUDING WITHOUT A WRITTEN OR VERBAL ORDER FROM A PHYSICIAN AND RESULTS SHALL NEVER BE GIVEN DIRECTLY TO A PATIENT RECURRING TESTS Laboratory standards require that the physician on a yearly basis must update orders for recurring tests Recurring tests are tests ordered so that such will be performed periodically with no end date stated Example monthly CBC s Weekly PT s etc To meet this standard 1 year from initial order for recurring tests patients will be advised that they should schedule a visit to their physician to obtain updated orders A letter explaining this policy will be given to the patient t
34. h care professional and in consultation with the ordering physician C Advise that the specimen was received improperly labeled and the Authorization to proceed with testing form must be completed prior to release of results d Faxthe Authorization to proceed with testing form to the physician e Ensure orders are placed in Meditech and the proper documentation and labeling of all specimens is completed The Irreplaceable Specimen comment is to be placed in Meditech as a specimen comment when entering the specimen The mnemonic for this comment is IRR and the comment states This specimen was received in the laboratory with an identification problem Due to the irreplaceable nature of the specimen it was processed and reported after the necessary laboratory documents were completed and returned by the ordering physician f Deliver specimens to other sections according to the requested test and provide explanation of the situation to the departmental technologists g Process the specimen as usual See Reviewing And Reporting below Reviewing and Reporting When reviewing and reporting a specimen that has the Irreplaceable Specimen comment ensure that the necessary documentation is present in the laboratory before the results are finalized The Manager or Senior Technologist or Team Leader or designate of the department involved with this specimen shall Ensure Authorization to Proceed with Testing form has been completed before
35. i HPYA CRP HSCRP PRENATAL Ql Initial Prenatal Screen RUB RPR VDRL HepBsAg CBC UA URNC UU U U U U U U U U U Group amp Rh Blood Type GRRH Antibody Screen ABS Transfused Preg in last 3 months Y Antibody Card Info _ Q Varicella Zoster if indicated VZ HIV HV lt 28 week Prenatal non fasting GTTLOAD ABS CBC UA URNC Gestational GTT 6116 RANDOM URINE COLLECTION Urinalysis uA HCG Screen ucc Microalbumin U AC Ratio 24 HOUR URINE COLLECTION Creat Clear cREct Ht cm Wt kg Creatinine 24 SHIAA u245HIAA 0 Total Protein 24 SEMEN ANALYSIS LJ Post Vasectomy sAPV Complete Fertility SA Date Received Time Received MICROBIOLOGY Diagnosis Q Urine Culture URNC Midstr IndwelCath In OutCath Other STOOL Q Stool Culture sroc C Diff Cytotoxin coiFF Ova 8 Parasites oPSR RESPIRATORY Q Throat Culture THRC Q Sputum spuc Ear EARC 32 Eye GENITAL REQUEST 2 Cervical Urethral for Chlamydia amp Gonorrhoeae CHLGCPCR Vaginal Swab VAGC lt Vaginosis Screen Vaginal Nugent Q Group B Strep Vaginal Rectal MISCELLANEOUS 0 Dermatophytes Fungal scraping FUCD Source Misc Cult Aerobic misc Site Other TRANSFUSION MEDICINE C1 Group amp Rh Blood Type GRRH Q Antibody Screen ass Transfused Pregnant in last 3 months Yes No __ Antibody Card Info
36. information shall be given to the nurse in charge of the patient or another individual who will take responsibility to communicate the information to the appropriate physician in a timely and accurate manner Acopy of the result is broadcast to the unit via the Meditech computer system Emergency Department e When the laboratory specimen request is ordered by an Emergency room physician ERP working in the Emergency department the technologist is responsible to a Call the Emergency department b Inform the person answering the phone that they are transmitting a critical value result to their printer c Document the date time and person notified in the computer Outpatients e During the regular working day the result is called to the physician s office If the doctor s office has a fax machine the office is called and informed that a critical value report is being transmitted by fax e If the ordering physician s office is closed the information on that telephone s answering machine voice mail will be followed to contact a physician to whom the report may be given e The ordering physician or his designate on call will accept this result e fthe answering machine voice mail does not specify an on call physician contact switchboard to obtain physicians pager and home phone numbers e The technologist will report this result verbally to the physician and document in the computer the date time called and the name of the physician who accepte
37. l name and unique patient ID number or healthcare number All identifiers must match those on the requisition Specimens that cannot be adequately identified will not be processed In all cases a request will be made to recollect the specimen in question In the event of an improperly labeled irreplaceable specimen an attempt will be made to contact the ordering physician to issue an order to proceed with testing Reports will contain a disclaimer that the laboratory will not accept responsibility that the results belong to this patient All specimens received in the laboratory must be received in a biologically safe condition Specimen containers and or requisitions that have become contaminated through leakage of the biological fluid will be discarded and will not be processed It is the responsibility of the individual packaging the specimen to ensure that leak proof containers are being used and to package specimens in such a manner that damage does not occur during transport Requisitions and paper must be packaged separately under protective plastic to prevent contamination if a biological specimen does leak or spill All specimens must be technically suitable for the purpose of testing Specimens that are received in a condition that is deemed unsuitable for testing will be disposed of without being tested Conditions identified as making a specimen unsuitable for testing include Insufficient quantity of specimen Hemolyz
38. linician has requested First read the instructions carefully make sure you are prepared and then follow each of the steps to ensure proper collection Notes It is essential that this procedure be followed very carefully Test results are based on the total amount of tested substance excreted by your body over a 24 hour period The results provided to your clinician depend upon the collection of all urine excreted during an entire 24 hour period For some tests there are dietary and drug restrictions Check with your clinician or the laboratory before beginning the specimen collection You may drink as much fluid as you normally would during the 24 hour collection period Instructions Obtain the proper 24 hour urine container for the test requested DO NOT remove any liquid preservatives that may be in the container Note any warnings or instructions which may be printed on the outside of the urine container Write your full name and date of birth on the container label DO NOT void directly into the 24 hour container Collect urine in another container and pour it into the 24 hour container DAY 1 First thing in the morning at a designated time for example 7 00 AM completely empty your bladder and DISCARD this first morning specimen Record this exact start time and date on the container Collect ALL specimens during the remainder of the day evening and night for the entire 24 Hour period And add ALL the specimens to the
39. lth Services Confirmed Hepatitis C Faxed by QEII to Public Health Services THIS IS A CONTROLLED MANUAL REVISION DATE August 16 2013 USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 GENERAL LABORATORY TESTS AVAILABLE AT PCHA LABORATORIES ABO RH PLASMA EDTA 6ML MAKE UP BB REQUISITION SERUM RED TOP 10ML ANTIBODY SCHEEN PLASMA EDTA 6ML MAKE UP BB REQUISITION CROSSMATCH SERUM RED TOP 10ML DAT PLASMA EDTA 6ML MAKE UP BB REQUISITION SERUM RED TOP 10ML KLEIHAUER WHOLE EDTA 6ML MAKE UP BB REQUISITION BLOOD ACETAMINOPHEN ACET LAB SERUM RED TOP 4ML TYLENOL Plasma Na Heparin 4ml AHDL HDL LAB PLASMA NA HEPARIN 4ML SERUM RED TOP ALBUMIN ALB LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML ALBUMIN PLEURAL PLALB LAB FLUID RED TOP 10ML ALBUMIN BODY FLUID BFALB LAB FLUID RED TOP 10ML ALBUMIN CREATININE U AC LAB URINE URINE 10ML RATIO RATIO ALCOHOL ETHANOL ETOH LAB PLASMA NA HEPARIN 4ML DO NOT USE ALCOHOL SERUM RED TOP SWAB ALKALINE PHOSPHORUS ALK LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML ALT SGPT ALT LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML AMYLASE AMY LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML APTT APTT LAB PLASMA NA CITRATE 4 5ML ASOT ASOT LAB SERUM RED TOP 10ML 4 ml AST SGOT AST LAB PLASMA NA HEPARIN 4ML SERUM RED TOP 4ML BICARBONATE HCO LAB PLASMA NA HEPARIN 4ML TOTAL CO BILI DIRECT BILD LAB PLASMA NA HEPARIN 4ML PERFO
40. mber Hospital Number Date of Birth Type of Specimen Due to the irreplaceable nature of the specimen processing has been initiated however laboratory policy requires that you provide further information and authorize the release of the report understand that this specimen will be processed and results released on my order and that the laboratory cannot accept the responsibility for the results belonging to this patient Dr Please Print Signature Date THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPENDIX D2 Pictou ealth PICTOU COUNTY HEALTH AUTHORITY LABORATORY SERVICES Notice for Standing Order Renewal Standing Orders for Laboratory Testing must be renewed each year This patient requires an updated laboratory requisition for further testing Without an updated requisition we will not be able to perform further testing for this patient Thank You Darlene Gilby Team Leader Specimen Procurement Pictou County Health Authority THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013
41. o present to his or her physician New orders will be required prior to the next visit for blood collection Consult Appendix D2 for sample of form letter that will be given to patient to deliver to physician TECHNICAL AND CLINICAL LABORATORY CONSULTATIONS Licensed Medical Laboratory Technologists employed by PCHA are available for telephone consult regarding all technical aspects of testing Appropriate contact numbers are listed in PCHA Laboratory Contact Numbers lists on page 5 For consultation and advice on medical indications and appropriate selection of available procedures telephone consult is available from Laboratory Management Contact Laboratory Management as appropriate at the phone numbers listed below Medical Laboratory Director Dr Leon Desormeau 1 902 752 7600 2850 Friday Laboratory Manager John O Donoghue 1 902 752 7600 ext 2830 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 SPECIMEN IDENTIFICATION Specimens received by the Lab that are not adequately identified will not be processed In all cases a request will be made to recollect the specimen in question A single label with two identifiers must be attached to each specimen that has been entered in the Meditech system All identifiers must match those on the requisition the patient s full name and health card number or other unique ID such as Hospital Unit Number or Health Card Number
42. rhoids or menstruation which could contaminate your stool with blood you should not be tested while the bleeding is active Diet and drug restrictions There are some foods and drugs that interfere with this test For seven 7 days before and during the stool collection period avoid non steroidal anti inflammatory drugs such as Ibuprofen Naproxen or Aspirin no more than one adult aspirin a day Acetaminophens Tylenol can be taken as needed For three 3 days before and during the stool collection period avoid Vitamin C in excess of 250 mg a day from supplements citrus fruits or juices The recommended daily amount of Vitamin C for an adult is 60 mg a day Some Iron supplements also contain Vitamin C in excess of 250 mg For three 3 days before and during the stool collection period avoid red meats including beef lamb liver Eat a well balanced diet including fiber such as bran cereals non citrus fruits and vegetables f you have any questions regarding your regular medication discuss this with your clinician or your pharmacist Instructions 1 The specimen cards will be labeled with appropriate laboratory labels when you pick up the cards at the laboratory registration desk 2 Fill in sample collection date and time just prior to a bowel movement 3 Pass urine into the toilet if you feel the need 4 Using a clean dry container collect stool before it contacts the toilet bowl water Let stool fall into collection container
43. rocedures INSTRUCTIONS FOR STAFF WITH ORDER ENTRY MODULE ACCESS PCHA staff who have access to the ORDER ENTRY NORTH LIVE module may enter Laboratory patient test requests electronically This is done under the ENTER ORDERS icon of this module Complete instructions for entering Laboratory patient test requests may be found in the manual provided by HITS NS The manuals currently in use for this module are available on the PCHA intranet link to HITzone at http hitszone nshealth ca Site Published extranet oedocuments aspx e IMPORTANT regarding add on tests Before entering add on tests into the computer a call must be placed to the Laboratory to confirm that the laboratory has the proper collection tube available to perform the test and to ensure that the sample meets laboratory standards for testing Example not too old THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 CLASSIFICATION OF LABORATORY ORDERS Indicates the results Not a medical Specific time of Indi needed but d cates collection required immediately because indicates results are routine use priority of f a medical requir s soon as rocessin S mede equi 9 Urgent or Routine emergency possible Unless a Enter N for current time Unless a specific time is required leave blank specific time is required leave blank Enter time of colle
44. sh urinating in the toilet If you are requested to collect two samples then use bottle 1 to collect the first part of your urine and bottle 2 for the remainder e Replace the cap of the container s tightly again being sure not to touch inside the cap or the bottle e If you wish you may use a brown paper bag to bring your sample to the bench Paper bags can be found on the counter tops in the washroom Note the following Please inform the technologist if you have any difficulty or questions For specimens not collected in the Lab e Follow the same instructions as above Make sure the specimen container label includes e Your legal name e Your Health Card Number or another unique identifier not date of birth e Date and time of collection Make sure the requisition form includes e Your legal name e Your date of birth e Your Health Card Number or another unique identifier not date of birth e Physicians full name and address e Date and time of collection If the specimen or requisition is not complete the specimen may not be processed Deliver the specimen within 2 hour to East River Road Blood Collection Clinic during regular hours THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPENDIX A2 PATIENT INSTRUCTIONS COLLECTION OF 24 HOUR URINE SPECIMEN The following collection instructions are intended to help you collect the correct specimen for the test your c
45. some 24 hour collections need special preservatives added To eliminate the need for recollection the lab will not give out containers unless they know what tests are ordered Instructions are included in this manual as APPENDIX A2 Occult Blood Testing Preparation for collection of these specimens may require change of diet and or medication changes as listed in the instructions that the patient will be given Instructions are included in this manual as APPENDIX A3 Seminal Fluids for Containers and patient instructions are available from the laboratory complete analysis Instructions are included in this manual as APPENDIX A5 Seminal Fluid Analysis Containers and patient instructions are available from the laboratory post vasectomy Instructions are included in this manual as APPENDIX A6 THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 MAINTAINING CONFIDENTIALITY OF PATIENT INFORMATION The Laboratory Services of PCHA recognize the individual s right of privacy in relation to his her hospital visits All PCHA Laboratory staff members are charged with the duty to maintain confidentiality of all patient information obtained as an employee of PCHA All PCHA Laboratory Staff are required to have signed and have on their employee file a confidentiality statement All information related to an identified individual must be treated as confidential
46. that the laboratory will not accept responsibility that the results belong to this patient SUBMISSION OF CODED PATIENT SAMPLES The physician may chose to identify the patient by a code name this name will be used to identify the specimens however a code will be assigned to the sample at the specimen processing area The following guidelines must be used when submitting coded patient samples to allow easy retrieval of information and comparison with previous results in the computer system The code format shall be as follows The first part of the code name should be the collection location example Aberdeen would be A R The second part of the code is the date the sample was drawn day Month 2105 The third part of the code is the first available letter for that day example client 1 would be A etc THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 The name of the ordering physician must be clearly indicated on the requisition this is essential so that reports may be communicated to the correct physician department REJECTION OF SPECIMENS It is the policy of the Laboratory Service to reject laboratory test specimens on the basis of improper identification unusual biological hazard or specific technical criteria These criteria are set out in the following protocol All specimens must be adequately identified by having attached to the specimen the patient s ful
47. uesters only The Laboratory must have evidence that the orders received are under the direction of an authorized Healthcare Practitioner To conform to Laboratory standards the request form shall contain information sufficient to identify the authorized requester To ensure that this standard is met the test request form or an electronic equivalent shall contain a legible name preferably legible signature or other unique identifier stamp pad signature electronic signature etc of the ordering physician or other person legally authorized to request examinations or use medical information Authorized requesters include Physicians licensed by the College of Physicians and Surgeons of Nova Scotia Physicians listed in the Canadian Medical Directory as published by the Canadian Medical Association Physicians who have been granted privileges by the District Health Authority Nurse practitioners who have been granted privileges by the District Health Authority Dentists who have been granted privileges by the District Health Authority Other persons as designated by the District Health Authority Agencies as permitted or required by law VVVVV NN SURGICAL SPECIMEN AND INPATIENT SPECIMEN DROP OFF Surgical specimens may be dropped off in Specimen Processing Monday Friday 7am 3pm excluding holidays after regular business hours surgical specimens should be delivered to the core lab with the exclusion of amputation specimens which should be
48. wing are the DO S and DON TS in phlebotomy e Identify the patient correctly e Explain why you are there DO e Position the patient in a comfortable lying or sitting down position e Prepare your equipment e Apply tourniquet e Palpate for suitable vein e Cleanse arm e Recleanse arm if vein is palpated after cleansing s Insert the needle to approx 15 degree angle e Release the tourniquet before removal of the needle e Hold gauze on the venipuncture for 2 3 minutes e Mix tubes containing blood and anticoagulant e Label specimen tubes correctly e Dispose of used equipment properly e Use the name card on the wall or bed for patient information DON T Tell the patient phlebotomy wont hurt e Draw a patient while they are standing up e Leave the tourniquet on in place for more than 1 minute e Enter the arm on blind chance without seeing or feeling a vein e Reuse a needle or a syringe e Attempt to draw blood from the same patient more than twice e Pre label blood tubes e Dispose of used needles or syringes in ordinary waste baskets e Recap needles e Draw blood from the same arm in which there is a haematoma or an IV hanging unless no choice e Attempt venipuncture on a structure that is pulsating could be an artery e Collect blood from an arm that has a dialysis shunt inserted into it THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 APPEN
49. ys a week as part of PCHA Laboratory Service DEPARTMENT LISTING OF STAT TESTS AVAILABLE Blood Gases Glucose BUN and or Creatinine Electrolytes and 1002 Cardiac Profile Enzymes AST LDH CK CKMB Troponin 1 Liver Enzymes AST ALT Alk Phos gamma GT T bili Bilirubin neonatal Amylase Calcium Phosphorus Magnesium Urinalysis and culture if required Urine Drug Screen Emergency and Pre Operative Pregnancy Tests urine HCG or serum HCG CSF Glucose CSF Total Protein CSF LDH Drug levels such as Acetaminophen Salicylate Alcohol digoxin lithium Dilantin tegretol or valproate to diagnose and or treat intoxication or poisoning or overdose Gentamicin levels to monitor treatment of infection THIS IS A CONTROLLED MANUAL USER S MANUAL VERSION 4 ISSUE DATE March 1 2009 REVISION DATE August 16 2013 CHEMISTRY Vancomycin levels to monitor treatment of infection Hs CRP HEMATOLOGY CBC Profile ESR only required STAT if suspected temporal arthritis INR PTT D dimer Fibrinogen PFA 100 CSF cell count and differential MICROBIOLOGY Direct Strep Screening Blood Culture collection and setup CSF Gram Stain and culture BLOOD TRANSFUSION SERVICES Blood Grouping Antibody Screening and Cross matching Rh Investigation in cases where mother may require injection of Rh immune globulin Where
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