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Compliance & Safety, Education & Training, Microbiology, Molecular Diagnostics, Referral/Sendouts, Test Utilization
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Education & Training
Education & Training, General Information, Test Utilization
Appropriate Thyroid Peroxidase Antibody Ordering
The most conclusive evidence for using thyroid peroxidase antibody (TPO) is predictive in nature when evaluating possible subclinical hypothyroidism. If this test is positive, hypothyroidism occurs at a rate of 4.3% per year versus 2.6% per year when the antibody is negative. While this scenario does not cover all clinical indications for ordering TPO, there is no definitive evidence that repeat TPO testing provides additional information.1
Based on this information the ordering of TPO within Spectrum Health is being modified. If the test is ordered more than once on a patient, a screen will appear in EPIC indicating the following: “This test should typically only be resulted once per lifetime. The duplicate checking indicates that this patient has already had this testing performed. Please see chart review for results.” This is not a “hard stop” but providers will need to click “Continue” to proceed with the order.
Chemistry, Compliance & Safety, Education & Training, General Information, Referral/Sendouts
Preservative For 24 Hour Urine Collections
In both the inpatient and outpatient settings, the laboratory has supplied 24 hour urine containers with preservative such as acetic acid, sodium hydroxide, and boric acid. Upon review of specimen stability requirements, it has been determined that a preservative is not needed prior to collection of most 24 hour urine tests as long as the 24 hour container is kept refrigerated or on ice during the collection period.
Blood Bank, Compliance & Safety, Education & Training, Test Utilization
Reminder: Choosing Wisely Recommendations for Blood Products
As part of the Choosing Wisely campaign, the American Association of Blood Banks (AABB) released five recommendations for transfusions:
Compliance & Safety, Education & Training, General Information, Referral/Sendouts
Chlamydia and Gonococcus Testing on Pediatric Patients
Spectrum Health Regional Laboratory is not validated to perform Chlamydia and Gonococcus testing on pediatric patients under the age of 14 years old. Testing for these patients must be sent to a reference laboratory. Please order a Reference Miscellaneous Test (#LAB848) and indicate complete test name when ordering.
Compliance & Safety, Education & Training, General Information
Maintaining Specimen Integrity – Purple Priority Bags
Spectrum Health Regional Laboratory supplies purple priority bags for specimens that must be handled and processed immediately upon receipt in the laboratory. The purple color priority transport bag will be a visual cue to the receiving laboratory that the specimens inside the bag need to be handled or processed immediately at the time of arrival in the laboratory or the integrity of the specimen will be compromised.
Use these bags for transporting specimens to the laboratory when:
Safety of our patient and quality of care are of utmost importance. For this reason we require specimens sent to the Spectrum Health Cytology Laboratory be labeled with at least two patient identifiers, (i.e., patient legal name, birth date and MRN.) We will no longer return to the collection site, unlabeled, mislabeled specimens lacking two patient identifiers or specimen containers with multiple different patient labels. These specimens will be discarded and repeat collection will be necessary.
Procedures to verify correct labeling of patient specimens at the time of collection are recommended. Specimen containers should not be pre-labeled. Variation of the “time-out” procedure used in the hospital and surgical center setting is an excellent way of confirming that the specimen is correctly labeled. This can easily be achieved by having the patient verify his or her name and birth date, by reading the label placed on the specimen container at the time the specimen is collected. This “time out” should occur before the specimen leaves the examination or treatment room.
It is our mission to provide the best and safest care we can to our patients. We know that physicians and other practitioners are required to see patients more efficiently and at times with less than adequate time allowed. Following a “time out” procedure and not pre-labeling specimen containers will prevent errors that may lead to diagnoses being assigned to wrong patients, hence, unnecessary procedures and lack of follow-up for the appropriate patient.
Leaky specimen containers may cause compromised test results and it is also a hazard to lab couriers and registration personnel. Please be sure to inform patients that leaky specimen containers are not acceptable and may be rejected.
In order to prevent leaky containers, please be sure to discuss the following tips:
In anticipation of “Flu season”, it is valuable to revisit available testing methods for influenza and discuss when each test should be ordered. Though generally a self-limited infection for otherwise healthy individuals, influenza can be particularly severe for high-risk populations including infants, elderly, pregnant women, and immunocompromised hosts. Influenza incidence is largely seasonal with the majority of cases occurring between December and April of each year.
All specimens submitted to Spectrum Health Laboratory for testing must be appropriately labeled to assure positive identification and optimum integrity of specimens. In accordance with standards issued by The Joint Commission, at least 2 patient identifiers should be used when providing care or treatment of services (National Patient Safety Goal, NSPG.01.01.01). If 2 patient identifiers are not used on the specimen, the specimen will be rejected, the order will be cancelled and a request for recollection will be made. This includes Gyn Cytology (i.e. Pap) specimens.
What are acceptable Patient Identifiers?
- Patient Full Legal Name
- Date of Birth
- Spectrum Health Medical Record Number (MRN)