The Role of Medical Laboratory Assistants - Assignment Example

The Role of Medical Laboratory Assistants: In the recent era of medical field, the diagnostics largely depend on clinical, radiological and laboratory findings, so the role of pathologists as well as lab assistants is of utmost importance as any ignorance or lack of latest knowledge on their part can be detrimental to the patient. Medical Laboratory Assistants (MLAs) are mainly involved in the preparation as well as in some cases the processing of the patient samples. They are also required to perform some pre requisite tests which are required to aid the pathologist or hematologist in performing the final analysis. But the main duty of MLAs is to process the sample so the MLA should have a sound knowledge about the sampling and the processing techniques as well as the local recommendations of the regional medical legislative authority. Now in order to have an overview of the work of MLAs we’ll try to answer a questionnaire to highlights their duties as well as its impact in the medical field. 1. What are the principles of testing planning techniques? The main principles of planning a test include the propose of carrying out the test, the knowledge of the clinical suspicion for a particular disease. Then the time frame of performance is planned followed by the list of the equipment and the chemical used and then the standard procedures for the investigation are gone through in detail to exclude the possibility of missing anything. 2. What methods can be used for controlling test variables? Basically the responsibility of accurate and timely reporting of test results lies on the personnel working in the laboratory as there are many problems which can arise even before the sample has undergone the analytical process. These errors can only be tackled properly if prior understanding of the process as well as the capability to identify any error in these processes is present in the MLAs. In addition to this, controlled and correct interpretation of results needs comprehensive knowledge of analytical, biological and pathophysiological variability and the extent of this change. There should also be sound knowledge about the time span in which changes can occur in the sample resulting in the variations and errors in the final results. 3. What are concepts of repeatability and reproducibility? Reproducibility is one of the main aspects of the laboratory working, and refers to the ability of a test or experiment to be accurately reproduced, by someone else working independently. Repeatability is different from reproducibility as it measures the rate of success in different experiments conducted by the same group of experimenters. Reproducibility shows the relation of the results of the tests carried out with different operators, test apparatus and in different laboratories, it is usually expressed in the form of standard deviation. It is directly related to the accuracy of the results and MLAs should be able to reproduce the results which are accepted worldwide. Repeatability is also required in medical laboratory work as it relates the ability of MLAs to carry out same experiment in a similar manner and under same conditions and to produce the same results. 4. What are the process review techniques? There should be some qualitative control tools which should be designed to assess how well and with how much uniformity medical lab tests are being carried out by MLAs. The process review techniques should be quick and easy as it will save the time of quality control supervisors. The startup plan for the review of the lab processes is made on the basis of guidelines from regulatory and accredited organizations related to quality planning process. A practical process review procedure will be one which will utilize the available tools and technology whether these are analytical tools or these are quality control procedures. In actual practice, there are two QC tools which include Allowable Total Error & Clinical Decision Interval as QC models are available to extract the specifications for QC. One of such tool is OPSpecs chart, which is quite easy to use & it provides a visual representation of imprecision and inaccuracy that is allowable for a certain procedure. Internet calculators are also available for quantitative assessment of the processes. With the help of these calculators and OPSpecs Allowable Total Error can be calculated. QC Validator is software which helps to prepare OPSpecs charts for both analytical as well as clinical quality requirement proposes. It also aids in the documentation of QC planning. 5. Why calibration is important and how to check calibration? For accuracy and precision, regular calibration services are required to ensure the accuracy of the instrument in use. Most of the lab equipment manufacturers have contracts with regular calibration groups to ensure that their equipment and instrumentation is working accurately. This is important in maintaining accuracy in the processes and also to avoid legal consequences for not abiding the regional medical legislation. Calibration is quite a simple thing and it depends on the nature of the equipment and the process involved. Professional calibration services mainly depend on their own calibration procedures and calculations which are approved by a certifying, licensed compliance bureau. Professional instrumentation used for calibration services is also checked for accuracy under strict conditions. 6. What is the reporting procedure in the event of deviation? In order to identify the deviations in the calibration, MLAs should have a sound knowledge of the calibration procedures and the allowable limits to which error or deviation can be accepted. These limits are provided at the time of calibration by the Calibration Services provider. So in the case if some significant deviation occurs then it should be reported to the department concerned with the calibration within the institution. It will subsequently check the error causing the deviation and will rectify the problem and if the problem is out of their capacity then they will report it to the respective calibration service provider which will rectify the error causing the deviation. 7. How to deal with deviation, and who are the relevant people? MLAs should be able to identify the deviations and after deviation had occurred the following protocol should be considered MLAs should report to the head of the department which in turn should report the deviation to the head of the institution and the QC division of the institution who will send the report in coordination with the head of institution to the corresponding service provider and they will respond to the problem by sending a team to rectify it and after the rectification of the deviation, they will submit a report to both the laboratory officials as well as the calibration service provider. 8. What methods can be used for validating data and what are the procedures for recording and retrieving data? MultiQC is window application software which helps in validation of data and it decreases the chances of heterogeneity in the results. It uses the continuous method validation of data by which it controls the performance of all the tools under it at all the times. The performance is always assessed in relation to allowable error limit. It verifies the reportable range and clearly indicate if something fallout of this range. It also does comparison of different analytical methods and their tolerance. Different regression tools are also integrated into the software for the validation of data. Usually for the recoding and retrieval of the data, a computerized system is used. To start with, a patient or attendant of a patient comes with a sample on which the test is to carried out, then the patient is awarded a registration number which is added in the lab software, then the sample is sent to the respective lab dept which carries out the test required and enters the result in the computer system against the same patient number and then the results are given to the patient by the receptionist. Extreme precaution should be taken at the time of entry of the credentials as any wrong entry at this time can lead to false results and also waste of resources. 9. What methods statistical and mathematical techniques may be used to evaluate data? There are mainly two statistical methods which are used to assess the ability of the test to detect the disease. Sensitivity: It refers to the ability of the test to give a positive result in a patient who has got the disease for which the test is performed. Specificity: It refers to the ability of the test to give a negative result for the presence of a disease in a patient who is actually disease free. 10. What methods can be used to evaluate results? There are two parameters which are widely used to evaluate the results. 1. Accuracy is how close a measured value is to the actual (true) value. 2. Precision is how close the measured values are to each other 11. What are the standard recording and reporting procedures to use? Results are recorded and generated electronically by MLAs and most of the reports of the results are available are available in less than one and a half hour time after the reception of the specimen except some more delicate tests which require more time. Then these results are reported through clinical information system which will be accessible throughout the pathology department. In the case when verbal communication of the results is done then following details should be spoken: Speaker Name & the section concerned, Patient’s full data, Patient’s medical registration number. This information should be read back by the patient for verification proposes. Critical information should be communicated directly to the concerned person to ensure that the results are collected as soon as possible. If despite of maximum efforts to communicate the results are not collected then a voice mail message can be left for the person concerned. 12. What documentation should be used and why it is important to complete it accurately? Documentation is necessary for the compliance with the standard protocols and it is the major source of evidence for the regulatory authorities, this documentation can include mission statements, quality manuals, laboratory procedures as well as the working protocols. It is quite a time consuming procedure to devise this documentation but it is mandatory to carry it out in a systematic way. Mainly four types of documentation are needed in the medical labs which include policies, procedures, working instructions and the forms and the records. The significance of filling the documentation correctly relates to the accredition of the particular lab. As these documents are the material which shows the working protocols which are followed so in case of any legal procedures these documents will be required. In addition to this, the higher authorities can check whether SOPs are followed or not and these can be proved with the help of documentation. 13. What operating conditions are necessary to conduct the investigation? Operating conditions may differ according to the nature of the investigation carried out in the lab. At large we’ll have a look at some standard precautionary measures which should be followed in the laboratories. As most of the lab tests are temperature dependant so temperature must be monitored closely and should be fixed accordingly for a particular investigation. Humidity level should also be monitored closely as it can affect the investigations badly, complete aseptic measures should be adopted for the accurate results and proper scrubbing facilities should be available for the MLAs. Infectious material should be handled with extreme care so as to minimize the chances of spread of communicable diseases. Additional operating instructions may be required for different sort of investigations. All the MLAs should be competent in operating the clinical information system so that they can do the accurate reporting of the investigations. 14. What are the essential features of an investigation plan, and how to initiate it? Following are the essential features of an investigation plan Request of a particular investigation at the reception of the lab, the entrance of the data in CIS and the dispatching of the sample to the concerned lab section which will follow the SOPs which are documented for that particular test and MLA will assure that optimum operating conditions are available for the performance of the tests. After the completion of the test, MLA will inform the pathologist who will then scrutinize the results and after his approval, these results will be entered in CIS and then these will be delivered to the patients. 15. How to identify and deal with contingencies? A standard and an accredited laboratory should be able to identify as well as report any matter of contingency, so they should coordinate with the respective college of pathology of that particular country so as to abide by the reporting requirements of any reportable disease condition, this should be reported immediately by fax, mail or electronically as per the regulations. The patient will also be responsible to comply with the health authorities regarding the contingency issue and MLAs may be required to give the patient address to the regulatory authorities. 16. What are the limits and tolerances of investigation techniques? Each test and investigations has its limitations and tolerance limits. Tolerance limits are usually defined statistically and can be parametrical which considers that the sample is taken from a population which follows a normal distribution or non parametrical which does not follow a normal distribution but these are not accurate and so cannot be relied upon. Limitations of a particular investigation relate its ability to detect a particular disorder. There are certain investigation which can aid in the diagnosis of a disease whereas on the other side there are some investigations which do not aid in the diagnosis but can aid in determining the prognosis of the disease and the response to the treatment. 17. What units of measurement are required? The units of measurement vary and depend on the type of investigation carried out; usually metric system is used to express the quantities. Mass is expressed in grams, volume is expressed in liters and the length is expressed in terms of meters. One of the advantage of the metric system is that is based on the multiples of 10 which makes the calculations easy and it is accepted universally. Other units can also be used for example moles or milli moles and different formulae are also available with the help of which one unit can be converted into equivalent other unit. 18. What methods can be used for report writing? Following portions should be included in a comprehensive medical lab report; at first the patient description of the disease is to be mentioned in patients own words which may aid in establishing the diagnosis along with the lab investigations; write your physical findings correctly; give all the required information which is extracted from the test performed and also mention the limitations of that particular test and recommend if there is any other investigation or procedure which may add in the diagnosis in addition to the investigation which is carried out, correlate the clinical findings with the lab investigation result. 19. Who are the relevant people in the organisation? These include the following people Receptionist, Phlebotomist, Computer Operator, MLAs, Lab Technicians, QC Supervisors, Pathologist (Clinical, Chemical, Forensic), Hematologist 20. What could be the legal consequences of breaches of quality procedures? In case of non compliance or breaches of the standard procedures, the registration of the lab can be suspended and the license of the lab can be cancelled. The patient or the patient insurance agency can initialize legal proceedings against the lab or in milder cases; the lab can be put on probation and will be supervised for a certain period of time so MLAs should be well aware of all the SOPs as well as the legal consequences so as to minimize the occurrence of such incidents. 21. What evaluation criteria should be used that is relevant to customer requirements? Mainly the customers require the knowledge of the normal values for a particular test so one of the thing which needs continuous evaluation is the reference values for the customers and these should be from current literature and should be scrutinized regularly, MLAs should make sure that the prevalence rates of different tests should be noted and regular evaluation of the results of the investigations as well as any deviation or any error which exceeds Allowable Medical Error should be monitored closely 22. What methods should be used for feedback? On behalf of laboratory, complete details of all the means of communication such as Phone, Fax, e-mail, Mobile Number as well as the website address of the lab should be clearly written on the report and on the other hand all these contacting details should be taken from the patient also and should be entered in the Clinical Information System at the time of patient’s record entrance. In addition to this, regular feed back forms should be sent to the institutions which are sending the patients regularly to the lab. 23. The relevant roles and responsibilities of yourself and others under the health and safety at work act 1974 and current legislation (e.g. management of health and safety at work regulation; workplace health and safety and welfare regulation; personal protection at work regulation ; manual handling operations regulations; provision and use of work equipment). MLAs should make sure that there is no emission of noxious or poisonous material into the air. All the employees should not be involved in the misuse of any of the material present in the lab; everyone should behave responsibly to ensure the safety of him as well as the safety of the other working at the same place. Manual handling of the materials and the equipments should be minimized and in the case where it cannot be avoided then proper measures should be taken to ensure the personal protection. 24. How to locate relevant health and safety information for your tasks and the sources of expert assistance when help is needed? This information can be gathered or search from the local medical regulation manual as well as such information is available on the net on the websites run by the state authorities which define the health laws such as the State Department Of health. If some problem arises while doing a particular investigation and the problem is above the comprehension of the involved MLA then that MLA should be able to contact the pathologist at that time or contact the QC supervisor if the matter relates to the quality control. The updated directory should be present in the laboratory through which MLA can contact the higher officials for expert advice. 25. What constitutes a hazard in the workplace (such as moving parts of machinery, electricity, slippery and uneven surfaces, dust and fumes, handling and transporting, contaminants and irritants, material ejection, fire, working at height, environment, pressure/stored energy system, volatile or toxic material, unshielded processes). Careful handling should be done when the movement of delicate lab instruments is taking place to prevent the breakage as well as to avoid damage to the machinery. Continuous electrical supply should be ensured as well as the sockets should be kept away from the humid surfaces. Slippery and uneven surfaces should be covered with smooth and flat blocks to avoid inaccuracy in readings and spillage. Proper ventilation system with powerful exhaust system should be there to pump out the toxic fumes. Contaminants and the irritants should be disposed off properly and to a safe place away from the public area. Proper dressing should be worn while doing a specific test and toxic materials should be dealt with extreme care. 26. What are your responsibilities for dealing with hazards and reducing risks in workplace? In case of any hazard related to the laboratory materials and the equipment, MLAs should ensure the following: Immediately inform the concerned national authorities and Disaster Management System. Evacuation of all the personnel from the vicinity, sealing off the work place to minimize the chances of spread of the contamination and help the people doing the disaster management. To reduce the risk of such an event, national guidelines regarding transportation and handling of lab equipment should be followed. 27. What are the risks associated with your working environment, the tools, materials and equipment that you use, spillages of oil and chemicals, not reporting accidental breakages of tools or equipment and not following laid down working practice and procedure? As in the laboratory, acid and basic substances are used which if not handled properly can cause burns and their spillage can also damage the other instruments. If accidental breakages are not reported then these can lead to fatal damages by spillage while performing the test being unaware of the breakage. If the SOPs are not followed then the quality control can be compromised and as a consequence legal consequences can be seen. 28. What constitutes dangerous occurrences and hazardous malfunctions and why these must be reported even when no one was injured? Dangerous situations can arise due to; Breakage, spillage, unsupervised transportation of chemicals, careless handling of the lab equipment, contamination of the laboratory and its spread to outside environment. Malfunction may include improperly working electrical socket, ineffective pumping of the fumes and dust out of the laboratory resulting in the accumulation of poisonous fumes inside the lab. These incidents should be reported to concerned authorities at the institution as well as national level immediately regardless of the casualties or the number of injured to ensure that such incidents may not occur in the future and proper actions should be implemented by the concerned authorities to prevent such occurrences. 29. What the organizational policy is with regard to fire fighting procedures, the common causes of fire and what you can do to help prevent them? Basically there are five steps in fire fighting which include rescue operations, protecting the building and the equipment within the vicinity of the fire from the damage, making the fire stay put , try to extinguish it with fire extinguishers and then carry out the salvage procedures. An officer should be made in charge of the proceedings and he should be experienced person who can decide the best strategy to fight the fire. The operation must be such that it ensures the safety of both the fire fighters as well as the people caught in the fire. In medical labs, the usual causes of the fire includes short circuiting, gas leakage from the burners, uncontrolled exothermic chemical reactions and accumulation of the inflammable fumes and their reaction with the chemicals present in the lab so proper guidelines should be followed and required measures should be taken while dealing with inflammable materials, ensure proper working of the ventilation system and regular assessment of the electrical supply of the lab. 30. How to lift and carry loads safely and the annual and mechanical aids available? As most of the lab equipment is glass ware and in turn is fragile so these should be transported with extreme care in specialized containers with the help of transporters which can move within the lab. These vehicles meant for the transport of lab equipment can be rented upon from different companies which are specialized in the transportation of the lab equipment. 31. How to prepare and maintain safe working areas, standards and procedures to ensure good housekeeping? Following measures should be taken to maintain safe working areas Each worker should have at least 18.6 m2 of space with 3 m run of benching and 24 m of free air space, floors should be resistant to slipping, seamless, be impermeable to liquids and resistant to most, if not all chemicals that are normally used in laboratories. The exteriors of partitions and walls should be smooth, impermeable and easily cleaned. Windows should be sealable and fitted with blinds. Ventilation system should be adequate to deal with any accident. MLAs should be well aware of the stock present within the lab and should report shortage of any substance before time so as to prevent the delay in the investigation due to unavailability of resources. On the other hand, MLAs should also make sure that the stocks are bought according to the requirement as excessive stock of less frequently used chemicals may lead to wastage of resources. Read More