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� �� Personal Protective Equipment (PPE) Goes Beyond Personal

PPE protects the user from physical, chemical, radiological and biological hazards; wearing PPE helps keep

others safe as well. To prevent healthcare-associated infections (HAIs) and limit their spread outside the

healthcare setting, it is worthwhile to remember that an ounce of prevention is worth a pound of cure. Benefits of

properly using PPE include:

• Fewer sick days used by healthcare workers

• Reduction in healthcare acquired infections

• Fewer in-patient hospital days used

• Reduction in the number of community-acquired Infections and sick family members

• Reduction in the spread of multi-drug resistant bacteria

• Decreased risk of epidemics such as, viral hemorrhagic fever (Ebola)

Pathogens can contaminate scrubs, hands, shoes, and lab coats if Personal Protective Equipment are not used

properly. Failing to use PPE appropriately means that those pathogens can potentially leave the workplace and

travel to your home, the community where you shop and places that you visit.

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Effective Laboratory Testing Leads to Efficiencies and Improved Patient

Outcomes

Does your laboratory employ any of the following:

• Automated 5-part differentials that include a manual differential when there are unusual cell types or

leukopenia or leukocytosis present?

• Microscopic examination of urine sediment when there are leukocytes, red blood cells, nitrites or protein

present on the biochemical analysis of the urine specimen?

• Performing anti-Factor Xa testing for patients who are receiving heparin therapy?

• Performing T4 analysis after TSH is outside of its reference range?

If your laboratory uses any of these types of testing protocols, you are employing Evidence-Based Laboratory

Practice, also called Effective Laboratory Testing. These types of protocols are effective (performing the correct

test) and efficient (saving time by not performing all tests on all patients) and patient-centered (performing only

those tests needed for each patient).

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Patient-Centered Care Is Associated with Decreased Healthcare Utilization

“A higher average amount of patient-centered care recorded in visits throughout a 1 year study was related to a

significantly decreased annual number of visits for specialty care, less frequent hospitalizations, and fewer

laboratory and diagnostic tests.” (Bertakis KD, Azari R. Patient centered care is associated with decreased

utilization. Journal of the American Board of Family Medicine. 2011, 24(3):229-39.)

• How can Medical Laboratory professionals work with clinicians to deliver patient-centered care?

• Decreasing utilization of laboratory testing is important, provided it addresses unnecessary or inappropriate

laboratory tests.

• Working with clinicians to develop laboratory testing protocols and consultation models will support patient-

centered care and improve the effectiveness (performing the correct laboratory test for the patient's

condition) of laboratory services.

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��When Minutes Count....Medical Laboratory Science Professionals Provide

Timely Services!

12:02am: 59 year old male patient presents to the Emergency Department with dyspnea and radiating abdominal pain12:22am: Hematology results: Hgb 15.0 g/dL, Hct 45.0% 1:37am: Abdominal aortic aneurysm (AAA) diagnosed; emergency surgery scheduled

• Type & Crossmatch for 2 units PRBC ordered• MLS reads patient diagnosis in the electronic medical record, then crossmatches 6 additional units,

assesses available blood supply, calls blood supply distribution center and alerts them to possible need for emergency supply transport

2:15am: AAA ruptures while patient is transported to the Operating Room2:25am: Emergency surgery begins

• Hgb 6.5 g/dL, Hct 19.8%• Blood pressure bottoms out.• Massive transfusion protocol implemented.

Patient undergoes 2 surgeries and a post-operative myocardial infarction.Many dedicated MLS professionals perform timely testing to guide the way to....

Day 18: Patient discharged to his home where his family welcomes him with open arms

Every day Medical Laboratory Science professionals provide critical laboratory testing, assessment, and responses that assist in assuring timely diagnosis, therapeutic intervention and positive health care outcomes.

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Medical Laboratory Professionals are a Vital Part of the Healthcare Team

Consultation initiatives strengthen communication among hospital staff. Better communication eliminates waste, such as duplicate or inappropriate test ordering or specimen collection errors, which results in better, more efficient patient care.

• Hospital Nursing Unit Ambassador Programs:o Assign each Laboratory Ambassador to one or two nursing units.o Develop open and honest communication between laboratory and nursing professionals. o Eliminate the "us vs. them" mentality--work together to improve patient care.o Identify issues as opportunities not as problems.o Coordinate visits from nursing staff to the laboratory.o Develop mutual respect and understanding for each profession's role in delivering quality patient care.

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Medical Laboratory Professionals Can Improve the Equity of Our Services

• As our patient populations become more diverse, we have the opportunity to provide care that is both

patient-centered and more equitable by distributing patient instructions in languages other than English.

• Create specimen collection instructions in languages spoken by your patient populations.

• Equitable access to laboratory services also means that patients can obtain our services at a time of day

that fits into their schedule.

• Open the outpatient laboratory specimen collection area early mornings, late evenings and

weekends.

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Phlebotomists Play a Key Role in Keeping Patients Safe

Phlebotomy impacts pre-analytic variability which can lead to unfavorable and life-threatening consequences

for patients.

Phlebotomists:

• Provide appropriate and adequate laboratory specimens for analysis

• Rectify discrepancies in patient identity

• Discover repeat test requests

• Deliver comfort to patients during specimen collection

Without trained phlebotomists patients are at increased risk of misdiagnosis and unnecessary diagnostic and

therapeutic procedures.

Phlebotomists obtain specimens for laboratory testing that directly impacts patient safety.

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Effective Use of Laboratory Tests Saves Lives

Selecting an appropriate laboratory test provides evidence for a clinician to induce labor for a pregnant woman.

A pregnant women arrived at the hospital concerned that her water had broken. She was admitted to labor and

delivery to prepare her for delivery.

• A nurse discovered that the vaginal discharge had an unusual color.

• The obstetrician then requested the laboratory to perform a Rupture of Membrane (Amnisure ROM) test.

• A sample was collected and sent immediately to the hematology lab.

• Positive results were reported to the clinician, resulting in a decision to induce labor.

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The healthcare team worked together to identify a problem, order the correct laboratory test and complete the diagnostic testing quickly to save a baby’s life.

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When Minutes Count...Medical Laboratory Science Professionals Provide

Timely Services!

Day 1: 6 month old baby girl transported by ambulance to Emergency Department

8:40am:

• History: Clinic visit 3 days ago: fever, cough, congestion, otitis media, treated with oral amoxicillin and sent home

• Current symptoms: Fever >1030F, lethargy, decreased response to stimuli, rash, anterior fontanel is full and tense

• Laboratory testing : lumbar puncture performed, CSF is hazy and sent to laboratory for testing

9:15am:

• Hematology results: WBC 11,500/uL, Neutrophils 75% (cytoplasmic toxic granulation and vacuolation noted)

• Mild seizures begin

9:45am:

Initial CSF results reported

• WBC 1000 cells/uL (�), Neutrophils 95%, Mononuclear 5%

• Glucose 25 mg/dL (�), Total protein 70 mg/dL (�)

• Gram stain initial smear review: 'no organisms seen' and only a few WBCs noted. However, before releasing the report, the

MLS assessed admission symptoms, consulted with MLS performing cell counts and chemistry testing, completed additional

review of gram stain, observed areas of WBC clumping in which gram-positive diplococci were identified. Gram stain test results

phoned to clinician.

9:55am: Patient admitted to the pediatric ICU and received appropriate antimicrobial and supportive therapy

Days2 & 3: CSF and Blood Cultures positive for Streptococcus pneumoniae

Day 15: Child discharged to home where she will be held, cuddled and loved

Every day Medical Laboratory Science professionals provide critical laboratory testing, assessment, and

information that are vital to timely diagnoses, therapeutic interventions and positive health care outcomes.

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6.�"*�Focusing on the Patient

The basic principle of patient-centered care is seeing events from the perspective of the patient.

• What happens when a patient has to return to the laboratory to have a specimen recollected?

• Recently, a phlebotomist noticed that she missed collecting one test listed on the patient’s laboratory

requisition. She phoned the patient to apologize and requested that he return to the laboratory for a

second venipuncture. When the patient returned to the laboratory, the phlebotomist apologized for her

mistake, and gave the patient a gasoline gift card as a token to recognize the inconvenience of having to

return to the laboratory to have a second venipuncture.

Medical Laboratory Professionals are thoughtful, caring and empathetic which ensures that patients

have a positive experience with the healthcare system.

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Healthcare Efficiency --The Laboratory’s New Role

Laboratory data are essential for managing coordinated care. Healthcare delivery in the 21st Century focuses

on identifying and reallocating wasted resources. To thrive in this era Laboratory Professionals need to find

savings through efficiencies and operational integration.

• In the 20th Century: Laboratory Professionals focused on the analytic process, assessed test costs and

provided clinicians with laboratory test results.

• In the 21st Century: Laboratory Professionals focus on the entire diagnostic process, assessing the

value of laboratory testing and actively managing test utilization.

• To add value:

o listen to the customer and develop user-friendly test menus

o display laboratory test results in an easy-to-understand format for clinicians

o develop a laboratory test formulary

o detect and manage inappropriate test requests

o provide diagnostic decision support consultations for clinicians

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Diversity and Laboratory Testing

Medical Laboratory Professionals provide care to all who are in need of laboratory test information: Patients are from all

walks of life: rich, poor, male, female, young and old. Medical laboratory professionals do not judge or alter their

commitment to ensuring that all laboratory tests are performed with high quality. Information about a patient such as

gender or ethnicity can be used to improve the quality of the information we provide for diagnosis and treatment.

• Females of child bearing age with undocumented blood types are given O negative red cells during trauma

situations to prevent sensitization to the D antigen.

• The prevalence of Sickle Cell Trait (SCT) is 1 in 12 in African Americans. Situations such as increased

atmospheric pressure, decreased oxygen and dehydration can cause a person with SCT to go into sickle crisis.

• Identifying tapeworm infections can be difficult because patients can have mild to no symptoms during the

infection. However, patients can experience digestive problems including abdominal pain, decreased appetite,

weight loss, and upset stomach. Tapeworms generally are more prevalent in under-developed communities with

poor sanitation or when raw or undercooked pork is consumed. Higher rates of illness have been identified in

people in Latin America, Eastern Europe, sub-Saharan Africa, India, and Asia.

.

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References:

January: PPE •Bugs on Scrubs. Healthcare has a dirty little secret. By Lisa Steinam, PBT(ASCP).

Advance Healthcare Network. Site visited 11/06/2014 at: http://laboratory-manager.advanceweb.com/Web-Extras/Online-Extras/Bugs-on-Scrubs.aspx

•Centers for Disease Control and Prevention. 1600 Clifton Road Atlanta, GA 30329-4027 USA. 800-CDC-INFO (800-232-4636) Site visited 11/06/2014 at: http://www.cdc.gov/

•United States Department of Labor. Occupational Safety & Health Administration.Regulations (Standards – 29 CFR) – Table of Contents. Site visited 11/06/2014 at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051

March: Patient-Centered Medical Care •The Journal of the American Board of Family Medicine. “Patient-Centered Care is

Associated with Decreased Health Care Utilization.” Bertakis, Klea MD, MPH and Azari, Rahman, PhD. May-June, 2011. p.229.

•“UC Davis Study Finds that ‘Patient-Centered Care’ Lowers Health-Care Costs.” UC Davis Health System. 2011. www.ucdmc.ucdavis.edu

•www.equipmentcare.com (Photo)

�� Story adopted from “Behind the Test: Promoting our profession within the walls of the hospital” by J. Eric Stanford published online in ADVANCE in 2012.

��1.National Physicians Alliance. http://npalliance.org/equitable-affordable-health-

care-for-all/ date cited: 02/21/2015. 2.ASCLS Legislative Symposium. Value of laboratory professionals. I Am Your

Clinical Laboratory Professional leave behind. http://www.ascls.org/government-affairs-main/legislative-symposium date cited: 02/21/2015

��•“REVIEW Phlebotomy Issues and Quality Improvement in Results of Laboratory Testing” Clin.

Lab. 2006;52:XXX-XXX ©Copyright. GIUSEPPE LIPPI1*, GIAN LUCA SALVAGNO1, MARTINA MONTAGNANA1, MASSIMO FRANCHINI2, GIAN CESARE GUIDI1. Site viewed on 10/28/14:

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&ved=0CEEQFjAF&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F6971742_Phlebotomy_issues_and_quality_improvement_in_results_of_laboratory_testing%2Flinks%2F0deec521f293b2d14c000000&ei=VAJPVOHaMMGzyAT00oLgCg&usg=AFQjCNHcWkU1UTfoPk6sDI7zuqFbkipZ6Q&sig2=TU7DFsdNbB0ogEt3VW3lgA

•“ASCLS Patient Safety Indicators”. Procedure to Evaluate the Clinical Laboratory's Total Testing Processes that Impact Patient Safety. The American Society for Clinical Laboratory Science | 1861 International Drive, Suite 200 | McLean, VA 22102 | Ph. 571.748.3770 | Email [email protected] © Copyright 2012- 2014 epower by pixelprintgraphics.com Site viewed 10/28/14: http://www.ascls.org/images/patient_safety/ascls_patient_safety_indicat.pdf

•Patient Rounding. Break through silos to provide excellent customer service, By Scott Warner, MLT(ASCP). Posted on: August 29, 2014. Advance Healthcare Network. Visited on 11/06/2014 at: http://laboratory-manager.advanceweb.com/Features/Articles/Patient-Rounding.aspx

November: Healthcare Reform and Efficiency Adopted from “Accountable Care Organizations: An Integrated Model of Patient Care Objectives” by Rick Panning published in the Spring 2014 issue of Clinical Laboratory Science

��Centers for Disease Control and Prevention. http://www.cdc.gov/ date cited: 02/21/2015

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Personal Protective Equipment (PPE) Goes - The American ...ascls.org/images/promotetheprofession/Calendar_last_proof_102915.pdf · • Decreased risk of epidemics such as, ... •