Laboratory Collection and Ordering Procedure Manual

Transcription

Laboratory Collection and Ordering Procedure Manual
Revision: 1/08/2016
LabSource
Collector Procedure Manual
TABLE OF CONTENTS
1. ORDERING TOXICOLOGY TESTING
3
2. URINE TOXICOLOGY ORDER FORM
4
3. ORAL FLUID TOXICOLOGY ORDER FORM
6
4. GENETICS ORDER FORM
7
5. PREFERRED PROVIDER ORDER FORM
8
6. LABSOURCE WEB PORTAL
10
7. URINE COLLECTION PROCEDURE
19
8. ORAL FLUID COLLECTION PROCEDURE
21
9. GENETICS (BUCCAL SWAB) COLLECTION PROCEDURE
23
10. SPECIMEN TRANSPORT
24
11. OBTAINING TOXICOLOGY LABORATORY RESULTS
25
12. ORDERING SUPPLIES
26
13. SUPPLY ORDER FORM
27
14. LABORATORY WORKPLACE SAFETY
28
15. EMPLOYEE REPORT OF INJURY FORM
30
16. DRESS CODE
31
17. CONTACT RESOURCES
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Toxicology Collector Procedure Manual
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ORDERING TOXICOLOGY TESTING
A requisition form must be completed for each patient sample selected to have toxicology
testing performed that day. There are two Requisition/Order Form options: Manual
requisition and Electronic Requisition.
Add on Orders: A request to add on additional testing for a specimen already received at
LaSource will require an order for that test before it can be performed.
Manual Requisition Forms
Manual requisitions are paper forms. The paper requisition forms are preprinted
containing the clinic’s name and demographic information. The requisition comes in
three (3) part NCR form.
The form provides space to record the patient’s demographic information, consent to test,
results of point-of- care cup (to be completed by the office staff), screening orders,
confirmation orders, diagnosis codes, medications list and a sticker to be placed on the
cup to link the requisition to the corresponding patient sample.
It is important the requisition is filled out completely and accurately.
The patient will need to read, sign and date the consent section of the form. (You should
have read and be familiar with the consent section and be able to answer any questions
the patient may have.)
The label in the upper right corner, with the patient’s first and last name along with the
date of birth, is to be removed from the form and placed on the cup. NOTE: DO NOT place
the label on the lid because lids can get mixed up but the cup will not.
Diagnosis code(s) must be provided by the physician. These are recorded in the
section “Diagnosis Codes.”
The Test Request section is where the provider’s toxicology/genetics order(s) should be
selected. This section lets the laboratory know which drug tests/classes/genes the
physician has ordered.
The provider may order specific compounds or drug class, profiles, confirm positive
screening tests or confirm the patients prescribed medications.
Under the “Prescribed Medications" section, select from the list, the medications that the
patient has been prescribed or is currently taking based on the records provided by the
provider.
For each patient collection make sure the following sections are completed and legible:
1. Collect date, collect time and collectors name
2. Patient Information, to include patient signature
3. Billing Information, include a copy of the insurance card
4. Prescribed Medication
5. Test Request
6. Provider information to include the signature
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Urine Order Form (front)
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Urine Order Form (back)
The back of the form lists the compounds found in commonly ordered profiles.
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Oral Fluid Order Form
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Genetics Order Form
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Preferred Provider Order Form (PPOF)
Used for client specific profiles
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Page 2
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REQUISITION FORM FROM WEB PORTAL
Using Microsoft Internet Explorer (not Mozilla FireFox, Google Chrome, Opera
Software’s Opera, or Apple’s Safari) access the following URL:
https://labsource.labsvc.net
I.
Enter your username and your password in the center of the Sign-on Form and
click submit.
NOTE: Your user name and password was set up with your account. Check
with your Laboratory Contact Person for this information.
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A. In the left-hand menu, click “New Test Order” or choose the “Order
Laboratory Work” icon in the middle of the page. (Both options will take
you to the “Orders” tab.)
xicology Collection and Ordering Procedure Manual (Revision 2.0: February 27, 2015)
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II.
In the “Orders” tab,
A. Enter the patient’s last name and first name.
B. If it is a reoccurring patient, select “Start Search”.
a. Find the patient on the list making sure to check two
identifiers (name and DOB) to ensure correct patient ID.
The patient information will populate the fields.
C. If this is a new patient, after the patient last name and first name are
entered select “CLICK HERE TO ADD A NEW PATIENT”.
a. Fill in the required fields.
Note: If multiple patients with the same name exist in the data base, they
will all appear. Carefully check existing patient information. If your
patient already exists, select the name. If your patient is an additional or
new patient, select
“Here to add new patient anyway.”
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Continue entering patient information….
A. All “green” info lines are required to continue.
B. Once all patient information is entered, on the bottom tool bar select
“Save/Continue.”
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Look up Insurance
Select “Save/Continue”
This will take you to the Insured / Guarantor tab.
A. At this time, select the appropriate
*********ALWAYS enter in Insurance Information**********
Step 1: Select the button “Lookup Insurance Code”
Step 2: Search for the patient’s insurance using the first three letters of the Insurance
Carrier
Step 3: Select the correct insurance from the menu paying close attention to the
address. Insurances may have the same names but different addresses to submit
claims. Enter in Primary Plan, Policy #, Plan Name, Group #, and choose the correct
option next to “Relation.”
Step 4: Enter in Secondary Insured information if applicable.
Step 5: Select “Save/ Continue”
Note: If the patient has an insurance that is not in the available list, write the
insurance information on the printed form, (attach a copy of the front and back of
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the patient’s insurance card) and also e-mail that information to
[email protected] to have that insurance carrier added to the
available list for the future.
Specimen Info. Tab will come up next.
A. All “green” info lines are required to continue.
B. Select “Ordering Phys.” If there are no physicians available in the
drop down box, “Look Up Phys” button by the arrow below.
C. Type in the physician’s last name and select “search.”
D. Fill out the remainder of the “green” items.
E. Fill in the “SOURCE” item as well. It is not green, but is
required information. Click on the drop down box and select the
correct sample type. (Example: Urine, Oral Swab, Buccal Swab)
F. Next to “Account/Unit” click the drop down to choose your clinic
name.
G. Change collect time if it is different than order time.
H. Select “Save and Continue” on the bottom tool bar.
Required
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Test Info. Tab is next.
A. Select the tab that is titled with “your clinic’s name”
B. Select the test code the physician has ordered by selecting the
appropriate test panel(s) listed under the tab titled with your
clinic’s name.
a. If you want to order additional tests for a particular patient,
you may use the “Add test by Code” field in the upper lefthand field of this page. You will need to know the code for
the desired test or you may look up the code using the
“Search by Test Name” field.
b. If the test ordered is “Confirm prescribed medications” enter
the test code P029.
C. Check only the test(s) ordered by the physician. (If you are unsure of
what to select, contact LabSource.)
Select Tab that is titled with your clinic’s name
D. Select “Save and Continue” on the bottom tool bar.
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Diagnosis Info. Tab is next.
A. Enter the patients ICD-10 diagnosis code(s) that were provided from the
patient’s chart in one or more of the boxes.
B. Select “Finish” from the tool bar at the bottom.
The Prescribed Medication list will appear.
A. ALWAYS check all medications that apply to the patient.
B. If patient is not on any medication or medications are unknown, select
appropriate statement at the end of the med list.
C. If the patient is on a medication that is not in the med list, write the
medication on the printed form and e-mail [email protected] to get
the medication added to the med list for the future.
D. If the provider’s order is to confirm the Patient’s Prescribed Medications
(you entered P029 on the previous screen) be sure to click the box next
to Confirm Patient’s Prescribed Medications. If this is not selected the
order will not go through.
The test requisition is now completed.
A. Select “print” to the desired printer.
B. The requisition and labels will print out.
C. The patient needs to review their information and sign at the “Patient
Signature.”
D. The physician needs to sign the requisition at the “Phys/Nurse Sig.” line
only if the laboratory does not have a Physician Preferred Order Form
(PPOF) on file.
E. A label is affixed to the specimen cup before the patient collects the
urine.
F. The patient is to review the name and information on the cup.
G. The original requisition needs to accompany the urine specimen to the
lab. Take the sticker from the label printer and label the urine sample.
H. See the Urine Collection Instruction procedure for more detailed
information on how to collect the urine specimen.
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III.
Label the Sample Cup
A. The label needs to be affixed to side of the specimen cup before the
patient collects the urine.
B. The patient must review and verify the name and information on the
cup.
C. See the COLLECTION PROCEDURES section for more detailed
information on how to collect a specimen.
Electronic ordering (E-reqs) should be used whenever possible. Manual requisitions should
be used at startup of a new clinic or during downtimes.
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URINE COLLECTION
COLLECTION PROCEDURE
The following the procedure for collecting a urine sample for drug testing from the
patient.
1. Greet the patient. Introduce yourself (first name) and explain to them
what you will be doing. Ask them to state their first name, last name
and date of birth.
2. Verify the patient’s address, phone number and insurance information.
Obtain a copy of the insurance card (front and back).
3. If using a manual requisition write the patients first and last name along
with the date of birth on the sticker provided with the paper requisition OR
place the label that prints when using the web portal, on the side of the
urine cup.
a. Do not write the name on the lid as lids can get switched with cups.
NOTE: CLIA REQUIRES that any patient sample is labeled with a minimum of
two unique patient identifiers (allowable identifiers: first and last name,
DOB, SSN, MRN). Any samples received without the necessary two identifiers
will require a specimen affidavit before testing may proceed.
4. Verify which medications the patient is taking. Check with the patient to be
sure the medications selected on the requisition form are accurate.
5. Inform the patient that you will be performing urine toxicology testing on
them. (as per their consent on the “Lab Source” they signed)
a. If the patient states they cannot void, offer the patient water and wait
30 minutes. Inform the physician or the nurse of the patient’s status.
b. Alternatively, you may use oral fluid testing in this case only if the
provider approves and writes an order for an oral fluid collection. Refer
to ORAL FLUID COLLECTION PROCEDURE for instructions.
6.
Ask the patient to verify the label information on the side of the cup.
7.
Let the patient know they cannot take anything into the restroom.
a. The patient can leave their belongings outside the restroom while
the specimen is being collected.
8. Inform the patient that they are not allowed wash their hands until they
have given you the sample.
9.
Allow the patient to go into the restroom and provide a specimen. Stand by
the door in order to make sure they do not run the water.
10. While the patient is in the restroom you will apply personal protective
equipment (Eg: gloves) to receive the specimen. (Always wear gloves when
handling urine specimens)
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11. Place the specimen in a biohazard bag ensuring the lid is securely
tightened. Place the requisition in the pocket of the biohazard bag.
Note: Be sure to complete this step before moving to the next patient.
This will ensure the correct requisition is with the correct sample.
12. Complete the Log Form for all patients collected during the specified month.
At the end of the month send the completed Log Form to Client Services at
LabSource.
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ORAL FLUID COLLECTION
The following is the procedure for collecting an oral fluid sample for drug testing
from the patient.
and date of birth.
3. Confirm that the patient has not had anything in his or her mouth for 10
minutes prior to providing the oral fluid sample. If the patient has had
anything in their mouth within the last 10 minutes, wait 10 minutes prior
to beginning the collection process.
4. Check the expiration date on the foil pouch to verify the device has not
expired.
5. Instruct the patient to remove the device grabbing the plastic shaft of the
Collection Pad from the foil pouch. Ensure the patient does not touch
the pad.
6. Instruct the patient to place the Collection pad under the tongue with the
white side of the stick facing upward. Instruct the patient not to bite
down on the plastic shaft but to grip the ridges on the shaft of the stick
between their lips which will help to secure the device in the donor’s
mouth.
7. Set a timer for 15 minutes. Instruct the patient to keep the pad under
their tongue until the indicator turns blue. The average collection time is
3-4 minutes. Should the collection time reach 15 minutes, stop the
collection and proceed to the next step.
8. If using a manual requisition write the patients first and last name along
with the date of birth on the sticker provided with the paper requisition
OR place the label that prints when using the web portal, on the vial label
above the lot number and expiration date.
9. Instruct the patient to unscrew the cap holding the vial in an upright
position.
10. Instruct the patient to slowly slide the collection device into the vial as far
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as it will go and be careful not to spill the fluid inside.
11. Securely screw the cap back on to the vial.
12. Place the specimen in a biohazard bag. Place the requisition in the pocket
of the biohazard bag.
Note: Be sure to complete this step before moving to the next patient. This
will ensure the correct requisition is with the correct sample.
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GENETICS BUCCAL SWAB COLLECTION
The following is the procedure for collecting a buccal swab for a genetics sample
from the patient.
and date of birth.
3. Confirm that the patient has not had COFFEE recently, wait until it has
been at least 30 minutes after their last drink before swabbing them.
4. If the patient has eaten anything in the past 30 minutes, have them rinse
their mouth with plain water before swabbing.
5. Check the expiration date on the swab tube to verify the device has not
expired.
6. If the patient is incapable of performing the swabbing procedure, the
collector may assist.
7. Write the patient’s name and date of birth on the outside tubes of two
unopened swabs.
8. The patient swabs their cheek using the two swabs provided.
9. Set a timer to 90 seconds. Open the first tube and remove the swab.
Hold the swab in the middle of the wand, firmly brush the inside of one
cheek, including the crease of the cheek near the gums, rotating the swab
as you brush. Be sure to avoid scrapping the teeth or the tongue.
10. Start the timer and continue swabbing for 90 seconds.
11. Return the swab to the transport tube, being careful not to touch the
buccal collection end of the swab.
12. Repeat the steps above with the second swab using the other cheek.
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SPECIMEN TRANSPORT
1. Once the collection process is complete store the sample to be sent out
for testing/confirmation at LabSource.
2. If samplesI are not shipped or transported to LabSource on the day of
collection, urine and oral fluid specimens may be held overnight and up to
72 hours at room temperature. Genetics specimens, place in the sealed
envelope, keep in the refrigerator until ready to be sent.
3. If urine and oral fluid samples are not shipped after 72 hours, specimens
should be stored in the refrigerator until ready for shipment.
4. Ensure the lids are on straight and tightly sealed and the correct paperwork
belonging to that sample is in the pocket of the biohazard bag.
SHIPPING SAMPLES
Samples are sent to the laboratory through UPS.
All urine and oral samples should be received at LabSource within 5 days of sample
collection. Friday’s samples should be at LabSource before Wednesday of the following
week. All genetics samples must be received at LabSource within 3 days.
LabSource will provide UPS return labels. (Refer to ORDERING TESTING SUPPLIES section
of this procedure for instructions for ordering UPS labels.)
1. All samples should be individually placed in the small biohazard bags along with
the paperwork for that sample which is placed in the pocket. DO NOT place the
paperwork inside the section of the bag containing the sample.
2. Place 1 – 10 specimens into the UPS shipping bag.
3. Place the shipping bag inside the UPS shipping box and seal the box.
4. Place the UPS shipping label on the box.
5. Contact UPS to pick up if automatic pick-ups are not scheduled or take specimens
to the UPS drop box location.
6. Store specimens according to time frames listed above while awaiting pick up.
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OBTAINING TOXICOLOGY LABORATORY RESULTS
HOW TO RECEIVE LABORATORY RESULTS
When Toxicology Testing is completed, results may be faxed or retrieved from the
secure web-portal. It is your responsibility to:
1. Make sure that the results are received.
2. Give the provider the results to review.
If the clinic has an EMR interface for their results, these results will cross the interface
and appear in the clinics EMR. If these results do not populate in the clinics EMR report
the problem immediately to the LabSource Information Services department by emailing
[email protected] or call 864-312-6930, option 3.
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ORDERING SUPPLIES
It is important that each clinic maintain adequate collection and shipping supplies at
all times. It is the collector’s responsibility to ensure that the clinic does not run out
of supplies. Use the Laboratory “Supply Order Form” for ordering the following
supplies:
1. Gloves
2. Urine Collection Cups
3. Oral Fluid Collection Kits
4. Buccal Swabs for genetics collections
5. Manual Requisition Forms
6. Specimen Collection Biohazard Bags
7. Disinfectant Wipes
8. UPS Pre-Printed Return Labels
9. UPS Shipping Boxes
10. UPS Laboratory Shipping Bags
11. Implementation Kit supplies
All supplies with the exception of UPS will be supplied by LabSource and ordered
using the supply order form.
UPS Shipping Boxes and Bags will be delivered by UPS.
If you have placed an order with the Laboratory and have not received your order
within3 - 5 business days, you should contact the Laboratory to determine why there
is a delay.
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LABORATORY WORKPLACE SAFETY
After performing specimen collections, it is important that you clean up the area with
disinfectant wipes/sprays and paper towels and dispose of them in a BIOHAZARD
trash bag, along with your gloves.
Check the restroom and clean with disinfectant wipes or sprays after each use.
Work practice controls are procedures that employees need to follow in order to keep
themselves safe. These required procedures are to be followed by all employees.
HAND/SKIN WASHING
It is extremely important that all employees follow strict hand/skin washing
procedures at the following times:
After removing gloves or other Personal Protective Equipment
Following contact with potentially infectious material
If an exposure occurs, hands and other skin areas must be washed with soap and
water OR alcohol based antiseptic cleanser (in the absence of water). Mucous
membranes shall be flushed with copious amounts of water for at least 15 minutes.
DO NOT use soap or alcohol based antiseptic cleansers for infectious agent exposures
to eyes or nose/mouth.
When an antiseptic cleanser is used, washing with water and soap should follow as
soon as possible.
MINIMIZE SPLASHING
All procedures involving potentially infectious materials shall be performed in such a
manner as to minimize splashing, spraying, spattering, and generation of droplets.
AVOID INGESTION
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses
are strictly prohibited in work areas where there is a reasonable likelihood of
occupational exposure to infectious material.
Food and drink shall not be kept where potentially infectious materials are present.
UNIVERSAL PRECAUTIONS
All employees will utilize universal precautions.
Note: “Universal precautions” require that blood and other potentially infectious
materials (urine, oral) be treated as if the employees know for sure that the blood,
etc., is infected with HIV, HBV, or other blood borne pathogens. Since it is not
possible to know in advance if someone’s fluids are contaminated with a pathogen,
the use of universal precautions should be implemented. Employees need to treat all
body fluids as potentially infectious. This is known as “standard precautions,” in
which all body fluids and substances are regarded as infectious.
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PERSONEL PROTECTIVE EQUIPMENT (PPE)
PPE is provided to employees. Training is provided in the use of the appropriate PPE
for the tasks or procedures employees will perform. The types of PPE available to
employees are gloves. PPE is located at various areas where exposure may occur.
Employees using PPE must observe the following precautions:
 Wash hands immediately or as soon as feasible after removal of
gloves.
 Remove PPE after each patient encounter.
 Used PPE may be disposed of in appropriate biohazard containers.
 Never wash or decontaminate disposal gloves for reuse.
EXPOSURE CONTROL PLAN
Employees receive an explanation of the Exposure Control Plan (ECP) during their
initial training session. It will also be reviewed in their annual refresher training. All
employees have an opportunity to review this plan at any time. Any questions may be
directed to your Collection Manager or LabSource Safety Officer.
PERSONEL PROTECTIVE EQUIPMENT (PPE)
PPE is provided to employees. Training is provided in the use of the appropriate PPE
for the tasks or procedures employees will perform. The types of PPE available to
employees are gloves. PPE is located at various areas where exposure may occur.
Employees using PPE must observe the following precautions:
 Wash hands immediately or as soon as feasible after removal of
gloves.
 Remove PPE after each patient encounter.
 Used PPE may be disposed of in appropriate biohazard containers.
 Never wash or decontaminate disposal gloves for reuse.
POST-EXPOSURE EVALUATION AND FOLLOW UP
Should an exposure incident occur, contact your Collection Manger or LabSource Safety
Officer.
Following the initial first aid (clean the wound, flush eyes or other mucous
membrane, etc.), complete the “Employee Report of Injury Form”. This form
can be found by clicking on the ownCloud icon on the laptop, under Collection
Manual and Resources.
Once completed send the form to your Collection Manager.
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DRESS CODE
It is our intent to ensure that all customers and patients are aware of whom they are
interacting with on behalf of LabSource. To achieve this goal, LabSource has instituted a
uniform policy for all collectors.
LabSource will issue uniforms to each new employee as part of the new hire process.
Uniforms must abide by the Dress Code policy as well as color and logo guidelines.
Uniforms then become the responsibility of employees for maintenance and care; if
uniform parts require replacement, employees will be required to turn in old parts as
part of the replacement process.
Periodically, LabSource may issue new uniforms or require uniforms be return for special
purposes, i.e., logo change, corporate color change. In these cases, advance notice to
employees will be provided to ensure that those collectors in customer and patient
interaction have suitable replacements.
Appropriate footwear should be comfortable, rubber soled, and cover the entire foot. If
splashing of infectious fluids is expected leather or a synthetic, fluid-impermeable
material is suggested.
Presenting a professional image of LabSource at all times is required.
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CONTACT RESOURCES
Collection/Clinical Account Managers:
Joy Leavenworth: 864-607-2174 [email protected]
Maril Anderson: 913-904-2760
[email protected]
Nicole Martin: 704-718-2910
[email protected]
LabSource: 864-312-6930
LabSource Client Services: 864-312-6930, option 2
LabSource Information Services: 864-312-6930, option 3 [email protected]
LabSource Safety Officer: 864-672-8567
LabSource Compliance Officer: 864-312-6930, ext 233
LabSource Technical Contact: 864-312-6930, ext 221
Human Resources:
Joy Crile: 864-343-2600 [email protected]
Mike Weaver: 864-343-2651 [email protected]
Written
Adopted
Reviewed
Revised
2/27/15 Julie Blackwell, Jamie
Hurlston
Jamie
Hurleston
2/27/15
2/27/15 Dr. Renee Thomas
11/10/15 SHA
Reviewed
Revised
11/20/15 RBT
1/8/16 SHA
Reviewed
1/11/16 RBT
Medical Director Review
Removed all references to POC testing, removed
all references to office employee duties,
removed all references to CLIA regs, removed all
workplace safety references not related to a
collectors job, added requisitions, added injury
form, added resources, removed appendix,
removed job description, removed LCMS testing
methodology, added PPOF form, added dress
code section
Added genetics order form and collection
procedure, added new clinical account manager
pppprocedur
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Laboratory Collection and Ordering Procedure Manual

Transcription

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