MERCY INPATIENT LABORATORY TEST INDEX INTRODUCTION

Mercy Medical Center-North Iowa Laboratory
Laboratory Test Index

1000 Fourth Street
Mason City, Iowa 50401
428-7256
1-800-243-6086

Table of Contents

1. Introduction
   Greeting from the Medical Director
   1. CLIA, CAP Accreditation numbers
      Test Index Summary
   2. Specimen Collection
           Patient/Specimen Identification
           Collection Tubes
           Order of Tube Draw
           Fasting Specimens
           Urine Collection
           24 hour Urine Collection
           Venipuncture Collection Procedures
           Heelstick Collection Procedures
           Fingerstick Collection Procedures
           Ordering Instructions
           Manual Ordering System 
   3. Results
           Critical Limits
           Reflex Testing
2. Special Helps
3. Cytology Collection Guide

A greeting from the Medical Director:

Following the Mercy Health Services mission of sharing in the healing ministry of Jesus Christ by striving to improve the health and well being of those we serve, Mercy Medical Center - North Iowa Laboratory strives to provide the utmost in quality laboratory and diagnostic services to our clients.

The Laboratory is accredited by the College of American Pathologists, a tradition maintained for over twenty years.

Over one hundred laboratory employees analyze, assess, and report findings on a 24-hour per day basis. Four board certified pathologists oversee the quality and performance of the technical areas, including Hematology, Clinical Chemistry and Toxicology, Blood Bank, Serology, Microbiology, Anatomic Pathology, and Cytology.

By serving our patients, we display the Mercy values of Mercy, Human Dignity, Justice, Service, and Preference for the Poor. We welcome you to the services and benefits of Mercy Medical Center - North Iowa Laboratory, and appreciate the opportunity to assist in your therapeutic and diagnostic quests.

                                                                       Sincerely,

                                                                        Steven P. Goetz, M.D.
                                                                        Medical Director
                                                                        Mercy Medical Center - North Iowa Laboratory

A. Accreditation Information

Mercy Medical Center - North Iowa Laboratory
     CLIA number 16DO384014
     CAP number 17594-01

Reference Laboratories used by Mercy

Mayo Medical Laboratories, Rochester, MN
     CLIA number 24DO404292
     CAP number 55901-002

University Hygienic Laboratory, Iowa City, IA
     CLIA number 16DO648109

University Hygienic Laboratory, Des Moines, IA
     CLIA number 16DO709301

University of Iowa Hospitals/Clinics, Iowa City, IA
     CLIA number 16DO648109
     CAP number 52240-002

North Central Blood Services, St. Paul, MN
     CLIA number 24DO651229

Specialty Laboratories, Inc., Los Angeles, CA
     CLIA number 05DO550302

Viromed Laboratories, Minnetonka, MN
     CLIA number 24DO400424

MedTox Laboratories, St. Paul, MN
     24DO665278

Marshfield Laboratories, Marshfield, WI
     CLIA number 52DO663760
     CAP number 17885-01

United States Drug Testing Lab, INC.
2201 W. Campbell Park Drive
Chicago, IL 60612-354701
     CLIA number 14D0712964

Laboratory Test Index Summary

Mercy Medical Center - North Iowa
Mason City, IA   50401
641-428-7256

All procedures performed or processed by Mercy Medical Center - North Iowa Laboratory (Mercy) are listed alphabetically in this index along with cross indexing of tests known by multiple names or abbreviations. The test will be followed by the Hospital Information System (HIS) mnemonic, Laboratory Information System (LIS) test name and mnemonic, and specific test information. All times will be given utilizing the 2400 clock. Updates to the Lab Test Index will be distributed periodically. When updates are received, please remove the current pages and replace with the new pages provided.  Because of the wide variety and often complicated nature of procedures, patient preparation and handling of specimens are of utmost importance. To avoid specimen rejection and prolonged turnaround time, it is imperative that all instructions outlined in this test index be followed. Please call the Laboratory for assistance if any questions arise concerning patient preparation or specimen handling.

B.   Specimen Collection

Patient/Specimen Identification:

All specimen containers delivered to the Laboratory will be labeled with patient name, collector's initials, date, and time of collection. All non-blood specimens must include the source.  Identification must be placed directly on the portion of the container which contains the specimen. Labeling the lid, wrapper, cardboard slide container, or any attached order form is unacceptable for specimen identification. NOTE: It is recommended that any specimen container/tube delivered to the laboratory, should have all the tests requested written on the container. It is especially helpful with CSF and body fluids.

Blood Bank Testing: Identification will also include the patient's Medical Record number (confirmed with a ü mark by the number) and initials of the person collecting the specimen. The patient will have a hospital band or emergency identification band in place.

Microbiology Testing: Identification will also include the specimen source and requested test on the container and requisition. Source information must include the main source (leg, BAL, etc.) and any other descriptive information (left, right, upper, etc.) is useful.  Deliver specimens to the Laboratory within 30 minutes of collection.

Cytology Slides: For slides, identification will be on the frosted end of the slide, not on the container. ThinPrep vials and any other fluid containers must be labeled with patient name adn a second form of identification.

Collection Tubes:

The following are instructions for proper specimen collection and handling.

Order of Draw:

  In addition to drawing the correct tube(s) for the test, it is important to draw multiple tubes in a specific order to avoid cross-contamination between tubes with and without additives. Contamination can affect test results.   To avoid contamination when drawing multiple blood samples from a single venipuncture, adhere to the following guidelines:

1. Trace-meta Nonadditive Tubes (Navy Blue), Citrate Tubes (Blue), Gel/nongel Serum Tube (Red/Yellow glass and/or plastic), Heparin Tube (Green), EDTA Tube (Purple), Oxalate/Fluoride Tube (Gray), ACT Tube (Yellow glass solution A or B), RDP tube (Navy Blue with blue ring)

2. B.   Never draw tubes containing EDTA (purple top) before the chemistry tube (red top).   Contamination will cause increased potassium and decreased calcium levels.

3. C.   Heparin tubes should not be drawn before coagulation tubes since contamination from heparin may alter coagulation test results.

Fasting Specimens

Fasting, for the Laboratory, means absolute restriction of solid and liquid food following the evening meal prior to the specimen collection. Water should be taken in normal amounts to prevent concentration of the blood constituents. Lipoprotein Analysis and Lipid Panels require further dietary restrictions. Nothing should be eaten 12 hours and no alcohol 24 hours prior to specimen collection. The evening meal prior to the test should contain no fatty foods and should be completed before 1800. Contact the physician if there is any question regarding administration of medication during a fast.

Urine Collection

Random collections: For routine analysis and microscopic evaluation, provide the patient with a clean container. Midstream urine collection is recommended.
1. Hold the container by the outside surface and begin urinating into the toilet.
2. Place the container under the stream of urine after a good flow has started.
3. Fill the container half full and void remainder of urine into toilet.
4. Cap container, label, and deliver to Laboratory within 1 hour of collection.

24-Hour Urine Collections

Containers for 24-hour urine specimens are to be obtained from the Laboratory. The Laboratory will need to know which test is ordered so that proper preservative will be placed in the container. Instruct the patient to use caution when handling the container as it may contain an acid perservative. Orders are to be placed at the completion of the specimen collection period.When the 24-hour collection period is to begin, the patient should empty their bladder and discard that urine specimen. All urine collected in the next 24 hours is to be placed in the container. The container should be kept in a cool place during the collection period. At exactly 24 hours after the start of the collection, the patient should empty their bladder and place that urine in the container. Direction cards for collection of 24-hour urine specimens are available from the Laboratory. Additional urine containers may be obtained from the Laboratory, which is open 24 hours a day.  NOTE: Creatinine Clearance Test requires that a blood specimen is drawn within 48 hours of urine collection.

Venipuncture Collection Procedure

1. Select proper site, considering IV placement, injuries or shunts, and age, geriatric, adult, adolescent, child, and infant.
2. Assemble equipment needed for venipuncture. Consider age by choosing smaller gauge needles for geriatric, child, and infant patients.
   Equipment needed: needle, needle holder, tourniquet, alcohol pad, gauze, and bandage, tubes for tests.
3. Apply tourniquet
4. Palpate site with finger to find vein
5. Cleanse area with alcohol pad
6. Dry area with clean gauze
7. Insert needle into vein, make sure bevel is facing up.
8. Push tube onto hub, allow tube to fill
9. Remove tube and put next tube on if necessary. Mix tubes with additive as soon as possible to prevent clotting.
   Tube order: Red, Blue, SST, Green, and Lavender
10. Remove tourniquet
11. Remove needle and apply gauze.
12. Apply pressure for 2-4 minutes. Apply bandage.
13. Label and process according to directions in Lab Test Index.

HEELSTICK COLLECTION PROCEDURE

1. Warm heel
2. Assemble equipment:
   lancet, alcohol, gauze, and spot or small bandage, micro tubes, lids, and scoopers.
3. Select proper site: see diagram
4. Cleanse area with alcohol and clean gauze.
5. Position lancet on heel and puncture skin.
6. Wipe away first drop of blood.
7. Massage foot with milking motion to enhance bleeding.
   Do not squeeze, this may cause hemolysis.
8. Let drops of blood form and then scoop them into the micro tube.
9. Fill all SST and red tubes 3/4 to full.
   Fill lavender tube to line and mix thoroughly.
10. Apply gauze and pressure. When bleeding stops, apply bandage.

FINGERSTICK COLLECTION PROCEDURE

1. Assemble supplies:
   lancet, alcohol, gauze, bandage
   micro tubes, scoopers, and lids
2. Select proper site - see diagram
3. Cleanse finger with alcohol and clean gauze.
4. Position lancet in proper site and puncture skin.
5. Wipe away first drop of blood.
6. Let drop of blood form and scoop into tube.
   Do not squeeze the finger, this may cause hemolysis.
7. Fill SST and red tubes 3/4 to full.
   Fill lavender tube to line. Mix immediately and thoroughly to avoid clotting.
8. Apply pressure and gauze. When bleeding stops, apply bandage.

Ordering Instructions:

Priority Code: Use of the correct priority is crucial with the Misys Laboratory Computer system.
Misys reads the priority code of the order and then assigns the order to the appropriate blood specimen collection list.
If the priority entered is Routine, the order WILL be assigned to the NEXT collection list, for the requested date.
Laboratory personnel will not be able to monitor the HIS orders for correctness of date, time, or priority.

Messages to change collection date and time will not be accepted.  The test must be cancelled and reordered with the proper priority code.

The Cerner PowerChart priority codes are as follows:

Collection lists are called every hour 10 minutes to the hour from 0300 to 2300 with additional lists scheduled as needed.

The use of the correct cerner PowerChart FREQUENCY is vital, as well as altering the pre-defined standard collection times associated with each frequency to reflect the desired collection times. Any ordering questions should be directed to a Project Genesis super user or the laboratory Information Staff at ext 6033.

"Next Scheduled Run” means that Chemistry test & profiles (gluc, panels, lytes, metabolic,etc.) and CBC's and Coag testing are normally completed within 2 hours of draw time. Please consult the test index for other tests.

The Laboratory has predefined the grouping code for all laboratory tests except Microbiology culture orders. No entry is necessary except for Microbiology culture orders. See Microbiology Section for further information.

The Lab Comment field should be used for other order information. This field is NEVER to be used to indicate date or time that specimens are to be collected. Only the first few characters of the comment appear on the laboratory collection lists. It is necessary to place the most important comment first.

Manual Ordering System

The Universal Hospital Laboratory Order Form is to be used whenever ordering on Cerner’s PowerChart is not possible. Tests not found on this order form are to be written in, with the exception of the following:

Cytology studies will be ordered on for MH-321, cytology (PAP).
Surgical specimen testing will be ordered on form MH-1461, specimen.
Bone Marrow studies will be ordered on form MH-375, bone marrow surgical specimen.

The manual requisition must include ALL information and the form must be legible and accurate.

1. Patient name or other method of specimen identification.
   NOTE: The name on the requisition will match the name on the specimen received. The name on the requisition should be the name on the patient's wristband. When a discrepancy is found, testing will be delayed until the problem is solved.
2. Patient birthdate and sex.
3. Patient medical record number or alternate record number in the event of downtime.
4. Room number or patient location. Please indicate if the patient is in as observation.
5. Ordering physician AND initials of person completing the form.
6. Test ordered and source (if applicable.)
7. Date and time of collection.
8. PAP Smears should also include LMP and patient's previous abnormal report, treatment or biopsy and information if the patient is at risk for developing cervical cancer or it’s precursors.

C.   Results:

Results are available in PowerChart as soon as testing has been updated or completed.

Pathology documents are available after the document has been electronically signed by pathology.
Please note that all pathology documents will have a collect time of 0000.

Critical Limits

Mercy Medical Center-North Iowa Laboratory publishes its critical limits list as a guideline for testing staff for calling abnormal results to patient care units or physicians. Testing personnel phone critical results when tests are completed and verified.

Use the following tables as guidelines for quantitative critical values:

LABORATORY SECTION: CHEMISTRY

Drugs

LABORATORY SECTION: HEMATOLOGY/COAGULATION

LABORATORY SECTION: SEROLOGY

Use the following tables as guidelines for qualitative critical results:

LABORATORY SECTION:  URINALYSIS

LABORATORY SECTION: BLOOD BANK

LABORATORY SECTION: MICROBIOLOGY

Reflex Testing

The laboratory automatically performs additional testing on the specified assays when defined conditions are met.
Refer to the Special Helps section for a complete listing of reflex testing.