I'm attached to the clinical laboratory under the administrative department for the first week. This gives me the chance to learn more and have a first-hand experience of what the LIS is all about. Basically, in our lab, the LIS is linked to both the Hospital Information System and the Central Management System. As everyone of you know, the HIS is all the patients' particulars while the CMS links the LIS to the rest of the clinic under the hospital.
Under the admin department, what we do everyday is to register and bill the samples received, and it is very important to make sure that no samples or tests to be done are left out as this will cause inconvenience to both the lab and the patients. These samples that we received are collected from the various clinics by the respective dispatchs and also from the different departments of the hospital. When we received the samples, it is important to check the various samples against the names on the request forms as human error such as labeling error is often. If a sample that belongs to patient B is registered under patient A, this will cause the results obtained to be invalid. Sometimes, the samples recieved are not the same as what is reflected in the form that the dispatchs use to state the amount of different samples collected. Therefore, we must call the clinics to double check with them about the number of samples sent. There are also times when samples are not received for a particular test, and this is when we will have to call up the clinic and confirm with them about the tests to be done for that patient.
Documentation is also very important in the admin department. Once the tests are being done and results are obtained with the availability of the various reports, the request forms will be sorted and keep according to the date of register for a period of six months in case any clinic calls to enquire about a certain test done on the patient. Any request forms that are dated six months before the current month are being disposed. For the tests reports, the date when the reports are recieved will be documented, and there is always two reports, the original for the patient or clinic and the other or photocopied for the lab. We always keep a photocopied or dupicate report for reference in case the clinic calls and ask for the same report to be faxed to them.
For the first week, all I was asked to do is to register samples for simple tests like anti-HIV, Malaria Prasites, Work Permit and VDRL. I've also prepared reports to be sent to the respective clinics for the dispatch and record the reports received and file accordingly. For this week, I finally know why a systematic and organised documentation system is important as there will always be people calling up to trace for the different reports, regardless of whether the reports have been sent to them. But, it is fun and exciting to be in the admin department! Have a try if you guys are given the chance, because challenges will pop out from no where suddenly!
Hui Juan
TG01
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Hi Hui Juan. I would like to confirm with you that the everyday registration and billing of the samples data into the LIS are done before each of the requested tests, am I right? And if so, besides checking the labels, do your team and you check the samples to accept or reject? E.g. A sample must meet a particular volume necessary to conduct and register for a particular test or if a blood sample must have been collected in the appropriate tube so as to ensure that there is no other pre-analytical variation. Or do you check all of these after you have registered the samples?
ReplyDeleteAnd gal, I miss you.
Nur Indahiryana binte Mohamed Amran
0705361D
Very good. Keep up the good work done. Continue the communication. You guys will enjoy what you are sharing after a while.
ReplyDeleteYo! Sorry for replying so late. Yah, besides billing the samples, we are supposed to ensure that the labels of the tubes are the same before they are sent for the tests. But because we also print and label the tubes ourselves after billing, sometimes we also paste the label wrongly. E.g. I switched the labels of this particular request form and the patient's plain tube (blood) on my second day of work. So it's very important to be alert although the medical technicians will double check the tube's original label with our label to ensure that the correct tube is labeled with the correct label.
ReplyDeleteAbout the checking part right, we do not reject samples at the admin area. We have a special corner set up where we put all the 'problem' samples together. E.g. If a sample is sent without a request form, we will call the clinic and ask for one. So the sample will be at the 'problem' area before we receive the form. Sometimes, the clinic made mistakes like sending the wrong samples for test. E.g. They sent plain tube when the patient is doing a complete blood count, so we will call the clinic and ask for the correct sample (EDTA) before billing the test.
As for rejection of samples, that will only be done after the medical technicians had spin the tube and check if the blood is lysed or not. Normally, once a lysed blood tube is noted, they will inform us if it's from other clinics or they will call the in-house clinics themselves to ask for another sample. In our lab, lysed samples are the most common reason for rejection, and many times, the subsequent samples sent up to the lab is still lysed. XC
I miss ya too!!! :(
Hui Juan
0702012F
Hey! Actually today there are 2 blood tubes where the bloood were lysed. But no one mentioned anything to me about letting the admin side know.
ReplyDeleteAnyway, I Still don't really understand the different kinds of forms avaiable. For example, the merge forms, package, etc.
What do merge forms actually mean? haha ^^
oops. I forgot to sign off.
ReplyDelete* Rebecca Chew
0703363B
Hey! Just thought I could add on a little too. The LIS thing is really cool huh. With the scanner attached, a barcode can help retrieve so much information. From patient's records to test ordered to product transfused etc etc.
ReplyDeleteAnd speaking of the rejection criteria, i'm sure we have different ones. Right, over here we look at the label,check the nric and name. Also, there must be a signature on the tube and it must be the same signature on the request forms. Volume required is 3ml, unless the doctor has a memo attached stating the patient has poor veins or if the patient is a baby.
Regarding the lysis, so far i haven't seen any tubes that are completely hemolysed. However, we have partially hemolysed tubes. Forward and reverse grouping can still be done though.
Poh Yan Hong
0703979E
Hi Hui Juan,
ReplyDeleteHope you are well =)
Thanks for the post. Sounds like you had an interesting experience =)
I’ve got a few questions to ask out of my curiosity.. Because i have not really had a chance to play with the LIS yet.. Thanks =)
1.Are there any limitations or problems when using the LIS program?
2.Is it a user friendly program? Are the commands difficult to use?
3.Also, what happens if by accident the wrong test order is entered?
Hmm then about specimen rejection criteria, i think for cytogenetics they try not to reject samples (slightly lysed etc) unless absolutely necessary (samples not labelled etc). They will still try to set up culture and hopefully find some metaphases for analysis. This is because of the nature of samples (eg bone marrow aspirate can be invasive and quite painful to the patient i suppose?). I’ll check out and confirm on it and get back.
Hey, all the best for SIP =) Keep in touch =)
Ng Tze Yang Justin
0703747F
Hey HJ!
ReplyDeleteI will only be attached to this department at the clinical lab i'm working during my last two weeks of SIP. Thanks for the heads up on what to expect :)
I want to know what kind of system is used to despatch the samples from the point of collection to the clinical lab? I'm wondering if it is the same for all the hospitals cause the one i'm attached to uses the pneumatic system.
And what about cases whereby only one sample is received but it requires 2 different tests? For example, a bottle of urine sample is received and it is requested for culturing as well as microscopic examination, will they need 2 samples instead? And if so, won't it impose on the patient?
Liyana
0703827F
I'm attached to the order entry section too, which also uses the LIS system and my hospital uses the pneumatic system as well(: Usually for the hospital I'm attached to, one blood sample drawn can be shared among a few tests unless the tests requires different blood tubes or there is insufficient volume for sharing. Furthermore, for us, culturing and microscopic examination requires 2 different collection tubes. I think it is alright for the patient as we can ask the patient to collect his/her urine in one container then we separate it on our own. All these are for the hospital I'm attached to so if hui juan's one has any differences, do share(:
ReplyDeleteThanks,
Goh Michelle
Please reply to the questions. If not, your posting will be disregarded.
ReplyDeleteHey guys, sorry for the late reply. Wasn't able to access to the blog with my internet...
ReplyDeleteTo Rebecca:
Actually, the technician will spin the tubes and check if the blood is haemolysed or not. If the blood is haemolysed, they will inform the clinic for a new specimen themselves if it is located within the hospital. If the specimen is from the clinic outside the hospital, the tube will be returned to us and we have to fill in a rejection form which will state the reason for rejection. The rejection form will be filled for either case, and a call will have to be made to inform the staff of the clinic that the tube is rejected and why is it so. And the name of the staff will be noted to prove that we did inform the clinic about the rejection and asked for a new specimen.
About the different forms available, in our laboratory, we have a total of three different laboratory forms (green, blue, yellow), which have different tests availble. Packages are a set of tests provided by the hospital in collaboration with the different companies or the hospital itself. The difference is that those hospital packages are paid by the patients while the companies or insurances packages are usually subsidised by the companies. Aa for merge form, it is to tell us that the specimen is for a test in the previous laboratory number and not a new one so that the patient need not pay twice for the test. Usually, patients are not able to provide pap smear, urine or stool on the spot due to various reasons such as menstration where the urine and stool cannot be used for testing. Packages usually comes with urinalysis and occult blood tests, hence if specimens are not received on the day of registration for the package, it will be sent to the laboratory with a merge form on other days.
Hope this helps!
Hui Juan
0702012F
To Yan Hong:
ReplyDeleteWell, I agree that different laboratory have different criterias. Because at our side, the blood need not be 3ml as long as it is enough to carry out the tests. Our tubes do not have signiture except fpr special cases like seven drug screen and cotinine, which require the urine to be sealed with signiture.
Regarding the lysed specimens, I have only encounted twice for the three weeks, and only saw one of the tubes. I am not sure if the tube is completely haemolysed, but I know that some tests can still be done depending on the haemolysed condition. For all the two cases of rejection that I encountered, they are all EDTA tubes. I will find out more before getting back to you about what tests can be done as soon as possible.
I am not able to use the scanner although we have two at the admin side as it is only for the use by the admin supervisors, and i have not seen them used it before. But i do know that during the mass screening on our fifth day of work, the admin supervisor used the scanner to scan the different requests forms as there were over 100 forms available in addition to the normal amount of specimens we received. I have not register any specimen during the mass screening but there are five more to come towards the end of the month, hence I'll provide more information when I get the hands-on experience. XD
Hui Juan
0702012F
To Justin:
ReplyDeleteYes, the LIS gives a big problem by hanging all the time in our laboratory. I'm not sure if it is the fault of the computer or the system, but the system always hang at the same time. This creates a big problem when the dispatchs come back, where the specimens are not able to be registered and run, and the specimens accumulates. I guess this cannot be help as the LIS contains alot of informations including reports from previous records. Although house-keeping is done on every wednesday to clear away 'unwanted' stuffs, the system is still slow. So I guess that if the house-keeping is not done, th system will be slower.
So far, I have only encountered one of the limitation of the LIS, that is, our system has a limited character space for the name of the patient. For newborn babys, we register the specimen by 'd/o XXX' or 's/o XXX' for daughter and son respectively. Sometime, the name of the mother is too long, hence after adding the d/o or s/o, we are not able to key the name of the patient fully in the system. The nurses will usually make a fuss over this before they realised that the missing letters from the name is due to the limitation of the system.
The LIS is basically quite a user-friendly programe, as it is easy to use and understand, but i've only used six of the programs available so far. For example, to register a specimen, go to 'Registration' and the labels will be printed automatically. If you want to merge a specimen, go to 'Edit lab request' and add in the specimen, after which you need to print the labels manually by going to 'Print label'. To trace reports, go to 'Report by lab request no.' and enter the laboratory request number or the NRIC provided by the staff that calls and trace the report. If the report to be trace if a microbiology report, go to 'Microbiology' and select the different 'Urine', 'Stool', 'AFB' or 'Others' report on culture or smear. For me, this is quite an easy program to use in a labouratory.
If a wrong test order is entered, just go to 'Edit lab request' to delete the wrong test
and enter the correct test. This occurs frequently during registration of specimens, so if the registration is not saved, it can be deleted and edit immediately before saving. Sometime, we also miss out the tests ordered for the patient, hence the person in-charge of doing the checking of forms and sales report is very critical as she is the one that will detect all the wrong tests, or missed out tests. Of course, if the test is missed out or edited after registration, the technicians must be informed so that they will follow-up and run the tests required, either in the same laboratory number which will lengthen the turn-around time of all the tests or a diffrent laboratory number which will only take longer for the miss out test to be run.
All the best!!
Hui Juan
0702012F
To Liyana and Michelle:
ReplyDeleteIn the hospital itself, we also used the pneumatic tube system which will transport the specimens to the labortaory. But usually, the nurses or phlebotomist will bring the specimens to the lab.
For blood specimens, usually, a plain tube of 3ml has enough serum to run a couple of tests. If a bottle of urine is received for both culturing and microscopic examination, it is fine as only a small amount of the urine is required for culture, unless the patient has difficulty in urination. If if is stool, using the normal stool bottle, if is able to do culture, and stool FEME which test for amoeba, cysts, and ova. If a blood culture is to be done, a special bottle will be used for the collection of blood. The volume of blood is quite alot compared to the normal blood tube, but I am not sure of the exact volume. I will find out on monday and get back to you guys if the internet is working properly. XD
Hui Juan
0702012F
Hey guys,
ReplyDeleteI've checked with my supervisors about the tests that can be performed using partially haemolysed blood. Actually, it can be used to perform any other tests except the biochemical tests, but the definition of partially haemolysed blood depends on individual laboratories. In our lab, we will try to run the test first, but if the results obtained are higher than usual or abnormal, we will reject the specimen.
As for the blood culture, volume of blood to be used is generally 5 ml. For adults, we always perform aerobic and anaerobic culture together, hence a total of 10 ml of blood is required in two different media for the cultures. For children, we only perform aerobic culture, hence only 5 ml of blood is required. For blood culture, the blood are collected in special bottles containing medium that aids in the recovery for the microorganism to help increase the yield of culture. More information will be provided when i attach to the microbiology section of the lab. XD
Hui Juan
0702012F