Non-Alberta Healthcare Testing Laboratory Manual

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1 Non-Alberta Healthcare Testing Laboratory Manual Developed and Supplied by: DynaLIFE Dx Suite 200, Street Edmonton AB T5J 5E2

2 Page i 1.0 Introduction for Laboratory Services Table of Contents 1.1 Consultation and Support Lab Supplies 2.1 Specimen Containers Ordering Supplies Example Order Form Specimen Identification 3.1 Completing the Requisition Labelling of Specimens Example Requisition Specimen Collection and Preparation 4.1 Order of Tube Draw Specimen Requirements Biochemistry Gold Top (SST) Hematology Panel Lavender Top Hematology Blue Top Blood Smear Preparation Urinalysis How to collect urine specimen (female) How to collect urine specimen (male) Packaging 5.1 Packaging Diagram Specimen Analysis 6.1 Specimen Entry Turn Around Time Test Cancellations Critical Laboratory Results Weekends and Holidays Finance 7.1 Accounts Payable Updating Account Information Change to Account Form Account Inactivity...7-1

3 Introduction Page 1-1 Section 1.0 Introduction for Laboratory Services 1.1 DynaLIFEDx Consultation and Support DynaLIFEDx Toll-free Phone Specimen Processing... Extension Inquiries (Results, specimen collection or transport) Shipment Notification Supply Order Status Account Updates, New Accounts, or Service Issues... Extension Faye Chambers, Client Support Specialist Fax Supply Order Forms... (780) Billing Inquires Invoicing and Payments... Extension Accounts Receivable DynaLIFE Dx Rev. 1: July 2012

4 Lab Supplies Page 2-1 Section 2.0 Lab Supplies 2.1 Specimen Containers Gold Top (SST, 5.0 ml) Stock# 0580 Blue Top (Citrate 2.7mL) Stock # 0492 Lavender Top (EDTA, 4.0 ml) Stock# 0587 Black Top (Seditainer ESR) Stock #: 1455 Royal Blue & Screw Top Vial (No Preservative, 7 ml) Stock# 0517 Royal Blue (EDTA, 7 ml) Stock# 0518 Sterile Urine Container (60 ml) Stock# 0361 Urine Chlamydia (Collection Kits) Stock #: 0040

5 Lab Supplies Page Ordering Supplies For Sites Performing Their Own Collections 1. Specimen containers and shipping material required for laboratory tests are listed on the Non-Alberta Healthcare Laboratory Supplies Order Form, and are provided at no additional charge for testing being performed at DynaLIFE Dx. 2. Should you require upon account set-up, a minimum order of supplies will be shipped to your office. A personalized order form will also be provided which is to be retained for duplication, as required. DO NOT USE THE EXAMPLE TO ORDER 3. To order additional supplies, complete your customized Non-Alberta Healthcare Laboratory Supplies Order Form and fax to (780) Specify the quantity required for each item. Please Note: Please consolidate requests for supplies as much as possible, such as once per month, to assist in controlling shipping costs and thus controlling your testing costs. The Vacutainer brand tubes supplied usually have an expiry date of three to six months from the date of order. Order quantities accordingly. SUPPLIES ARE SENT BY GROUND TRANSPORT. ALLOW 5-8 DAYS FOR DELIVERY.

6 Lab Supplies Page 2-3

7 Lab Supplies Page Completing the Requisition Refer to Example requisition on following page: Section 3.0 Specimen Identification 1. Healthcare Number - This number will be used for identification purposes only. 2. Patient sex - Indicate M (male) or F (female). 3. Patient s name - Patient s legal name (last name, full first name). 4. Date of Birth - It is imperative that the order day, month, year (DD/MM/YY) be followed. 5 Ordering Physician 6. Fasting Status - 7. Collection Date & Time - Indicate ordering physician in Chart # box on requisition. If you do not provide the ordering physician it will not appear on your report. Indicate number of hours patient was fasting. This is a required field for the laboratory. Day, month, year (DD/MM/YY). Time in 24 hour format (i.e., 16:00). A completed DynaLIFE Dx is mandatory for testing to be billed to your account, clients presenting without your completed requisition will be required to pay for services. DO NOT USE THE EXAMPLE TO REQUEST TESTING If there are not enough IDENTIFIERS provided on the specimen(s) or the information is inconsistent with what is submitted on the Requisition, the samples may not be acceptable for analysis. 3.2 Labeling of Specimens All specimens submitted for testing must be labeled with two unique identifiers. One must be a name identifier, the patient s full first and last name, which matches the requisition and provides positive identification of the patient. A second unique identifier would be a PHN, date of birth, Driver License number etc. The following are examples of unacceptable specimens that may NOT be processed: Specimen is not labeled with the full first and last name and a second unique identifier as listed above Specimen is unlabelled Specimen label does not correspond to the information on the requisition Specimen label is on the slide container, transport container or biohazard bag, and not on the specimen itself

8 Lab Supplies Page 3-2

9 Specimen Collection and Preparation Page 4-1 Section 4.0 Specimen Collection and Preparation Care in preparing specimens can be the most critical step in assuring accurate test results. Blood should always be drawn prior to exercise to avoid enzyme elevations related to muscle exertion. Specimens should only be collected and shipped on a day where there will not be more than a 24hour delay in being received by the testing lab. A delay in receiving the samples may affect the specimen results. 4.1 Order of Tube Draw Mix EACH tube 8 to 10 times by gentle inversion immediately after collection except for light blue top sodium citrate tube - mix 3-4 times ORDER TUBE TUBE DESCRIPTION COMMON TESTS 1 st Royal Blue Top with Red Label (no additive) Trace Elements, Serum nd Light Blue Top (Sodium citrate) 2 For plasma collection Coagulation (FULL tubes required) 3 rd Black (Sodium citrate) Sedimentation Rate (ESR) th Gold or Red/Black Top (Gel with clot activator) 4 For serum collection th Mauve Top (EDTA) 5 For anticoagulated whole blood collection Routine Chemistry Routine Hematology, Hemoglobin A1c 6 th Royal Blue Top with Mauve Label (EDTA) Trace Elements, Whole Blood 4.2 Specimen Requirements For the most up to date specimen collection and processing requirements: DynaLIFE Dx Tips: 1. To assist in determining the # of SST Tubes to draw for multi-test requests: A full 5 ml SST (Gold Top) Tube will provide approximately 2.0 ml of serum when spun this amount will be enough to perform approximately 10 general chemistry tests. For every individual test requiring serum, submit 1.0 ml of serum (unless indicated otherwise) 2. Check expiry date on vacutainer tubes prior to collection. 3. Always completely fill tubes when possible.

10 Specimen Collection and Preparation Page Biochemistry Gold Top (SST) Label the 5 ml gold top SST tube and transport vials as described in Section 3.2 Labelling of Specimens. Draw blood using routine venipuncture procedures. Allow the SST tube to fill with blood completely to ensure that enough serum is attained. Remove the tube from the holder and gently invert the gold top tube 8-10 times. This tube contains a clot activator, which must be mixed with the blood sample. Allow the blood in the SST tube to clot at room temperature for at least 30 minutes but no longer than one hour. Centrifuge the tube until the cells and serum are separated by the polymer barrier. Using a plastic disposable pipette transfer the serum from the SST tube into the labelled screw top plastic transport vial, if required. Refer to for minimum volumes and sample requirements for each test. 4.4 Hematology Panel Lavender Top Label the 4 ml lavender (EDTA) tube as described in Section 3.2 of this manual. Draw blood using routine venipuncture procedures. Determine if sample will not arrive at downtown testing facility with 4 hours of collection and a slide is required. For detailed instructions, read the section 4.6 Blood Smear Preparation. Remove the tube from the holder and gently invert the lavender top tube 8-10 times. This tube contains an anticoagulant (EDTA) which must be mixed with the blood sample. X 8-10 Store the lavender top tube at room temperature prior to shipping. At DynaLIFE Dx, a Blood Smear Morphology (Pathologist Check/PC) is added to a CBCD report at the discretion of the reviewing pathologist, to assist in patient management. Clients are responsible for all additional charges incurred. NOTE: Test results are optimal on a specimen kept at room temperature and less than 24 hours old. Samples Greater than >24 hours old may not be fully resulted due to sample degradation. Temperature extremes should be avoided. 4.5 Hematology Light Blue Top Label the 2.7mL blue (Citrate) tube as described in Section 3.2 Labelling of Specimens. Draw blood using routine venipuncture procedures. Remove the tube from the holder and gently invert the blue top tube 3-4 times. This tube contains an anticoagulant (Citrate), which must be mixed with the blood sample.

11 Specimen Collection and Preparation Page 4-3 Refer to for proper handling.

12 Specimen Collection and Preparation Page Blood Smear Preparation if sample not at testing facility within 4 hr of collection Use a pencil to label the frosted section of each slide with the patient s name and a second identifier. Do not apply a label to the outside of the slide mailer. A B C D Hold the lower slide firmly on the counter with the thumb and index finger. Holding the upper spreader slide with your thumb and index finger of your other hand, place the edge of the slide in front of the drop of blood at an angle of degrees. Slowly draw the upper slide back into the drop of blood, which will spread it along the edge of the top slide. Do not allow the blood to spread off the edges of the lower slide. Keeping the same angle, push the upper slide rapidly along the length of the lower slide. The thickness of the smear can be varied by the rapidity with which the upper slide is pushed; the slower the motion, the thinner the smear. A thin smear is preferred for Hematology evaluation. Allow the first slide to air-dry. Proceed the same way for the second slide, using the first slide as the spreader. DynaLIFE Dx TIPS: 1. The thickness of the smear can be varied by the rapidity with which the upper slide is pushed; the slower the motion, the thinner the smear. A thin smear is preferred for hematology evaluation. 2. Good smears result from numerous slide preparations. For each patient, make several smears and submit the 2 best smears. 3. When blood smears are too thick, they tend to wash off the slide during the staining process. 4. When blood smears are not made immediately following venipuncture, ensure tube of blood is thoroughly mixed prior to making blood smears.

13 Specimen Collection and Preparation Page Urinalysis Instruct the patient to collect approximately 40 ml of midstream urine in a 60 ml urine container (refer to ). Refrigerate the specimen prior to shipping.

14 Packaging Page Packaging Diagram Section 5.0 Packaging It is the responsibility of the shipper to ensure packaging instructions are followed carefully in complying with requirements for Transportation of Diagnostic Specimens, and maintaining optimum specimen integrity. Transport couriers will reject boxes improperly packaged and the shipper may be subject to large fines if packages are found to be leaking. Blood Samples Insert the tubes into the bubble pack. (One vial per sleeve of the bubble pack). Roll up the bubble pack and place it inside the zippered compartment of the specimen biohazard bag, containing the absorbent. Each biohazard bag should only contain the specimens of a single patient. Requisition Fold the top copy of the Requisition and slip it into the outer sleeve of the bio-bag. Urine Samples Place urine specimen into a separate biohazard bag (seal the biohazard bag securely) and then into the ziplock compartment of the biohazard bag with other specimens. Shipping Box Enclose all biohazard bags inside the shipping box by replacing the lid and securing the box with tape. Use one shipping box for transporting all specimens.

15 Specimen Analysis Page Specimen Entry Section 6.0 Specimen Analysis On arrival at DynaLIFE Dx, the condition of the specimens and completeness and consistency of the information on the requisition will be assessed. The shipping site will be contacted if the technical condition of the specimen is unacceptable, absence of information, or inconsistencies on the requisition is noted. 6.2 Turn Around Time Most results are available 24hrs after samples are received at DynaLIFE Dx. Overdue Results If a report appears to have an excessive turn around time, please do not hesitate to call us at ext DynaLIFE Dx staff can view the data to ensure each test has been requested. We can immediately produce a report that will contain all of the results available to date for a particular collection. This report can be mailed, as necessary. 6.3 Test Cancellations The lab reserves the right to cancel testing on unsuitable specimens (clotted, insufficient sample, etc.) or to reject specimens due to insufficient patient identifiers or misidentification. Your office will be informed about unacceptable specimens. The lab will not reimburse cost of courier fees. Both the cancellation and reason are noted on the lab report. 6.4 Critical Laboratory Values A critical laboratory value is a value at such variance with normal as to represent a pathophysiologic state that is life-threatening unless some action is taken in a very short time and for which an appropriate action is possible. Critical Laboratory Values according to DynaLIFE Dx laboratory policy must be telephoned to the physician as soon as possible after the result is available. 6.5 Weekends and Holidays DynaLIFE Dx operates 24 hours per day, 365 days per year. However, commercial courier delivery is restricted to Monday through Saturday, some holiday restrictions apply. Check with your chosen courier for holiday restrictions.

16 Specimen Analysis Page Accounts Payable Section 7 Finance DynaLIFE Dx Finance Department completes the invoicing and payment process for your account. DynaLIFE Dx Finance Department is located in Edmonton and can be contacted during business hours from 8:00 am to 4:00 pm, Monday through Friday at: DynaLIFE Dx ATTENTION: ACCOUNTS RECEIVABLE Suite 200, Street, Edmonton, AB, T5J 5E2 Tel: (780) ext Secure Fax: (780) DynaLIFE Dx has provided you with a five-digit client number used to identify all of the activity regarding your account, pricing, contact information etc. It is located on the bottom of your monthly invoice. When contacting the finance department with questions regarding your account, please provide the finance staff with your client number and also include it on any cheques or other forms of payment. 7.2 Updating Account Information It is important to ensure that DynaLIFE Dx has your current account information on file at all times. To update any account information (i.e. change of address, phone and fax numbers, and changing the primary company physician on your account), contact Faye Chambers: Phone Ext Fax Account Inactivity Accounts having no activity for a period of one year will be made INACTIVE without notification. To resume services and re-activate your account, there is a $25.00 fee.

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