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CLS School

Study cards for CLS school, tests are cumulative

What does licensure imply? Licensure is a means of practice control and is done by state agencies.
What is certification? Certification is a means of title control and is done by organizations of professionals.
What is registration? Registration places a professional's name on a list usually kept by the state. It normally costs a fee to keep up and requires your name and address to be listed.
What does it mean to be in a licensure state and does this apply to Virginia? Licensure states require anyone working in that field (in this case CLS) to be a licensed professional in order to be hired to a position in that field. This is not a requirement in Virginia, but most hospitals will not hire unlicensed persons for CLS.
Is certification required? In Virginia, you are not required by the state to be certified as a CLS, but many employers will not hire without a certification.
Which is accepted in all states: ASCP-BOT or MLT? ASCP-BOT is accepted as a certification test across the board, but many places do not think the MLT meets the needs.
What determines quality? accuracy, reliability, and timeliness
Who/What pays the highest cost from laboratory errors? Patient's pay, errors do not bode well for patient outcomes
How can a better quality of results be achieved? By achieving excellent performance in the lab through use of many coordinated activities.
Who defines the Quality Management system? The ISO (International Organization of Standardization)
What are the three phases of the Quality Management System? Preanalytical - samples must be good samples, this stage can start with the patient and finishes with transport Analytical - performance of test and quality control Post Analytical - After analysis, records are kept and reported to those who need it
What crosses all three phases of the Quality Management System? Data and Lab Management, Safety, and Customer Service
Why is the workflow important? it takes the entire process into consideration, starting with sample collection and ending with reporting and saving results as well as the steps in between.
What blends together to make up the quality policy? responsibilities and authorizations, provision of resources, and communication.
What kind of personnel should be working in Clinical labs? Qualified, competent personnel who are oriented and trained in hospital procedure, assessed for competence, professionally developing, and continuing their education even after graduation.
What is required of the equipment? That the proper equipment is installed, validated, maintained, calibrated,serviced and repaired. It also needs to undergo troubleshooting and have records kept on it.
Information should be managed with _____? Confidentiality, meaning that documents are properly discarded of by shredding, redaction, etc. so that patient information does not get into the wrong hands.
What needs to be done about occurrences? They need to be addressed: why the occurrence happened and what can be done to prevent it from happening again.
What is an external lab assessment? an assessment performed by an outside company which occurs at least quarterly. They provide a sample that is treated as a patient and results are compared to the known result as well as the other labs undergoing assessment.
What happens if there is no Quality Management System? There is no detection of error.
What happens after a la accident? Loss of staff confidence and reputation as well as litigation.
Who is responsible for quality and safety and What should be reported? Everyone is responsible for safety and quality. If these are present they need to be reported: ignited burners, frayed cords, or spills.
What biosafety level must labs be designed and organized to accommodate? Biosafety Level 2 or higher.
What does Biosafety Level 3 deal with? TB and diseases like it, these labs need negative pressure.
What does Biosafety Level 4 deal with? Ebola and other diseases.
What is necessary in the stock room? Proper storage as well as acknowledgement of temperature sensitive items. Stock needs to be rotated and stacked properly so it won't tip.
Who is responsible for MANAGING safety? The safety officer
What is LIS? Laboratory Information Systems
What good does automation serve? Allows for more work with less labor.
Why is it good that automation requires less labor? A majority of lab workers are baby boomers and will be either changing jobs or retiring. Since there are less individuals in the younger generations than baby boomers', this means there will be less replacement into these positions.
What makes machines so helpful? They reduce safety risk factors (less risk of exposure to samples), reduce incidence of repetitive stress injuries, and increase patient and physician satisfaction.
What is continuous flow analysis? the samples and reagents are sucked through the system with bubbles to separate them and to "scrub" the tubing. There is a lot of carryover though so it is not too accurate.
What is discrete analysis? Analysis in which each sample has its own reaction cuvette. With this type of analysis, multiple tests can be run on one sample or multiple samples can be run through the same test
What are the steps in the analytical process? Specimen collection, identification, prep, delivery, loading and aspiration, processing, and introduction and internal transport This is followed by reagent handling, storage and delivery. Followed by chemical reaction, measurement, signal processing, etc
Where does specimen collection occur? Specimens may be collected on- or off-site
When are samples labeled? May be labeled at collection or later, the tube needs to be given some sort of identifier.
Where do a majority of testing "errors" occur? Most errors occur in the collection process, or pre-analytical stage.
What are the pros and cons of courier services? There is the benefit of batch delivery with the draw back of the possibility of specimen breakage or loss.
What are the pros and cons of pneumatic tube systems? Pros: Point-to-point delivery with increased reliability. Cons: Switching mechanisms can lead to misrouting. Close attention needs to be paid to design to prevent hemolysis of specimens.
What are the pros and cons of electric track vehicles? Pros: No risk of hemolysis Cons: Costly to install and move and less rapid than pneumatic tubes.
What are the pros and cons of mobile robots? Pros: easily adapted Cons: require human intervention to load/unload and are expensive.
How are specimens processed? They are identified and "recieved", labeled with barcodes, sorted and routed, centrifuged as needed, tubes are decapped, sample levels are detected, aliquots are prepared, samples are recapped stored and retrieved, and then transported to testing area.
How does automation help the specimen processing? Some automated systems can do most if not all of the steps in specimen processing instead of technicians having to do it manually.
How is specimen ID and preparation done? Lab testing is ordered in Meditech and labels are generated containing barcodes indicating pt information, unique lab accession number, and tests ordered and this barcode needs to be properly aligned. Specimen is "recieved" into the computer at the lab.
What is automated specimen processing? Some systems recieve incoming specimens, centrifuge (even auto-balance), decap the tube, sort by instrument, and aliquot. It is directly connected to instrumentation and a stockyard or refrigerator is connected for specimen retrieval.
What is the goal of automated specimen processing? To increase efficacy and decrease costs.
What can instruments detect in specimen loading and aspiration? Instruments may have the ability to detect hemolysis, Lipemia, icterus, clots, and high acid levels. Some instruments can achieve this by penetrating the stopper with a hollow needle.
What indicates lipemia? fat globules in the specimen.
what is Icterus? Icterus is bilirubin from RBC breakdown. It changes the color of the specimen to green.
How can some machines detect clots? uses a pressure sensor to determine the pressure of a clot in the specimen.
What means can be used to mix samples? magnetic stirring, rotating paddles, forceful dispensing, ultrasonic energy, centrifugation.
What are some of the means used for incubation? Circulating air, water bath, heat block.
What is used during the measurement phase? most common technique is to use visible and ultraviolet light spectrophotometry. High performance liquid chromatography and freezing point are also used.
What is measured in the BMP (basic metabolic profile) of the chem panel? Na, K, Cl, CO2, Calcium, Glucose, BUN, and CRE
What does the LIS do to report? LIS uses barcodes system to electronically post results to the patient's record.
What does the instrument display show? reagent stability, abnormal results, clot detection, and status of testing (will show how much time is left on the test).
what is the central command center? At Augusta, "centralware" is used. It is an autoverification process.
What do CLS have to review and not review? CLS do not need to review results that fall within predetermined limits. They focus on specimens that fall outside acceptable range since these require review.
What does the future hold for automation? increased efficiency, decreased cost/test, decrease in space requirement, increase in integration, decrease in size of components for point of care and in-lab testing, increased push to total lab automation, increased use of biosensors for in-vivo testing
What are some examples of biosensors for in-vivo testing? transcutaneous blood gases and bilichecks for neonates.
What is an immunoassay used for? detects and measures antigen and antibody reactions in a solution. These antigens can be hormone, vitamin, or drug as well.
What is fluorometry? Based on energy exchange process that occurs when valence shell electrons absorb electromagnetic radiation, become excited and return to an energy level lower than their original level; light emission from a singlet state is called fluorescence
What is refractometry? Based on refraction of light as it passes through a medium such as glass or water. Light changes between mediums by refracting in different directions. This is an indirect measure of the total solute concentration.
What is Freezing point osmometry? based on measuring changes in colligative properties, normally freezing, that occurs due to variation in particle concentration.
What is electrophoresis? electrophoresis separates charged components in liquid medium under the influence of an electrical field when a voltage is applied to a salt solution.
What is densitometry? Obtaining a quantitative profile of separated fractions performed on the stained support medium
Amperometry Measurement of the current flow produced by and oxidation-reduction reaction.
Light scatter technique - Turbidimetry Measure of the reduction in light transmission caused by particle formation. this is used to measure bacterial growth in micro, clot formation in coag, and protein in CSF and urine for clinical chem.
HPLC (High Performance Liquid Chromatography) Sample injected into packed column. Flows through and differing pH buffers separate sample into analytes which are then measured using photometer.
Potentiometry Basis of ISEs, pH, and pCO2 electrodes. ISEs detect Na, Li, Ca, Mg, H, Cl, K
Mass Spectrometry Ionization of chemical compounds to generate charged molecules and measure their mass-to-charge ratios
Flow Cytometry Measurement of multiple cell parameters (and other particles) as they flow individually in front of a light source. Signals triggered by physical factors and fluorescent emissions from these cells as a result of illumination and staining.