Lab Volunteers Table of Contents 1. Lab Manual a) Ordering Labs for a New Patient b) Ordering a Specific Lab c) Ordering Blood Work for an 042 (HIV) Patient 2. Vaccine Manual 3. Q & A a) Where do I find needles for immunizations and PPD? • In the top right drawer of the front desk area (directly to your right when you enter the door to the front desk area) b) Where are the vaccines located? • In the refrigerator inside the pharmacy (check you lab binder for the pharmacy door code!) c) Can I administer vaccines to a feverish patient? • NO!! The patient’s immune system is occupied with fighting an infection, so do not administer a vaccine! d) Can I draw blood on an HIV+ (042) patient? • NO! Only the LabCorp Technician is allowed to draw the blood of HIV+ patients Lab Volunteers Table of Contents (Cont’d) 3. Q & A (Cont’d) e) Can I administer vaccines to an HIV+ (042) patient? • Yes, if the attending orders them f) Where can I find forms for immunizations and PPD? • All vaccine forms are located in your lab binder; please make photo copies of the originals! g) Can I give medications to our patients? • Yes, if they are requested by the attending physician. Medications are located in the pharmacy (check your lab binder for the pharmacy door code); be sure to write your name and details about the medication being dispensed on the sign-out sheet in the pharmacy h) How do I know which tube to use for a blood draw? • Make sure to find out from the exam room team which test they ordered, then look up that test in the Lab Corp book to find the right tube type Lab Manual Lab - Introduction • Lab volunteers will be ordering labs for the patients and entering them into the ECW system • After a lab is entered into ECW (but before it can be ordered), you must link the lab back to the appropriate ICD code (or assessment) • Exam room volunteers will be responsible for filling out the patient‟s lab sheet which will provide lab volunteers with the following information: – The patient‟s name and DOB – The specific lab test(s) to order – The appropriate ICD code (or assessment) to link each ordered lab back to Lab – Introduction cont‟d • In general, there are 3 main types of labs volunteers will be ordering: – 1) A regular blood panel for new patients – 2) Other specific lab tests pertaining to various assessments – 3) A routine blood panel for 042 patients (HIV+ patients) • When ordering any labs, you must “link” each of them back to the appropriate assessment (or ICD code). A list of labs to order, as well as the ICD code to link it to, will be indicated on the patient‟s lab sheet (completed by the exam room volunteers) The next few slides illustrate how to order routine blood tests for first time patients. Although the assessment, or ICD code, should be indicated on the patient‟s lab sheet, keep in mind that for first time patients, the blood panel ordered will most likely be linked back to the ICD code V70.0 for “ROUTINE PHYSICAL EXAM.” 1. ORDERING LABS FOR FIRST TIME (NEW) PATIENTS 6 Click “Treatment” from the Progress Notes. Select “Browse” in the “Labs” section. 7 Type “New” in the Lookup field. All of the blood tests for a new patient will appear. 8 List of Blood Tests for New Patients: (regular blood panel) • L-Cholesterol, Total • L-Lymphocyte Act. Profile • L-Comp. Metabolic Panel (14) • L-RPR • L-Cytomegalovirus (CMV) Ab • L-Toxoplasma gondii Ab, • L-G-6-PD, Quant, Blood and RBC IgG • L-HIV-1/0/2 Antibodies, Preliminary • L-Triglycerides • L-HLA B5701 Test • L-Urinalysis, Routine • L-HP4 • L-Venipuncture • L-RNA, Real Time PCR Click on each test which you need to order individually and link it to the appropriate ICD code (aka assessment or diagnosis) ) by checking the box in the new dialogue box which appears and then clicking “OK”. Below, each of the labs ordered have been linked to the ICD code V70.0 for the assessment “ROUTINE MEDICAL EXAM” 10 You must link each test you perform back to the appropriate assessment. Note: L-Venipuncture is ordered in place of a L- CBC (no need to do both) (every time you select a new test from “Today‟s Labs”, the dialogue box on the previous slide will appear and you must link the tests to the the appropriate assessment - “ROUTINE PHYSICAL EXAM” shown here - by checking that box) 11 Lookup “l-rn” to order the L-RNA blood test as well Note: the L-RNA blood test does not come up under the blood panel for “new” patients, so you must lookup and select this test separately 12 Sometimes you will need to lookup and order a specific lab (instead of an entire blood panel) pertaining to an individual assessment (i.e. ordering a strep test for the assessment of “strep throat”). The next slide explains how to search for specific labs and link them to their indicated assessment as per the patient‟s lab sheet. 2. ORDERING OTHER LABS FOR SPECIFIC ASSESSMENTS Ordering other labs: to search for the labs you want you must select “component” and “contains” then you can search for whatever test you wish (here we‟ve searched for a strep test); once the test is selected, you still must link it back to the appropriate ICD code or assessment indicated by the exam room volunteers on the lab sheet 14 In case you need to order blood work for an 042 patient, there is a regular blood panel of lab tests always ordered… The following slide explains how to link back the blood tests for 042 patients to the appropriate assessment 3. ORDERING BLOOD WORK AN 042 (HIV+) PATIENT 15 Ordering Blood Work for an 042 Patient cont‟d • Follow the same directions as in slides 6 - 10 • For treatment: – Instead of “new” lookup “routine” • Select all the tests (except L-CBC) and link it back to the “HIV disease” assessment – Lookup “l-rn” (select L-RNA and link it to “HIV disease”) • Link each lab test back to the ICD code 042 for “HIV disease” (instead of “ROUTINE MEDICAL EXAM”) 16 List of Blood Work for an 042 Patient: (routine blood panel) • Rahul, I don‟t have the list of labs for this or any screenshots... – Type in “routine” under lookup to get the list of blood tests for 042 patients – Also, include the “L-RNA, Real Time PCR” test (which you have to lookup separately) Vaccines Patient Safety: DO NOT administer vaccines to a patient with a fever. 1. The exam room team will inform you if their patient requires a vaccine(s) 2. Obtain the pharmacy list from your Lab Binder then proceed to the pharmacy room (door code: 05021) 3. Open the top door of the refrigerator and retrieve the vaccine vial(s) (most multi-use vials are located in green tub on the bottom glass shelf). If the dosage instructions are not on the vial, check the mini boxes the vaccine vials come in. There is a folded paper with dosage instructions in each vaccine vial box. 4. Return to the lab room and obtain the relevant paperwork from your Lab Binder: A. Seasonal influenza (non-VFC): vaccine vial DOES NOT say ‘VFC’ on it B. Season influenza (VFC): vaccine vial says ‘VFC’ on it C. H1N1 D. Other vaccine (e.g. Hepatitis A; Twinrix; Tetanus) 5. Go the the front desk area to obtain a clipboard and needle(s). As soon as you open the door to the front desk area, the first drawer on your right contains the needles. There are 2 needle sizes: 1) 3cc/mL – All vaccines (note: smaller needle tips for thinner patients and pediatric patients can be found in this drawer as well; replace the original needle tip with a smaller tip as needed) 2) 1cc/mL – PPDs and insulin injections 6. Proceed to the patient’s exam room. You must be supervised by a 4th year medical student or the attending. 7. Have the patient fill out the necessary part of the paperwork. Examples of how to fill out each vaccine form are located in your Lab Binder. For the seasonal influenza vaccine, make sure you ask the relevant allergy questions (on the influenza form) prior to administering the vaccine. 8. Adminster the vaccine(s) according to the protocol you learned during the HEALing Clinic vaccine training session. Refresher instructions on administering vaccines are located in your Lab Binder. 9. Discard your gloves and waste in the red waste basket; discard the needle in the sharps bin hanging on the wall; if the vaccine vial is empty discard it in the sharps bin, otherwise return it to the refrigerator in the pharmacy room. 10. Return to the lab with the paperwork and vaccine vials. It is now time to record this information in the eClinicWorks system. Enter the patient‟s progress note and select „Immunizations‟ Click „Add‟ Under „Find‟, lookup the name of the vaccine 1) On the left, select the vaccine 2) On the right, fill out the sections outlined in red. For „Given By‟ select the volunteer attending who is working today; if this person is not in the system, select Veronica Jenkins 3) Click „OK‟ when finished VFC: Select „UNKNOWN‟ Vaccination Given in the Past: Select „Y‟ Decrement the Doses in the Lot: Check the box Click „OK‟ when finished Click ‘X’ VFC: Select „UNKNOWN‟ Vaccination Given in the Past: Select „Y‟ Decrement the Doses in the Lot: Check the box Click „OK‟ when finished Inform the exam room team that you administered the vaccines and completed the immunization portion of the SOAP note. The End.