Can a C-DIFF specimen be collected in a sterile container?+
C-DIFF specimens should be collected in only sterile containers with no additives.
Can I use any other swab for a strep test aside from the Dacron swab?+
No, Gamma only accepts the Dacron swab for strep testing.
How long is a C-DIFF specimen viable for testing?+
C-DIFF specimens are viable for 24 hours at room temperature or five days refrigerated. Do not freeze the specimen.
Can a micro albumin test be collected in the same container as a C&S?+
No, a micro albumin must be collected in a sterile specimen container that contains no additives.
What identifiers need to be on a specimen to keep it from being rejected?+
Any specimen submitted to the laboratory for testing must include two identifiers. The identifiers must include the patients FULL first and last name and either the social security number or date of birth. This applies to all specimens whether it is blood, urine, stool, or culture swabs. If the patient has demographic labels, it is acceptable to use a demographic label on the specimen.
What do I need to know about timed draws?+
Timed draws should be ordered with as much notice as possible. Gamma requests a facility schedule a timed draw with customer service with 24 hours advanced notice as company policy. If less than 4 hours notice is given, Gamma will try to accommodate the facility, but in some cases medication may have to be held until the phlebotomist can arrive or the timed draw rescheduled for a later date or time. Timed draws such as a VANC peak and trough cannot be made a recurring order.
How can the hemoglobin and hematocrit be so different from early morning draws to a draw in the afternoon?+
: Blood Pooling - morning blood draws from bedridden patients can lead to artifacts in testing results. A patient that has had little activity overnight can succumb to a phenomenon often referred to as blood pooling or hemoconcentration. That is blood drawn from the arm is not at equilibrium with the rest of the body and can lower blood counts—most alarming is a low hematocrit or hemoglobin level. This can lead a medical director to conclude that the patient requires a blood transfusion, and if it is a LTC patient, they may be transported to a local hospital, only to be retested and the hematocrit or hemoglobin level is not nearly as low as previously indicated.
The process of getting the patient to the hospital has re-equilibrated the blood components and they are more normal and often less alarming, not requiring any intervention. Of course such a transport is not only a concern to the patient and their family members, but represents a considerable expense to the facility or other payer. Furthermore, the laboratory that performed the early morning blood draw is questioned about the quality of the testing result — unfairly so, based on the postural state of the patient.
Such low hematocrit or hemoglobin results, resulting from hemoconcentration, complicate the setting of a threshold for clinical intervention and perhaps a blood transfusion. New evidence from studying 19 different studies, representing over 6,000 patients, concluded that hemoglobin thresholds greater than 7-8 gm/dl triggered unnecessary transfusions without adverse associations of mortality, cardiac morbidity, functional recovery or length of hospital stay.
The bottom line is that a facility with a patient who has a low hemoglobin result might be advised to retest the patient following some activities that help equilibrate the blood components, prior to transporting the patient to an ER and potentially transfusing a patient unnecessarily. The study suggests that panic values for clinical intervention might be best set at levels of less than 8 gms/dl hemoglobin without adverse patient affects.
What can cause erroneous elevated potassium levels?+
Answer: 70% of erroneously elevated potassium levels are caused by pre-analytical (variables before measurement occurs) variables. The red blood cell has a high intracellular concentration of potassium, and anything that causes the leakage of potassium into the extracellular (serum) environment will result in erroneous elevated potassium levels. Below are some pre-analytical variables that can cause falsely elevated potassium levels:
Specimen Collection Issues
• Excessive fist clenching during the sample collection releases potassium from skeletal muscle. Instruct patients not to clench their fist.
• Prolonged tourniquet application causes rupture of red blood cells, which release the potassium. The tourniquet should be on no longer than 1 minute, and released once the vein is entered.
• Improper order of draw can cause carryover of potassium from anticoagulant tubes.
• Collection using small gauge needles, such as butterfly needles, can cause the red blood cell to rupture, therefore releasing potassium into the serum.
• Improper tube mixing can interfere with the clotting process. Plastic clot activator tubes require gentle inversion to ensure activation of the clotting process. Do not shake the tube, as this will rupture the cells and cause potassium to leak into the serum.
• Mislabeled Specimens can cause results to be reported on the wrong patient. Always verify the patient identity before drawing the sample and properly label the tubes before leaving the patient.
• Delays in processing and transporting can cause the release of potassium from red blood cells. Separate serum from the red blood cells within 2 hours of collection
• Improper centrifugation can cause lysis of the red blood cells and the leakage of potassium. Do not run a centrifuge continuously for long periods of time, which allow it to build heat.
• Poor barrier formation in gel barrier tubes can cause the potassium to leak out of the red blood cells into the serum. Always follow the tube manufacturer’s instruction.
• Recentrifugation of the original gel barrier tube can cause mixing of serum above and below the gel. If a tube must be recentrifuged, make sure that it is within the 2 hour time limit.
• Freezing whole blood causes the rupture of the red blood cells, releasing potassium into the serum. Make sure that specimens are stored correctly.
• Thrombocytosis can cause potassium elevation due to the platelet release of potassium during the clotting process.
• Anticoagulant therapy and liver disease induces delay in the clotting process. Allow 1 hour for good clot formation.
• Dehydration can result in elevated serum electrolytes.
• Hyperventilation by an anxious patient can cause an increase release of potassium into the serum.
• Serum and plasma potassium values are different. Serum potassium values are higher than plasma due to the release of platelet potassium during clotting. Reports of differences range from 0.1-0.4 meq/L. Be aware of the differences.
• Hyperkalelmia occurs in about a third of the patients being treated with spironolactone and trimethoprimsulfamethoxazole.
• Penicillin VK and Penicillin G can deliver a substantial potassium load to patients; this can be significant when it is administered to diabetic patients or others who may have chronic kidney disease.
• Nonsterodial anti-inflammatory drugs and heparin can provoke hyperkalemia in susceptible patients.
What are the different ways a facility can receive laboratory results?+
It is possible for a facility to receive results by fax, online through iConnect, or EMR.
What does the asterisk * mean on my lab results?+
The asterisk is for billing purposes only.
What is required on requisitions?+
Nursing staff may use patient demographic labels on the requisition. If patient demographic labels are available the following information is still required on the requisition: date to be collected, signature of the nurse filling out the requisition, test(s) ordered and diagnosis.
If demographic labels are not available for the patient, the nursing staff must fill out the requisition with all the required fields. Required fields include the following: date to be collected, signature of nurse filling out the requisition, full last and first name of the patient, date of birth, gender, social security number, room number, physician, complete billing information, test(s) ordered and diagnosis.
How do I get patient demographic labels?+
If the patient already has labels and needs more, attach a demographic label to the requisition and check the box next to patient labels in the supply area of the requisition.
If the patient is a new resident, fill out the requisition in it's entirety, mark the box next to patient labels in the supply area, and attach a facesheet to the back of the requisition.
When can I expect lab results?+
Gamma will result all routine in-house testing within 24 hours of being drawn. Tests considered "send outs" will be resulted within 3-5 days of being drawn. Cultures will be resulted out within 48-72 hours of being received at the testing site.
Q: What businesses must comply with HIPAA laws?-
A: Any healthcare entity that electronically processes, stores, transmits, or receives medical records, claims or remittances. The keyword here is electronic.
Q: What is Protected Health Information (PHI)?+
A: Information collected from an individual by a covered entity that relates to the past, present or future health or condition of an individual and that either identifies the individual or there is basis to believe that the information can be used to identify the individual...and thus must be protected.
Q: What is HITECH and when does it go into effect?+
A: Stands for the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act provides over $30 billion for healthcare infrastructure and the adoption of electronic health records (EHR). According to the Act, physicians are eligible to receive up to $44,000 per physician from Medicare for meaningful use of a certified EHR system starting in 2014.
Q: What is a Covered Entity (CE)?+
A: Any business entity that must by law comply with HIPAA regulations, which include healthcare providers, insurance companies, and clearinghouses. In this context, health care providers include doctors, medical, dental, vision clinics, hospitals, and related health caregivers.
Q: Does the HIPAA Security Rule require data encryption over a network?+
A: The HIPAA Security Rule require encrypt ions only when individually-identifiable health information is sent over a public network, such as the Internet. Encryption is not required for other network connections, such as Intranets.
Q: What are the penalties for HIPAA non-compliance?+
A: Fines can be up to $250,000 for violations or imprisonment up to 10 years for knowing abuse or misuse of individual health information.
Q: HIPAA-ready vs. HIPPA-compliant – what is the difference?+
HIPAA-ready refers to software and other products used by the healthcare industry that complies with HIPAA guidelines. HIPAA-compliant refers to the actual physicians, clinics, and insurance companies that are in compliance with HIPAA regulations.