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Qatar UniversityDepartment of Biomedical Science

College of Health Sciences

Clinical Practice Manual

For

Biomedical Science Students

Fall 2018

Women’s Campus, Science. Building - Room SE 126

P.O. Box 2713 Doha, Qatar

Preface:

This manual, required as a text for students enrolled in clinical practicum, is intended to serve as a guide concerning the policies and procedures of the clinical training program. Explanation and examples of requirements, formats, and information pertinent to the student's successful completion of practicum are included. If, at any time, a student is uncertain about policies or procedures, or finds requirements unclear, she is strongly encouraged to seek clarification from her supervisor, the instructor of the practicum class, or the Clinical Coordinator.

Should any change or update in this handbook be required, the Clinical Coordinator or Department Head will provide it as an addendum.

Purpose:

The purpose of this manual is to provide information about your clinical practice and to provide you some guidelines in developing your new role. Essentially, you are still a student, but with responsibilities similar to an employee. Under the guidance and supervision of a clinical coordinator and one or more clinical instructors, the Biomedical Science student is expected to meet clinical practice goals and objectives, which directly relate to the theory and practice of Biomedical Science. Thus, the practicum is an opportunity to become immersed in the clinical setting, to use your knowledge base to make decisions, to communicate and to collaborate with others in the clinical setting, and to refine your technical skills. You will be functioning as an important member of the health care team, with increased responsibility and accountability for your own decisions and actions. In other words, you’re learning at the clinical site(s) is your responsibility but supervised by QU faculty and facilitated by a team of experienced Medical Laboratory Scientist at various levels.

Course Information:

Course Code Course Title Credit Contact Hours* Prerequisite

BIOM 491 Clinical Practice in Chemistry 3 96 BIOM 346

BIOM 492 Clinical Practice in Hematology 3 96 BIOM 451

BIOM 493 Clinical Practice in Immunology 3 96 BIOM 426

BIOM 494 Clinical Practice in Microbiology 3 96 BIOM 422

BIOM 495 Clinical Practice in Immunohematology 3 96 BIOM 452

* Actual contact hours are subject to change due to the scope of laboratory testing conducted in a given laboratory area

Course Description:

Please refer to Clinical Practice Objectives for the respective Course Descriptions. Each course is a three-week clinical practice rotation offered during the final semester of the Biomedical Science Department.

Faculty:

The clinical affiliate has a specified clinical coordinator and clinical instructor(s) for each of the laboratory sections. Clinical instructors expect students to be prepared for each day by reviewing relevant material from on campus courses. They expect students to have a solid foundation in theory. Clinical instructors are not in a position to provide basic theory review or instruction.

Qatar university Personnel

Rotation Name Office Email Office Phone Mobile

QU-BIOMHoD

Dr. Marawan Abu-Madi QU-SE 229 [email protected] 44034791 55482023

QU-BIOM Taghreed Abunada QU_SE 223

[email protected] 44036553 55239892

Hamad Medical Corporation Personnel


DLMP coordinator

Ebtisam Shaikh Al Yafeai

Lab administration office


Chemistry Jassamin Buluran

Chemistry lab


Chemistry Taghreed Ahmed Mohamed

Chemistry lab

[email protected]

44392282 55227877

Chemistry Rima Jamal Ashour

Special chemistry lab


Immunology Raja H. M. Abdel Hadi

Immunology lab


Immunology Hjar Al Khalili Virology lab [email protected] 44395119 55622986

Microbiology Mariamma Abraham

Microbiology lab

[email protected]

44392038 55228951

Microbiology Hiba Ali Saeed Ali

Microbiology lab


Blood bank Maryam Abdulla A. A. Al-Abdulla

Blood bank in HH

[email protected]

44395660 55565540

Blood bank Marya Ibrahim Mohamed

Blood bank in HH

[email protected]

44395659 33717008

Hematology Nevine Rasheed M Elsalasiny

NCCCR lab [email protected]

44397755 55442628

Hematology Mervat Abdulwahab

NCCCR Lab [email protected] 44397755 66887335

mailto:[email protected]




















Ali KassabHematology Sumaya Al

MullaHematology lab


Hematology Dekra Al Faridi Hematology lab


Hematology Heyam Mohammed Assaad

Hematology lab


SIDRA Medicine & Research Center Personnel


Training Manager Allan Hicks 2MF.105 [email protected] 40032973 66871872

Training Coordinator

Meda Elshobasy 2MF.106 [email protected] 40032977 55403469

Training Coordinator Ruby Mathew 2MF.106 [email protected] 40032976

Chemistry (TO) Furzana Malik 2MF.145 [email protected] 40032909Chemistry (Senior) Suzan Faddoul 2MF.145 [email protected] 40032909Chemistry (Senior) Jodelyn Asinas 2MF.145 [email protected] 40032909Chemistry (Senior)

Zoe Carwardine 2MF.145 [email protected] 40032909

Hematology (TO) Moosa Kazi 2MF.145 [email protected] 40033017Hematology (Senior)

Mohammad Khan 2MF.145 [email protected] 40033017

Hematology (Senior) Mary Mensah 2MF.145 [email protected] 40033017

Transfusion Medicine (TO)

Daniel Grebrekidan

[email protected]

g 40033020

Transfusion Medicine (Senior)

Rehab Elamin 2MF.145B [email protected] 40033020

Transfusion Medicine (Senior)

Milagros Perez 2MF.145B [email protected] 40033020

Microbiology (TO) Nazik Elamin 2MF.155 [email protected] 40037482Microbiology (Senior) Lamya Dalil 2MF.155 [email protected] 40037482Microbiology (Senior)

Anisa Mohamed 2MF.155 [email protected] 40037482

Serology Andrea Corgorno 2MF.155C [email protected] 40032945

Pathology Faheem Mirza - [email protected] -























Sciences (Molecular) Pathology Sciences (Molecular)

Thabisile Xaba - [email protected] -

Immunology Ferdousey Aziz - [email protected] -

Goals and Objectives for Clinical Practice:

The following applies to all areas of the clinical laboratory. Specific objectives are included separately under each discipline area.

Goals:Upon the completion of each Clinical Practice rotation, the student will be able to:

State/recognize normal reference values for the various test procedures performed. Select what is needed for each test procedure performed given appropriate reagents and

supplies. Select appropriate quality control products and specimens from supplies provided. Identify the proper time to collect various specimens which are sent to the laboratory. Apply routine and statistical calculations as necessary. Explain/recognize the principle and theory of the various tests performed. Discuss/recognize the clinical significance of test results. Recognize panic values and immediately report these findings to the appropriate

authorized persons. Suggest additional tests to aid in further diagnosis of the suspected pathology after

identifying abnormal results from test procedures performed. Identify any possible discrepancies/inconsistencies in test results when given data

generated from various divisions for the clinical laboratory. Evaluate the validity of test results and institute proper procedures to remedy

discrepancies against quality control data. Correlate laboratory data with other lab test results and other clinical findings. Evaluate multiple patient laboratory test data to take/recommend corrective action. Evaluate laboratory quality control data and recommend appropriate course of action.

Contact Hours:

A Practicum Schedule based on required contact hours for each individual course will be prepared for each student. Students are required to adhere to this schedule unless specified otherwise by the QU faculty and/or appropriate Clinical Coordinator/Instructor at each site. Due to complexity of testing performed at certain clinical affiliate locations, additional contact hours may be required.

Specific times for arrival and departure will be determined for each clinical area in cooperation with the clinical instructor and/or clinical coordinator and the QU faculty. The student should note that the time for arrival will vary by clinical site and rotation area.

In a typical practicum rotation, a student is required to complete 32 hours/week for 3 weeks per course for a total of 16 weeks per CP rotation:

Sunday, Monday, Wednesday, Thursday- 7 hours, 7:00 am to 2:00 pm



Tuesday- 4 hours, 7:00 am to 11:00 am

Teaching Methods:

Demonstration and observation of test procedures. Supervised performance of clinical tests. Problem-solving with clinical and simulated samples. Discussion and question and answer sessions.

Evaluation Methods:

Performance in clinical practice courses is evaluated in three areas:

A. Affective Performance:The student’s performance in the practicum area comprises their technical skills and also their professional attributes such as communication skills, attendance, and interaction with multiple clinical site employees, the student’s affective behavior will be assessed by the clinical instructor(s) and/or clinical coordinators. The ratings and comments are designed to provide information and counseling to recognize problems and assist the student to achieve personal and professional improvements. The ratings/comments should reflect the typical actions observed.

B. Performance Tasks: These are the laboratory tasks and skills that are detailed for each rotation and unit. The competencies are reflected in the objectives stated in the Course Section of this manual. The student must demonstrate acceptable progress and performance for these tasks in order to receive a satisfactory grade in the course. Additional tasks may be included as determined by the clinical affiliate. Students will be evaluated by clinical instructors using the following: Consistently exceeds standards, consistently meets standards, Doesn’t consistently meet standards, Consistently fails to meet standards. Definitions for these are provided below.

C. Knowledge Performance:The student must achieve a minimum of 70% on each of 5 comprehensive Department developed final examinations. The content of the examinations are mapped against both sub-content and taxonomic level of the ASCP Medical Laboratory Scientist (MLS) examination.

In addition to final exams in Hematology, Microbiology, Chemistry, Immunohematology, and Immunology, a final on Laboratory Operations with content as listed in the ASCP Medical Laboratory Scientist Examination Content Outline will be administered.

A final exam on Urinalysis content as listed in ASCP guidelines will be administered with the Chemistry final examination.

Clinical Practice Evaluation terms :

Students will be evaluated using a 4-scale assessment as described below:E – Consistently Exceeds Standards/ExpectationsM – Consistently Meets Standards/Expectations

U – Does not consistently meet Standards/ExpectationsF – Consistently Fails to Meet Standards/Expectations

Consistently Exceeds Standards /Expectations (E)The student consistently completes the tasks and demonstrates in an outstanding way in both quality and quantity of work and/or knowledge that surpasses other students or what would be considered as expected of a typical student. The student is viewed as an “exceptional performer” based on her knowledge, skills, and/or attitude.

Consistently Meets Standards/Expectations (M)The student consistently completes the tasks and demonstrates in an acceptable way in both quality and quantity of work and/or knowledge that is typical of other students or what would be considered as expected of a typical student. The student is viewed as an “acceptable performer” based on her knowledge, skills, and/or attitude. Performance at this level is fully satisfactory.

Does Not Consistently Meet Standards/Expectations (U)The student does not consistently complete the tasks and demonstrates an unacceptable way in either both quality and quantity of work and/or knowledge that is expected or what would be considered as expected of a typical student. The student is viewed as “below performance” based on her knowledge, skills, and/or attitude and thus one who still needs improvement. Performance at this level is unsatisfactory.

Consistently Fails to Meet Standards/Expectations (F)The student consistently fails to complete the tasks and demonstrates an unacceptable way in either quality and quantity of work and/or knowledge that is expected or what would be considered as expected of a typical student. The student is viewed as “unwilling or incapable” based on her knowledge, skills, and/or attitude and thus one who did not demonstrate satisfactory improvement by the end of the clinical practice rotation.

Course Grading Criteria:

P To obtain a passing grade in each course the student must:o achieve satisfactory (Exceed or Meet) performance in the technical evaluation o achieve satisfactory (Exceed or Meet) performance on the professional attributes

(affective evaluation)o Achieve a minimum of 70% on a comprehensive computer administered

department developed final examination.

NP o Unsatisfactory or Fail on any specified technical competencies o Unsatisfactory or Fail on any specified affective competencies.o Less than 70% on the course Final examination

If a student receives unsatisfactory on any part of an affective and/or technical evaluation, a conference will be held between the clinical instructor, the clinical coordinator and the student to discuss the problem.

The determination of unsatisfactory performance, unprofessional conduct or unsafe conduct will be made by the Clinical Instructors in consultation with the QU Clinical Coordinator. A determination will

be made and approved by the Department Head when or if a student will be removed from or return to clinical practice, the condition(s) for doing so, and the level of clinic practice or laboratory activity permitted. Depending on the severity of the incident(s) and/or number of prior incidents, the sanction/disciplinary action may result in dismissal from the Department; repeating the clinical practice course; mandatory clinical practice time extensions; and/or remedial instruction.

If students achieve less than 70% in the knowledge exam in any of the five CP courses, she will be allowed to have a reset exam one time only for each course. Schedule will be announced by the clinical coordinator after approval of Biomedical HOD in the last week of clinical rotations. Failure to achieve the required 70% in each of the knowledge exams will result in “incomplete” grade. Students with incomplete grade should make appointment with their instructor to have an exam in the first week of the following semester.

A student who demonstrates unsatisfactory performance in a clinical practicum course may be required to repeat one or more of the course requirement areas with the respective evaluation method, as determined by the Clinical Coordinator and/or Department Head.

Scheduling of the repeat rotation or clinical course is subject to availability of an appropriate clinical affiliate site and adequate clinical supervision. It may be necessary for the student to wait until a rotation site becomes available. The above are negative consequences which the student may incur if she does not satisfy the course cognitive, affective behavior and technical performance requirements.

Clinical practice Policies:

Scheduling and Assignment of Practicum RotationsPracticum rotations are scheduled to assure adequate supervision, staff interaction and representative caseload. Practicum rotations (days, times and sites) are scheduled and confirmed by the Department Faculty in consultation with the Clinical Faculty. In no event is the student permitted to make her own arrangements for Practicum rotations or to change scheduled rotation days, times or sites without a prior written email request to and approval by the Clinical Coordinator and/or Department Head.

Chain of CommunicationIn reference to day to day laboratory queries regarding policies and procedures or other matters of concern students are encouraged to intercommunicate first with their immediate instructors followed by the Clinical Coordinator. For further clarification students are recommended to approach the Department Head at QU.

Attire/Dress CodeA clean, white full-length lab coat and an Identification card is required for all students while on rotation. Professional attire should be worn at all times during practicum rotations. Sandals, very high heeled shoes, long dresses and long abayas are prohibited. Further or additional details may be provided by the Clinical laboratory coordinator. Follow the dress requirements established by the clinical site.

Attendance 1. Students must arrive on time and remain in the clinical site for 4 hours on Tuesday and 7 hours

on Sunday, Monday, Wednesday and Thursday unless approved by the Clinical Instructor and/or Clinical Coordinator.

2. Attendance each day is required . There is no allowance for up to 25% absences without penalty. In the event of absence, the student must notify the clinical instructor as soon as possible or at least by the beginning of the scheduled work hours for the clinical site but no later than 8:00 am for each day of absence. The QU Clinical Coordinator must also be notified at the same time. Records will be kept of all hours, absences and tardiness. Additional on-site time may be required to make up for time missed.

3. Any absent time must be made up during the term in which the absence occurs and before a grade is recorded, unless QU Department Clinical Coordinator expressly waives this requirement and the documentation of the waiver is in writing in the student's Department file.

4. Absentee time will be made up at the site from which the student was absent and will be arranged by the clinical coordinator.

5. The QU Department Clinical Coordinator will assume absences have not been made up unless make-up time is clearly indicated on the student's worksheets, noted with the Clinical Instructor's signature.

6. Tardiness is not permissible . If, under certain circumstances the student expects to be late by 15 or more minutes, then he/she must contact the clinical instructor. Each unexplained and/or unacceptable incident of tardiness will be considered as ½ day absence.

SafetyStudents must comply with safety requirements and universal precautions as directed by Clinical instructor and which adheres to clinical site requirements. If you need to see a doctor from an accident, please inform the clinical instructor. If an emergency arises, the clinical site will provide emergency treatment.

Universal PrecautionsHepatitis B and Human Immunodeficiency Virus (HIV) infections are significant and growing risks for health care workers who are especially at risk for developing these diseases due to exposure to needle-sticks and splashed blood/body fluids. Hepatitis B, which infects thousands of health care workers and kills approximately 200 people each year, is preventable by immunization. Hepatitis B and HIV + status can be prevented through the consistent use of UNIVERSAL PRECAUTIONS. There is no known method to prevent the development of AIDS in HIV+ individuals. Therefore, it is mandatory that efforts be taken to prevent exposure to these diseases. Universal Precautions must be followed by students and faculty in the clinical settings. Students are encouraged to be immunized against Hepatitis B or must sign a waiver accepting responsibility for potential consequences of not being immunized.

Cell phones, pagers, etc.All cell phones must be either switched off or put on silent while in the laboratory and should not be used while at the work station.

ProfessionalismStudents are expected to abide by the guidelines incorporated in their professional Code of Ethics, and by standards and regulations applicable to clinical laboratory practice. Students should strive to establish good working relationships with all personnel with whom they come in contact during the

Practicums. Students must demonstrate responsibility in the care of equipment and materials they use and the integrity and confidentiality of specimens they process during the assigned practicum rotations. Students should seek consultation with the Clinical Faculty member at the rotation site for problems that may arise during the practicum. In the event that a problem arises that is not resolved to the satisfaction of the Clinical Faculty member or the student, consultation will take place with the student, Clinical Coordinator and the Department Head.

Department, laboratory and affiliate institution policiesStudents are expected to abide by the established daily work routine and attendance schedule at the Practicum rotation site or to the schedule prepared by the Department in conjunction with Clinical Faculty. If preparation or monitoring of techniques/experiments necessarily extends attendance beyond scheduled hours, it is the student's professional duty to follow through to complete the necessary work. However, at no time is unsupervised practice or unauthorized presence in a laboratory facility permitted. Since the purpose of practicum rotations is to maximize student exposure to and competence in laboratory practice, the use of practicum time to work on other course or department assignments (e.g. research project papers, class projects) is not permitted. Likewise, use of practicum site laboratory computers (for email/internet searches/text messaging) or copy machines for personal reasons is not permitted.

Gifts/GratuitiesIn appreciation for services rendered, patients and/or their families sometimes offer to give money or other gifts to the student clinicians. It is requested that this not be done. Students in training should not receive gratuities.

Activity Log Each day please keep a record of your activities on a copy of the Activity Log and turn it in to the Clinical Coordinator at the conclusion of the clinical practice. Be sure to include the number of each procedure that you perform during the day. Have your clinical instructor initial the entries.

RecordsStudents are required to:

1. Review clinical practice evaluation form with clinical instructor during the first days of a clinical practice course.

2. Consult with the clinical instructor for the official mid-rotation evaluation at the end of the second week.

3. Keep daily records of the number and types of tests performed on the activity sheets. Have the clinical instructor initial the sheet.

4. Review the completed evaluation form with the clinical instructor, comment (if you wish) and sign at the conclusion of the scheduled clinical practice.

5. Turn in the evaluation to the respective clinical instructor, all task activity logs, evaluation forms, and any assignments at the end of each clinical practice.

6. Complete a student evaluation of your clinical practice experience and turn in to the Clinical Coordinator.

DeadlinesThroughout this manual there are various deadlines associated with requirements which are necessary before admission to the clinical practice area(s). Under no circumstances will a student who fails to meet the deadlines of specific requirements be allowed entry to the clinical practice.

Service Work Students in the Biomedical Science Department will not receive financial remuneration for the

clinical practicum experience. Students are not allowed to work as regular staff during the internshiprotation. They must be supervised at all times, and cannot work independently as part of the laboratorystaff. Working in a clinical laboratory setting outside of regular academic hours is noncompulsory.

ConfidentialityAll patient and institutional information will be held in the strictest confidence at all times. The discussion of any patient information outside of the “classroom” setting is not permissible. Confidential information concerning the institution is not to be discussed with any unauthorized individuals. All students are required to update the certification via signature.

Students may be required to sign a confidentiality statement at the hospitals. Violation of this policy and/or of other hospital or laboratory policies may result in the dismissal of the student from the hospital and clinical practice course(s). Laboratory Information System / Hospital Information SystemEach facility has established policies and procedures relating to use of their respective hospital and/or laboratory information computer system. This includes the use of passwords, or code words and patient data entry. Students should adhere to the protocol as communicated by the clinical instructor and/or clinical coordinator. In some institutions, students are allowed the opportunity to learn the respective computer systems and report results under the direct supervision of the clinical instructor.

Health and Accident LiabilityThe student must maintain appropriate coverage via insurance or other method. If an exposure or accident does occur, notify the clinical instructor and/or clinical coordinator immediately. Each facility has established policies and protocols to adhere to in these circumstances. The student may be responsible for payment of services such as testing and prophylactic treatment.

A physical/medical examination and/or proof of vaccinations may be required by the hospital clinical sites. Students not completing these requirements prior to practicum will not be allowed to start the practicum.

Probation and Dismissal for Non-Academic ReasonsStudents who do not exhibit the attitudes and skills deemed necessary to function as a professional medical technologist may be placed on probation or dismissed from the clinical site. Professional attributes for which a student may be placed on probation or dismissed include, but are not limited to, those which are starred on the Affective Behavior Evaluation Form. Thus, a student may be placed on probation and/or dismissed for acting in any unprofessional manner or violating policies and/or procedures as outlined in this Clinical Practice Manual and/or the clinical site (laboratory/hospital/healthcare facility). Examples of such unprofessional or unsafe conduct include, but are not limited to:

1. Tampering with, destruction or theft of equipment, specimens or teaching materials.2. Verbally abusive, physically threatening or harmful behavior.3. Falsification of documentation (laboratory or student records).4. Gross interference with the educational process or health care services.5. Inappropriate or unauthorized use of laboratory equipment, supplies, reagents, data,

laboratory information systems, or communications systems.6. Unsupervised clinical practice or unauthorized presence in a laboratory facility.7. creating unnecessary risk of exposure to or harm from environmental, chemical-and/or bio-

hazards.8. Unauthorized, unreported and/or excessive absence during scheduled clinic time.9. Non-compliance with the work rules, policies and/or procedures of the laboratory and/or

institution.

Affective Objectives and Evaluations:All students will be evaluated regarding professional/ethical behavior and organizational skills while enrolled in the Biomedical Science Department. The objectives and evaluation instrument are shown below. The first failure to meet an affective domain objective will result in the student receiving a verbal warning from the instructor and an evaluation of "Does not meet Standers" will be given for that objective. The second failure will result in a written warning and an evaluation of "Does not meet Standers" will be given for that objective. All subsequent failures to meet the same objective will result in a written warning and an evaluation of " Fails to Meet Standers". The faculty reserves the right to immediately evaluate as "Fails to Meet Standers" any failure to meet an affective domain objective that is viewed as flagrant or dangerous.

The Student will demonstrate attainment of the following professional affective behavioral skills according to the qualifying descriptions:

Honesty Demonstrates honesty and integrity Accepts responsibility for own actions Adheres to confidentiality

Personal Interactive Skills Effectively communicates and cooperates with peers Establishes or strives toward effective rapport with peers Handles stress well Takes advantage of technological communication tools (i.e. email, Blackboard) Effectively and accurately submits legible handwritten documents Effectively communicates orally with instructors

Organization Accepts responsibility for cleaning up Demonstrates carefulness Strives towards better organization and efficiency

Professional Demeanor Adheres to safety precautions Strives to have a pleasant manner (attitude) Demonstrates interest in learning Demonstrates perseverance Demonstrates promptness and dependable attendance Demonstrates appropriate professional attire Practices good personal hygiene habits

Professional Responsibility Demonstrates awareness of need for accuracy and precision Is willing to do more than his/her share Accepts instructor criticism in constructive manner

QATAR UNIVERSITYBiomedical Science Department Affective Behavior Evaluation

Student Name: ________________________________ Date: _______________

Consistently Exceeds

Standards

Consistently Meets

Standards

Doesn’t Consistently

meet Standards

Consistently Fails to Meet

Standards

Honesty

Demonstrates honesty and integrity

Accepts responsibility for own actions

Adheres to confidentiality

Personal Interactive Skills

Effectively communicates and cooperates with peers

Establishes or strives toward effective rapport with peers

Handles stress well

Takes advantage of technological communication tools (i.e. email, Blackboard, etc.)

Effectively and accurately submits legible handwritten documents

Effectively communicates orally with instructors

Organization

Accepts responsibility for cleaning up

Demonstrates carefulness

Strives towards better organization and efficiency

Professional Demeanor

Adheres to safety precautions

Strives to have a pleasant manner (attitude)

Demonstrates interest in learning

Demonstrates perseverance

Demonstrates promptness and dependable attendance

Demonstrates appropriate professional attire

Practices good personal hygiene habits

Professional Accountability

Demonstrates awareness of need for accuracy and precision

Is willing to do more than her share

Accepts instructor criticism in constructive manner

Record comments supporting “Unsatisfactory”:

QATAR UNIVERSITYBiomedical Sciences Department

Activity Log

Name ________________QUID______ Dates of the Rotation_____ Clinical Rotation Area____

Date Time in

Time Out

List Major Activities Done During the Day Instructor Initials

15

BIOM 491Clinical Practice in Chemistry

Objectives

Course Description Directed clinical practice in Clinical Chemistry laboratory procedures and methods, problem-solving, quality assurance, preventive maintenance, and safety. This clinical site experience is divided in to three main part: routine chemistry, special chemistry and point of care testing.

Reading Assignments:1. Board of registry study guide: Clinical laboratory certification examinations by Batricia

Tanabe, SIBN:97808918958792. Success! In clinical laboratory science by Anna Ciulla, SBIN: 97801351264863. Lecture materials and texts from BIOM 346, BIOM 418, BIOM 446, BIOM 4634. Site-specific laboratory and instrument manual.5. Reference materials as assigned by clinical instructor

Specific Course Objectives – Chemistry:

Upon completion of the chemistry rotation, the student should be able to meet the following objectives within acceptable limits as determined by clinical instructors (HMC / SIDRA labs) and faculties (Qatar University).

1. Follow the safety procedures and protocol in the chemistry laboratory.2. Explain the purpose, principle and methodology of the tests pertaining to the following

subjects:Routine Chemistry Special Chemistry CarbohydratesLipids & LipoproteinsProteinsEnzymesNon-Protein NitrogenElectrolytesRenal FunctionCardiac FunctionPancreatic FunctionBody Fluids (in chemistry)TDMsTumor Markers Toxicology Endocrinology

Trace ElementsFetal HemoglobinCryoglobulinUrine CystinePorphyrin & PBGSweat ChlorideG6PD Qualitative/ Quantitative Stones AnalysisOxalate & CitrateStool Elastase & CalprotectinReninAMH, 17-OH Prog. & AndrostCatecholaminesVitamin A,E & B1Electrophoresis

16

3. For the tests associated with the subjects in #2, correlate normal and abnormal values with disease states and other laboratory results.

4. Recognize the interference substances in the analytical procedures.5. Recognize critical (panic) values and medical decision values and employ reporting

procedure, verifying and documenting these values.6. Perform automated tests on chemistry instruments as per applicable performance criteria.7. Perform under supervision manual and automated chemistry testing according to the

standard operating procedures of the laboratory.8. Select and prepare appropriate specimens, reagents, and controls for testing as applicable.9. Perform QC and maintenance on instruments as needed. 10. Evaluate and interpret QC results and formulate a logical course of action when violation

of Westgard rules occur.11. Identify sources of error in testing, evaluate the situation, troubleshoot and correct the

problem.12. Identify and define essential components of instruments and principles of instrument

operation.13. Calculate basic mathematical operations and certain results obtained from supplied data

(such as creatinine clearance, LDL, unconjugated bilirubin).14. Evaluate specimens for acceptability of testing.15. Evaluate laboratory data to determine quality and validity of test.

17

HMC ModuleBIOM 491 – Clinical Practice in Chemistry

Performance Tasks

Student Name: ______________________________ Clinical Site: ___________________

Note: For tasks that are not applicable to the clinical site, write “NA” in the date area.

Some performance tasks have numerical values. These are minimum values and the clinical instructor has the right to change the number required. In addition, other tasks may be requested which are not included in this checklist. You will perform those as deemed appropriate by your instructor.

Routine Chemistry

Performance Task Evaluation Date

Demonstrate knowledge of general procedures

- Laboratory safety procedures.- Laboratory organizational structure.- Analytical methods used by instruments.- Main components of automated analyzers.- Diagnostic value of test and interpretation of

results.

Consistently exceeds standards

Consistently meets standards

Doesn’t consistently meet standards

Consistently fails to meet standards

Sample Processing - Minimum of 40 clinical samples with 80% accuracy

- Evaluate acceptability criteria of samples.- Manually process samples according to

laboratory policy & under supervision.- Recognize samples for possible interference.- Practice loading, unloading of samples on

instruments.- Prepare reagents and samples and replace

supplies as needed.





Transplant Bench:

- Observe and perform pretreatment of transplant immunosuppressant drugs.

- Perform RBC folate.- Manually ordering after pretreatment and

releasing.





18

Reports - Minimum of 10 reports (case studies) with 80% accuracy

- Adheres to confidentiality policy.- Review lab reports and correlate lab results

with patient clinical status.- Recognize pre-analytical errors on lab results

e.g. hemolysis, lipemia …ect- Recognize rejection, repeats and releasing

criteria of lab results- Identify and employ calculations before

reporting lab results e.g. dilution





Quality Control – Minimum of 4 monthly QC data for different tests with 80% accuracy , tests are selected by instructor

- Observe quality control preparation and loading.

- Process quality control and record results correctly.

- Interpret control data for 20 runs using LJ chart and Westgard rules.

- Recognize course of action when violation of Westgard rules occur.

- Differentiate between calibration and QC processing.





Maintenance & Troubleshooting – 1 or 2 instruments as designated by the instructor

- Perform the appropriate routine and/or preventive maintenance procedures with 90% accuracy on instrument(s) as designated by the instructor.

- Check reagent inventory.- Perform troubleshooting under supervision

and understand documentation and course of actions required.





Clinical Instructor: _________________________________Date: ____________________

Student Signature: _________________________________ Date: ___________________

19

BIOM 491 – Clinical Practice in ChemistryPerformance Tasks




Automated/Special Chemistry


Trace Elements & Misc. Manual Screening Tests

- Read SOP for tests analyzed by ICPMS.- Observe maintenance and preparation of QC.- Process samples if applicable.





Sweat Chloride Test – Minimum students practice on themselves with 80% accuracy

- Read SOP for sweat testing.- Observe maintenance and QC.- Observe patient preparation for sweat

inducing, collection and analysis.- Perform procedure (as applicable).





G6PD Screening Test - Minimum 4 samples / reports per student with 80% accuracy

- Read SOP for Qualitative & Quantitative methods.

- Process samples - Interpret results.





20

Stone Analysis - Minimum 3 stone samples / reports per student with 80% accuracy

- Read SOP for stone analysis- Process stone analysis for 3 samples (as

applicable) after demo.- Interpret results.- Perform urine oxalate and citrate tests and

apply calculations.





ELISA Bench

- Read SOP for manual ELISA tests: stool calprotectin, stool pancreatic elastase, renine) and for automated ELISA tests: 17-OH progesterone, androst.

- Prepare reagents, QC and observe procedure.- Interpret results.





HPLC Method & Electrophoresis – Interpretation results of minimum 1-2 chromatograms and gel electrophoresis with 80% accuracy “if applicable”

- Read SOP- Recognize principle of used methodology of

instruments.- Observe samples and reagents preparation.- Interpretation of chromatograms.- Interpretation of gel plate after staining.







21

Summary of procedures

Routine Chemistry Special Chemistry

Instrument Sample # QC # Reports # Maintenance & Troubleshooting



22

SIDRA ModuleBIOM 491 – Clinical Practice in Chemistry

Performance Tasks




Routine Chemistry


Demonstrate knowledge of general procedures

- Laboratory safety procedures.- Laboratory organizational structure.- Analytical methods used by instruments.- Main components of automated analyzers.- Diagnostic value of test and interpretation of

results.





Sample Processing - Minimum of 40 clinical samples with 80% accuracy

- Evaluate acceptability criteria of samples.- Manually process samples according to

laboratory policy & under supervision.- Recognize samples for possible interference.- Practice loading, unloading of samples on

instruments.- Prepare reagents and samples and replace

supplies as needed.





Transplant Bench:

- Observe and perform pretreatment of transplant immunosuppressant drugs.

- Perform RBC folate.- Manually ordering after pretreatment and

releasing.





23

Reports - Minimum of 10 reports (case studies) with 80% accuracy

- Adheres to confidentiality policy.- Review lab reports and correlate lab results

with patient clinical status.- Recognize pre-analytical errors on lab results

e.g. hemolysis, lipemia …ect- Recognize rejection, repeats and releasing

criteria of lab results- Identify and employ calculations before

reporting lab results e.g. dilution





Quality Control – Minimum of 4 monthly QC data for different tests with 80% accuracy , tests are selected by instructor

- Observe quality control preparation and loading.

- Process quality control and record results correctly.

- Interpret control data for 20 runs using LJ chart and Westgard rules.

- Recognize course of action when violation of Westgard rules occur.

- Differentiate between calibration and QC processing.





Maintenance & Troubleshooting – 1 or 2 instruments as designated by the instructor

- Perform the appropriate routine and/or preventive maintenance procedures with 90% accuracy on instrument(s) as designated by the instructor.

- Check reagent inventory.- Perform troubleshooting under supervision

and understand documentation and course of actions required.







24





Point of Care Testing

Chemistry – Minimum 3 samples / reports per student with 80% accuracy

- Processing of minimum 3 random urine samples.

- Perform glucose tests, HBA1c or creatinine for 3 patients including controls and interpreting results with 80% accuracy.




Consistently fails to meet standardsBlood Gas Analysis – Minimum 3 samples / reports per student with 80% accuracy

- Explain principle of methodology of BGA.- Recognize acceptable criteria for sample

processing.- Process 3-5 samples along with controls- Retrieve previous 5 lab reports and interpret

results.- Perform troubleshooting as needed.- Understand course of action in term of critical

(panic values).





Fetal Fibrinonectin – Minimum 1 -2 samples / reports per student with 80% accuracy

- Explain principle of the test.- Explain collection and processing procedure.- Interpret results with 80% accuracy.







25





Automated/Special Chemistry


Trace Elements & Misc. Manual Screening Tests

- Read SOP for tests analyzed by LCMSMS.- Observe maintenance and preparation of QC.- Process samples if applicable.





Sweat Chloride Test – Minimum students practice on themselves with 80% accuracy

- Read SOP for sweat testing.- Observe maintenance and QC.- Observe patient preparation for sweat

inducing, collection and analysis.- Perform procedure (as applicable).





G6PD Screening Test - Minimum 4 samples / reports per student with 80% accuracy

- Read SOP for Qualitative & Quantitative methods.

- Process samples - Interpret results.





26

Stone Analysis - Minimum 3 stone samples / reports per student with 80% accuracy

- Read SOP for stone analysis- Process stone analysis for 3 samples (as

applicable) after demo.- Interpret results.- Perform urine oxalate and citrate tests and

apply calculations.





HPLC Method – Interpretation results of minimum 1-2 chromatograms and gel electrophoresis with 80% accuracy “if applicable”

- Read SOP- Recognize principle of used methodology of

instruments.- Observe samples and reagents preparation.- Interpretation of chromatograms.-







27

Summary of procedures

Routine Chemistry Special Chemistry POCT

Instrument Sample # QC # Reports # Maintenance & Troubleshooting



28

BIOM 492 Clinical Practice in Hematology

Objectives

Course Description:Directed clinical practice in Hematology laboratory procedures and methods, problem-solving, quality assurance, preventive maintenance, and safety.

Reading Assignments:1. Texts and lecture materials from BIOM 451, BIOM 3462. Laboratory Procedure Manual3. Handouts and/or Journal articles as provide4. Board of registry study guide: Clinical laboratory certification examinations by Batricia

Tanabe, SIBN:97808918958795. Success! In clinical laboratory science by Anna Ciulla, SBIN: 9780135126486

Specific Course Objectives – Hematology:

Upon completion of this rotation the student should be able to:

1. Adhere to the proper procedure for specimen handling.2. Comply with all the safety procedures and protocols for the clinical laboratory.3. Explain the purpose and principle of each test listed below:

Reticulocyte countErythrocyte sedimentation ratePlatelet countDifferential Cell CountBody Fluid Cell Counts and Differentials

4. Perform tests according to performance criteria using established methods and quality assurance procedures.

5. Perform automated blood cell counts on a multi-parameter instrument according to performance criteria.

6. Assess patient’s sample acceptability using established criteria.7. Evaluate acceptability of instrument results and correlate with blood smear results,

disease state and other laboratory results.8. Compare and contrast the principle of operation of the various automated hematology

analyzers (CBC, HPLC).9. Prepare blood films for evaluation of blood cells meeting established criteria. 10. Stain blood films using an automated instrument/ Manual staining procedure, as

applicable11. Discuss principle of operation for instrument used in staining blood films and troubleshoot improperly

stained smears.12. Review, the maturation sequence for each of the following cell lines: Erythrocytic,

Lymphocytic, Monocytic, Granulocytic and Platelet.13. Distinguish between cells of each series when stained by a Romanowsky type stain.14. Review abnormal erythrocyte and leukocyte morphology.

29

15. Perform differentials according to performance criteria.16. Evaluate RBC and platelet morphology according to established criteria.17. Correlate results of CBC and differentials with disease states and other laboratory results.18. Review principles and procedures for body fluid examination.19. Correlate results of body fluid examinations with disease states and other laboratory

results.20. State the principle of the Leukocyte Alkaline Phosphatase stain (ALP).21. Correlate results of LAP stains with disease states and other laboratory values.22. Review the purpose of special stains and correlate results with disease states.23. Correlate results of hemoglobin electrophoresis with disease states and other laboratory

results.24. Prepare blood films for evaluation blood parasite meeting established criteria.25. Distinguish between the different species of malaria parasite/ reporting malaria results

and paracitemia level.

Specific Course Objectives – Coagulation:

Upon completion of this rotation the student should be able to:

1. Predict results of coagulation tests when a deficiency of one or more factors is present.2. List coagulation tests used to screen for deficiencies in the extrinsic, intrinsic and

fibrinolytic systems and common pathway.3. Distinguish between tests for deficiencies in the extrinsic and intrinsic coagulation

systems.4. Outline a procedure for identification of a specific factor deficiency.5. Discuss the principle of the automated coagulation instrument(s).6. Perform at least four daily "runs" of routine coagulation testing on an automated

instrument according to established procedure/protocol including maintenance and quality assurance.

7. Discuss the principle of the tests listed below, correlating results with specific deficiencies or disease states.

PFA factor assayThrombin time FDPFibrinogen Platelet CountFactor substitution (PTT) PT

Anticoagulants/circulating inhibitors PTTPlatelet aggregation/adhesion studies D-dimerMixing study (correction study) HITLMWH Thrombophelia screening tests BFT II

8. Perform at least one of each of the tests listed above (if applicable to clinical site) observing established protocol and Quality Assurance procedures.

30

Specific Course Objectives – Phlebotomy

Upon completion of this rotation the student should be able to:1. Demonstrate professionalism as described on the Affective Behavior form.2. Identify proper specimen requires for laboratory tests.3. Identify the main superficial veins used in venipuncture procedures.4. Define and explain limitations regarding the amount of blood drawn.5. Describe substances that can interfere in clinical analysis of blood constituents and ways

in which the phlebotomist can help to avoid these occurrences.6. Explain special precautions and types of equipment needed to collect blood from a

newborn infant.7. Identify anticoagulants, preservatives and gels; state the principle of action and

utilization.8. Recognize the legal and ethical importance of proper patient/sample identification.9. Identify and perform methods for facilitating skin or venipuncture.10. Describe common complications associated with skin and venipuncture and what to do

about each.11. Perform safe phlebotomy procedures in the collection of various specimens.12. Determine when to reject a specimen.13. Discuss and perform proper techniques for hand washing, gowning, gloving, masking,

entering and exiting isolation settings.14. Describe the significance of time constraints for specimen delivery.15. Transport and process specimens according to acceptable protocol.16. Instruct the patient on collection of specimens as necessary (i.e. GTT).

31

HMC ModuleBIOM 492 – Clinical Practice in Hematology

Performance Tasks




Routine Hematology


Perform automated blood cell count operating a multi-parameter instrument with minimal supervision for a minimum of 4 runs. Each run must include at least 5 clinical samples with 80% accuracy.

a. Assess specimen acceptability considering:Procedure requirementsAnticoagulant/blood ratiosMixing technique, absence of clots in anti-coagulated bloodLabeling criteria

b. Accurately log patient and/or test data according to established policies

c. Operate Analyzer according to established technique and manufacturer’s directions

d. Process venous blood specimense. Process control according to directionsf. Evaluate patient and control data for acceptabilityh. Establish when reagents must be correctly replaced





Stain blood films for morphologic evaluation of blood cells by the established procedure including judging acceptability of stained slides, correcting and/or documenting problems with 90% competency





32


Perform a minimum of 10 - 20 differentials with 80% competency. This will include the classification of leukocytes and the evaluation of RBC morphology.

a. Determine red cell variants and inclusions enumerating according to established criteria, using correct terms, and spelling correctly.

b. Assess relationship of RBC morphology to RBC indices.c. Estimate WBC and platelet counts and compare to

automated counts for at least 5 patient samples.d. Assess platelet morphology identifying abnormal forms.e. Report all data according to established policies, using

correct terminology.f. Operate and maintain microscope following established

protocol.





Perform preventive maintenance procedures for the following instruments according to established protocol with 90% competency

a. Automated Hematology Anlayzerb. Slide Maker & stainer as applicablec. Microscoped. Centrifuge





With 80% competency, perform a minimum of three patients and control blood run by back-up (manual and/or automated) procedure for the following procedures for (List method and/or instrument):__________

a. WBC countb. Platelet count

Evaluate and compare resulting data to routine automated method results.

*numbers will be established by bench instructor if platelets are part of hemogram or blood profile on a multi-parameter instrument.





33


Perform a minimum of 3 patients and/or control reticulocyte counts by established method, setting determined values with 80% accuracy.





Perform minimum of 5 patients erythrocyte sedimentation rate runs by established method, correctly setting up, reading, evaluating, and reporting results with 80% accuracy.





Body Fluid EvaluationWith 80% competency, perform a minimum of 4 body fluids cell counts diluted and undiluted using the hemocytometer

a. Consider biohazards and observe safe techniqueb. Calculate and report accuratelyc. Use and maintain Cytospin

Prepare films, stain, identify and differentiate cells morphologically enumerating according to type. Perform or discuss required procedures and physical and chemical characteristics for the following body fluids.

a. CSF (minimum 3)b. Synovial or Pleural fluids (minimum 1)

Identify cells on unknown films or photomicrographs determining whether abnormal or normal within 80% accuracy using proper terms and correct spelling





Assist (or observe) with performance of minimum of one Bone Marrow procedure following policies and procedure

a. Observe technologist with materials maintaining sterilitiy for patient contact materials.

b. Receive marrow, prepare films and process clot.c. Label all materials correctlyd. Perform routine Wright’s Stain following appropriate

bone marrow directions





Perform cytochemical stain for Leucocyte Alkaline Phosphatase (as applicable) according to procedure manual.

a. Score and count neutrophils on a minimum of 2 patient and 1 control slide

b. Score should agree within 80% of previously determined score





34


Perform or observe demo for at least one Eosinophil count (as applicable)





CoagulationPerformance Task Evaluation Date

Operate an automated coagulation instrument to perform routine coag tests (PT, PTT, FIB, DD, TT) on 2 consecutive days. Minimum of 10 clinical samples with 80% accuracy

a. Process specimens b. Determine specimen acceptabilityc. Reconstitute reagents and controlsd. Utilize appropriate pipetting technique e. Load and operate instrument correctlyf. Evaluate patient and control values for acceptabilityg. Report data using correct units and termsh. Perform instrument maintenance according to

established protocol





Perform/Discuss the following special coagulation tests:a. AT3b. Protein Cc. Protein Sd. Lupus anticoagulante. Heparin Assay f. Other (list)_______________





With 80% competency, perform all quality assurance procedures for a minimum of 4 consecutive days as directed.




Consistently fails to meet standardsPerform or discuss aggregation studies according to established procedures (if applicable to clinical site).





35

PhlebotomyPerformance Task Evaluation Date

Assist or observe at least 8 blood specimens collection , order of draw, specimen requirement with an 80% competency level





Followed hospital policies and procedures with 100% competency





Cooperated and communicated with patient and other personnel in a professional manner with 100% competency





Identified/assembles appropriate supplies needed to perform procedures with 90% competency





Cheerfully greeted and identified self to patient and explained procedure with 100% competency





Collected specimens as requireda. Avoided undue stress or harm to patientb. Followed acceptable techniquesc. Recognized formation of hematoma or other

abnormal conditions utilizing corrective measuresd. Apply correct pressure for cessation of bleeding





36


with 100% competency, collected and identified specimens considering correct:

a. Order of tubesb. Anticoagulant for assayc. Volume of specimend. Labeling e. Timing of specimens





Ensure the delivery of specimens to appropriate areas following established protocol with 100% competency





Adheres to universal precautions and safety protocols with 100% competency





Please list any graded assignments, quizzes, unknowns or tests given to the student:

Please indicate any areas that are not applicable to your facility and make any additional comments:

Clinical Instructor: _________________________________ Date: ____________________

Student Signature: __________________________________ Date: ___________________

37

SIDRA ModuleBIOM 492 – Clinical Practice in Hematology

Performance Tasks




Routine Hematology


Perform automated blood cell count operating a multi-parameter instrument with minimal supervision for a minimum of 5 runs. Each run must include at least 10 clinical samples with 80% accuracy.

1. Assess specimen acceptability considering:Procedure requirementsAnticoagulant/blood ratiosMixing technique, absence of clots in anti-coagulated bloodLabeling criteria

2. Accurately log patient and/or test data according to established policies

3. Operate Analyzer according to established technique and manufacturer’s directions

d. Process venous blood specimense. Process control according to directionsf. Evaluate patient and control data for acceptabilityh. Establish when reagents must be correctly replaced





Stain blood films for morphologic evaluation of blood cells by the established procedure including judging acceptability of stained slides, correcting and/or documenting problems with 90% competency





38


Perform a minimum of 60-75 differentials with 80% competency. This will include the classification of leukocytes and the evaluation of RBC morphology.

1. Determine red cell variants and inclusions enumerating according to established criteria, using correct terms, and spelling correctly.

2. Assess relationship of RBC morphology to RBC indices.3. Estimate WBC and platelet counts and compare to

automated counts for at least 5 patient samples.4. Assess platelet morphology identifying abnormal forms.5. Report all data according to established policies, using

correct terminology.6. Operate and maintain microscope following established

protocol.





Perform preventive maintenance procedures for the following instruments according to established protocol with 90% competency

1. Automated Hematology Anlayzer2. Slide Maker3. Slide stainer4. Microscope5. Centrifuge





With 80% competency, perform a minimum of one patient and control blood run by back-up (manual and/or automated) procedure for the following procedures for (List method and/or instrument):__________1. WBC count2. Platelet countEvaluate and compare resulting data to routine automated method results.

*numbers will be established by bench instructor if platelets are part of hemogram or blood profile on a multi-parameter instrument.





39


Perform a minimum of 5 patient and/or control reticulocyte counts by established method, setting determined values with 80% accuracy.





Perform minimum of 10 patient erythrocyte sedimentation rate runs by established method, correctly setting up, reading, evaluating, and reporting results with 80% accuracy.





Body Fluid EvaluationWith 80% competency, perform a minimum of (6) body fluid cell counts diluted and undiluted using the hemocytometer1. Consider biohazards and observe safe technique2. Calculate and report accurately3. Use and maintain CytospinPrepare films, stain, identify and differentiate cells morphologically enumerating according to type. Perform or discuss required procedures and physical and chemical characteristics for the following body fluids.1. CSF (minimum 3)2. Synovial fluid (minimum 1)3. Pleural fluid (minimum 1)Identify cells on unknown films or photomicrographs determining whether abnormal or normal within 80% accuracy using proper terms and correct spelling





Assist (or observe) with performance of minimum of one Bone Marrow procedure following policies and procedure1. Observe technologist with materials maintaining

sterilitiy for patient contact materials.2. Receive marrow, prepare films and process clot.3. Label all materials correctly4. Perform routine Wright’s Stain following appropriate

bone marrow directions





Perform cytochemical stain for Leucocyte Alkaline Phosphatase according to procedure manual.1. Score and count neutrophils on a minimum of 2

patient and 1 control slide2. Score should agree within 80% of previously

determined score





40


Perform at least one Eosinophil count with 80% competency Consistently exceeds standards




CoagulationPerformance Task Evaluation Date

Operate an automated coagulation instrument to perform routine coag tests (PT, PTT, FIB, DD, TT) on 2 consecutive days. Minimum of 20 clinical samples with 80% accuracy1. Process specimens 2. Determine specimen acceptability3. Reconstitute reagents and controls4. Utilize appropriate pipetting technique 5. Load and operate instrument correctly6. Evaluate patient and control values for acceptability7. Report data using correct units and terms8. Perform instrument maintenance according to

established protocol





Perform/Discuss the following special coagulation tests:1. AT32. Protein C3. Protein S4. DRVVT5. Lupus anticoagulant6. Heparin Assay 7. Other (list)_______________





With 80% competency, perform all quality assurance procedures for a minimum of 4 consecutive days as directed.




Consistently fails to meet standardsPerform or discuss aggregation studies according to established procedures (if applicable to clinical site).





41

PhlebotomyPerformance Task Evaluation Date

Collected at least 20 blood specimens with an 80% competency level in an average amount of time





Followed hospital policies and procedures with 100% competency





Cooperated and communicated with patient and other personnel in a professional manner with 100% competency





Identified/assembles appropriate supplies needed to perform procedures with 90% competency





Cheerfully greeted and identified self to patient and explained procedure with 100% competency





Collected specimens as required1. Avoided undue stress or harm to patient2. Followed acceptable techniques3. Recognized formation of hematoma or other

abnormal conditions utilizing corrective measures

4. Apply correct pressure for cessation of bleeding





42


with 100% competency, collected and identified specimens considering correct:1. Order of tubes2. Anticoagulant for assay3. Volume of specimen4. Labeling 5. Timing of specimens





Delivered specimens to appropriate areas following established protocol with 100% competency





Adheres to universal precautions and safety protocols with 100% competency





Performed a minimum of 30 routine venipuntures which include (see note above) with 80% competency:1. Therapeutic drug monitoring2. Timed tolerance tests (glucose)3. Blood bank specimens





Performed a minimum of 3 fingersticks or infant heelsticks with 100% competency





Collected a minimum of 2 blood culture specimens with 100% competency1. Used correct sterile technique2. Timed and labeled accurately3. Follow all pertinent routine phlebotomy criteria





43





44

BIOM 493 - Clinical Practice in Immunology Objectives

Course Description:Directed clinical practice in Immunology laboratory procedures and methods, problem-solving, quality assurance, preventive maintenance, and safety.

Reading Assignments:1. Site-specific laboratory and instrument manuals as assigned2. Lecture notes and text from BIOM 426, BIOM 3243. Other reference materials as needed or assigned4. Board of registry study guide: Clinical laboratory certification examinations by Batricia Tanabe, SIBN:97808918958795.Success! In clinical laboratory science by Anna Ciulla, SBIN: 9780135126486

Specific Course Objectives:Upon completion of this rotation the student should be able to:

1. Follow the safety procedures and protocols in the immunology laboratory.2. Describe the laboratory’s role in the institution’s quality assurance program.3. Report and record quality control and patient results according to SOP.4. Review and evaluate laboratory quality control data and formulate a logical course of

action when a violation of the rules of quality control occurs.5. Demonstrate the proper procedure for specimen handling and distribution for testing to be

performed within the laboratory and off-site. 6. Prepare reagents, controls, and standards as directed by the clinical laboratory staff and

recognize usage limitations such as shelf life and expiration date.7. Complete all assays consistent with laboratory deadlines except in cases of mechanical

malfunction or violations of standardization/quality control protocols.8. Identify, employ and appraise all calculations as required for each immunological test.9. Perform serial dilutions accurately and define titer.10. Differentiate between sensitivity and specificity.11. Operate all instruments and equipment according to the procedure used in the laboratory.12. Discuss the theoretical principles of the following procedures: agglutination reactions,

precipitation reactions, radioimmunoassay, enzyme-linked ummunoabsorbent assay, immunofluorescent assay and immunoprecipitation assay.

13. Perform above stated assays according to laboratory procedures.14. Prepare specimens and perform molecular diagnostic tests for qualitative and quantitative

detection of viruses.15. Recognize abnormal, critical results and employ proper procedures for reporting,

verifying and documenting these values. 16. Correlate laboratory results, data with diagnosis and treatment to the patient.

45

17. Demonstrate basic troubleshooting skills as they relate to all analyses performed.18. Demonstrate initiative to maximize the educational experience from the learning

opportunities at the clinical site.19. Demonstrate professional standards and attitudes with other professional within the

laboratory and the institution.

46

HMC ModuleBIOM 493 – Clinical Practice in Immunology

Performance Tasks





Minimum of 10 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol:

Protein unit:

1. Run calibration and controls.2. Evaluate the results of QCs and check LJ chart &

Westgard Rules.3. Prepare the work sheet & Perform assays of IgG,

IgA, IgM, C3, C4, ASO and C1EIP..






Fluorescence unit:

1. Operate and perform daily and weekly maintenance of the slide processor.

2. Perform routine maintenance on the fluorescent microscope.

3. Read and Evaluate slides under the microscope & identify the ANA patterns.

4. Read the slides for AMA, ASMA, APCA, LKM, ANCA and Endomysial.





47



Allergy unit:Fluoroenzymeimmuno assay (Phadia 250)

1. Run routine maintenance on Phadia 250.2. Operate the Phadia and troubelshoot the instrument.3. Recognized flagged results of controls and

calibrators and recalibrate the machine.4. Recognize IMMUNOCAP/EliA methods.5. Run T-IgE, Trytase and S-IgE for food and inhalant

allergens.6. Run ANA screen test (ctd), dsDNA and ENA.7. Run ACA, β2Gp, TPO,TG, TTG, CCP, MPO, PR3,

M2 & GBM.8. Recognize and correlate results with medical

conditions.






ELISA unit:

1. Operate & Perform daily maintenance of Davinci Quattro Processor, TECAN and Agility.2. Understand the acceptance of quality control and standards curve for each assay.3. Perform Anti-bacterial tests, IF, GAD and quatiferon test.





Flow cytometry unit:

1. Define principles, practice and applications of flow cytometry. 2. Observe the operation and perform QC of flow cytometry.3. Discuss patient sample processing and data analysis.4. Perform procedures such as lymphocyte subset, CD45RORA Assay, LAD, and phagoburst.





48



Virology Separation Bench:1. Read separations and receiving SOP.2. Identify all kinds of specimens collected and all kinds of specimen's tubes (e.g. plane tube, CBC tube).3. Check the patient information on request form match with sample tube.4. Describe the rejection criteria of the sample and procedure of rejection: leaked specimens, Haemolysed / lipaemic specimens, inadequate volume, no doctor stamp.5.Observe procedure for serum/plasma separation, labeling proper tubes according to test requested and storage and disposal of specimen.6. process specimens according to priority of registration, such as STAT tests (e.g. H1N1, CSF viral tests, tests for brain death patient) and rejected forms.7. Clean-up work area and centrifuge with proper disinfectant before and after shift duty.8. Perform daily and weekly centrifuge Quality Control procedure (temperature and speed).9. Adhere to correct procedure for dealing with specimen spills.






Torch Bench (*):1. Define the principle of ELISA.2. Observe performance of Enzyme immunoassay Evolis and Architect recognizing the microtiter plate with clear color change in positive and cut off and no color change in negative controls.3. Identify positive, negative and equivocal results and identify when a repeat test is required.4. Differentiate between past (IgG +ve & IgM –ve) and acute (IgM +ve) infection.6. Monitor temperature of refrigerator, water bath & centrifuge and take action when the temperature is out of range.





49

Performance Task Evaluation DateMinimum of 20 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol:

Hepatitis bench (*) :1. Explain the principle of chemiluminescence of the Architect instrument. 2. Using serological markers, differentiate between chronic, acute, and past hepatitis B infection.3. Identify when a repeat test or a confirmatory test (HBsAg confirmatory test and HCV PCR) is required.

Consistently exceeds expectations

Consistently meets expectations

Does not meet expectations

Fails to Meet Expectations


Syphilis bench (*):1. Define the principles of all tests performed in Syphilis bench including, ELISA, RPR (Rapid Plasma Reagin), Inno-Lia (line immuno assay; immunoblotting), CSF-VDRL (cerebrospinal fluid-venereal disease research laboratory).2. Describe the principle of card agglutination assay and perform RPR with titration.3. Explain the principle of Inno-Lia as a confirmatory test for syphilis and interpret the results.






Molecular Biology: 1. List all tests performed in molecular the biology lab. (HBV, HCV, HIV, CMV, HSV, EBV)2. Explain the principle of PCR.3. Distinguish between different types of DNA extraction methods: manual (using Qiagen kit) & automated (using EZ1 automated machine).4. Differentiate between different types of real time PCR instruments: ABI and Taqman.5. Outline the multiplex PCR principle and the viral tests performed with this technique (multiplex tests for: respiratory viruses, influenza 2009H1N1, Adenovirus, Cytomegalovirus, Epstein-barr virus, Herpes virus 6 & 7, enterovirus, mumps, Varicella zoster virus, Herpes virus 1 & 2, enterovirus, parvovirus B19.measles).6. Trail the steps of HCV genotyping and explain the purpose of the test.





50



Clinical Instructor: _______________________________ Date: ____________________

Student Signature: __________________ _____________ Date: ___________________

51

SIDRA ModuleBIOM 493 – Clinical Practice in Immunology

Performance Tasks






Allergy unit:Fluoroenzymeimmuno assay (Phadia 250)

1. Run routine maintenance on Phadia 250.2. Operate the Phadia and troubelshoot the instrument.3. Recognized flagged results of controls and

calibrators and recalibrate the machine.4. Recognize IMMUNOCAP/EliA methods.5. Run T-IgE, Trytase and S-IgE for food and inhalant

allergens.6. Recognize and correlate results with medical

conditions.





Minimum of 5 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in ELISA unit:

1. Operate & Perform daily maintenance of Agility.2. Understand the acceptance of quality control and standards curve for each assay.3. Perform quatiferon test.





52


Minimum of 10 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in Virology Separation Bench:1. Read separations and receiving SOP.2. Identify all kinds of specimens collected and all kinds of specimen's tubes (e.g. plane tube, CBC tube).3. Check the patient information on request form match with sample tube.4. Describe the rejection criteria of the sample and procedure of rejection: leaked specimens, Haemolysed / lipaemic specimens, inadequate volume, no doctor stamp.5.Observe procedure for serum/plasma separation, labeling proper tubes according to test requested and storage and disposal of specimen.6. Clean-up work area and centrifuge with proper disinfectant before and after shift duty.7. Perform daily and weekly centrifuge Quality Control procedure (temperature and speed).8. Adhere to correct procedure for dealing with specimen spills.





Minimum of 5 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in Torch Bench:1. Define the principle of ELISA.2. Observe performance of Enzyme immunoassay Tendigo & Agility recognizing the microtiter plate with clear color change in positive and cut off and no color change in negative controls.3. Identify positive, negative and equivocal results and identify when a repeat test is required.4. Differentiate between past (IgG +ve & IgM –ve) and acute (IgM +ve) infection.6. Monitor temperature of refrigerator, water bath & centrifuge and take action when the temperature is out of range.





Minimum of 20 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in Hepatitis bench:1. Explain the principle of chemiluminescence of the Diasorin instrument. 2. Using serological markers, differentiate between chronic, acute, and past hepatitis B infection.3. Identify when a repeat test or a confirmatory test (HBsAg confirmatory test and HCV PCR) is required.



Doesn’t meet expectations

Consistently fails to Meet Expectations

53

Performance Task Evaluation DateMinimum of 5 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in Syphilis bench:1. Define the principles of all tests performed in Syphilis bench including, ELISA, RPR (Rapid Plasma Reagin),).2. Describe the principle of card agglutination assay and perform RPR with titration.3. Explain the principle of Inno-Lia as a confirmatory test for syphilis and interpret the results.





Minimum of 5 clinical samples with 80% accuracy. Perform the following procedures according to established laboratory protocol in Molecular Biology: 1. List all tests performed in molecular the biology lab. (HBV, HCV, HIV, CMV, HSV, EBV)2. Explain the principle of PCR.3. Distinguish between different types of DNA extraction methods: automated (using EZ1and Easymag automated machine).4. Differentiate between different types of real time PCR instruments: ABI 5. Outline the multiplex PCR principle and the viral tests performed with this technique (multiplex tests for: respiratory viruses, influenza 2009H1N1, , , , Herpes virus 6 & 7, enterovirus, mumps, Varicella zoster virus, Herpes virus 1 & 2, enterovirus, parvovirus B19.measles).









54

BIOM 494- Clinical Practice in MicrobiologyObjectives

Course Description:Directed clinical practice in Microbiology laboratory procedures and methods, problem-solving, quality assurance, preventive maintenance, and safety.

Reading Assignments:1. Texts from BOIM 322, BIOM 323, BIOM 324, BIOM 4222. Laboratory Procedure Manual3. Handouts and/or Journal articles as provided4. Review from BIOM 322, BIOM 422, the following topic areas:

Specimen collection, transport and handlingProcessing of cultures to include specimen types and media Identification protocol for all organisms studiedIdentification of MycobacteriaProcedures for culture of MycobacteriaAntibiotic sensitivity testing methodsPrinciples of biochemical tests used in identification of organisms

5.Board of registry study guide: Clinical laboratory certification examinations by Batricia Tanabe, SIBN:97808918958796.Success! In clinical laboratory science by Anna Ciulla, SBIN: 9780135126486

Specific Course objectives:

Upon completion of the rotation the student should be able to:

General Bacteriology:1. Choose appropriate control organisms for evaluation of reactivity of prepared media and

reagents.2. Evaluate reactivity of prepared media and reagents.3. Formulate plan of action for follow-up of unacceptable results in media/reagent

reactivity.4. Operate, maintain and perform Quality Assurance procedures on the Automated Blood

Culture instrument according to established protocol.5. Choose and set up appropriate atmospheric conditions for culture of anaerobes and

Campylobacter.6. Process specimens for culture, evaluating specimen acceptability, using specimens from

varied sources.7. Correlate results on primary isolation media with categories of organisms studied in

BIOM 322 and BIOM 422.8. Formulate identification procedures based on analysis of primary isolation media.9. Perform secondary/confirmatory procedures, using appropriate controls.

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10. Select and perform staining procedures to observe microscopic morphology.11. Identify organisms isolated from varied culture sites as provided by the instructor with

90% accuracy, using established protocol.12. Perform sensitivity testing according to established protocol.13. Interpret results of sensitivity tests and controls.14. Correlate organisms isolated with disease state and other laboratory results.15. List and describe principle of operation for instruments used in the Microbiology

Laboratory.

Mycobacteriology:1. Process specimens for culture, evaluating specimen acceptability, according to

established protocol.2. Assess need for concentration, decontamination and digestion of specimens for culture of

Mycobacteria.3. Select appropriate media for culture of Mycobacteria.4. Describe principle of the acid fast stain, perform staining procedure.5. Describe procedure for reporting presence of Mycobacteria on stained slides.6. Formulate a plan of action for identification of Mycobacteria from primary cultures.

(Include DNA Probe Technology)7. Describe principle of operation for the Bactec instrument in culture and identification of

Mycobacteria.

Feces Analysis:1. Review from Strasinger's Urinalysis and Body Fluids, normal composition of feces.2. Describe procedure and principle for the following tests:

Occult BloodFecal fat (Sudan III stain)Specific stain for WBC and muscle

3. Correlate results from tests in #2 with hematology and chemistry lab values.4. Evaluate specimen acceptability for tests in #2.5. Describe situations in which false positive and/or negative results occur for the tests

listed in #2.

Parasitology:1. Review from BIOM 323 & BIOM 422, routine and special parasitology procedures

including concentration methods and staining procedures.2. Prepare specimens for analysis using appropriate handling procedures and preventatives.3. Assess specimen acceptability using established criteria.4. Perform ova/parasite concentration methods to assure recovery of organisms present.5. Perform trichrome stain procedure, assessing acceptability of results. 6. Operate and maintain microscope according to established protocol.7. Calibrate an ocular micrometer and measure organisms accurately.8. Review from BIOM 323, criteria used in identification of the following groups of

parasites: Intestinal Protozoa, Trematodes, Tissue Nematodes, Blood and Tissue Parasites9. Correlate parasites in #8 with source (specimen), clinical signs and history.10. Correlate presence of parasites in #8 with other laboratory results.

56

11. Identify ova and parasites with 80% accuracy in unknown specimens provided by the instructor.

12. Report ova/parasite exam results (using correct spelling) according to established protocol.

57

HMC ModuleBIOM 494 – Clinical Practice in Microbiology

Performance Tasks(Includes Parasitology & Mycology)

Student Name: ______________________________ Clinical Site: ______________________



Performance Task Evaluation DateOrientation and Laboratory Safety introduction.Components include. Hospital Fire safety/Evacuation plans manuals.MSDS Sheets(Chemical $ Infectious).Identifies location of safety devices;Emergency Exits;Fire Exitinguishers;Fire Alarms;Fire Blankets;Safety ShowersShowers;First aid kit;Eye Washes;Spill kit.Practise safety in the Laboratory including.Use of protective clothsSafe handling of specimens.Understands the procedures used for the cleaning of various spills.(Chemical,Infectious & other spills)small spills ;Big spill;Needle&sharpsrpsMedia Preperation.Sterilization and Disinfection.Methods of Sterilization.Physical Methods.Incineration or Direct flame;Moist Heat;Dry Heat;Filteration;Gas sterilization ETO or EO.;Liquid Chemical Sterilization.PH of Microbiological Media.Reagents,Buffers ;Stains and Medias.Quality controls of media by using ATCC strains and storage .





Urine analysisPre-Analytical ConsiderationIRIS Automated Urine Microscopy Analyzer.Principle of Iris ;Quality controls;Preperation of specimensProcedure.Barcode reader,Pipetting;Calculation;Autoclassification of Particles;Microscopic Particle identificationAnalytical ConsiderationsInterpretations of the result.Bacteria;Crystals; Casts;Yeast;SpermatozoaTrichomonas ;Detection of spoiled leucocytesPost Analytical ConsiderationsMicroscopy-Iris analyzer result; reporting(Turn around time -24hours)





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Urine Culture.Definitrion of Bacteriuria.Types of urine/Types of urine containers.Calibrated Loop and colony count.Cled media.Pre-Analytical Considerations.Duplicate specimens and Unaccepted specimens.Optimal time of specimen collection..Clean-catch midstream urine.Specimen transport and storage.Accessioning the specimen.Analytical Considerations . Specimen processing;Test selection;Semi quantitative screening culture.Calibrated loop/Surface streak method;Quality control;Examination ofCulture;Colony count;Identificaion and susceptibility test Legionella and Fungal culture..Post Analytical Considerations.Preliminary and Final reporting .





Genital Culture.Introduction of Lower and Upper genital tract infections.Pre-Analytical Considerations.Specimen collection;Specimen transport and storage.Type of culture Swabs.Reagents and media.Quality control.Analytical Considerations . Processing of Smears.Direct Examinations;1. Wet preparation 2.Grams stain.Culture media, Incubation conditions and Target organisms.Chlamydiae and Ureaplasma.Post Analytical ConsiderationsReporting wet preparation for Trichomonas;PMNs;Yeasts;Clue cells.Reporting Culture.Normal flora;Insignificant and Significant





Miscellaneous Culture.Introduction of all types of fluids/tissues/wounds/abscess/pus/boils etc.Pre-Analytical Considerations.Specimen processing.Qality control.Optimal time of specimen collection.Before antimicrobial treatment started.Send specimens immediately to the laboratory.Specimen transport and storage.Principle of aerobic and an-aerobic organism associated with infectionAnalytical Considerations . Processing of specimens.Microscopy Direct Examination.Culture reading Identification and susceptibility testingPost Analytical ConsiderationsInterpretation of Cultures;Result reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Critical test and Critical value reporting.





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Respiratory Culture Bench.Upper Respiratory and Lower respiratory Tract Infections.Pre-Analytical ConsiderationsSpecimen collection of T/s ;sputum;Ett;Bronchial wash and Lavage;Pleural fluids and Pleural tissues.Transpot and storage.Qality control.Analytical Considerations.Microscopy.Evaluation of sputumCulture Procedure(Interpretation of cultures from Normal flora)Identification and susceptibility testingPost Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Blood & CSF Culture.BACTEC FX Fluroscent Technology.Intended Use.Principle of the procedure.Software and Operation Overview.Load vials and testing vials;Removal and printing Positive vials.Introduction of bacteremia.CSF –Critical test /collection procedure..Qality control.Pre-Analytical ConsiderationsTiming of blood collection.Collection procedure.Transport and storage.Types of bottles and importance of volume.Safety in specimen processing.Culture media material and reagents.Analytical Considerations . Microscopy –Gramsstain.No organism by Auramine stain.Culture investigatons.(Positive and Negative bottles)Bacterial latex test when necessary times in blood and csf.Reporting of crit and criv results.Result reporting .Preliminary report/Negative report/Positive report.Post Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Stool Culture Bench.Introduction of bacteria commonly associated with Gastrointestinal Infections.Bacteria associated with toxin-induced food poisioning.Viruses; Rotavirus and Adenovirus.Pre-Analytical ConsiderationsSpecimen collection;Specimen transport and storage.Method of collection.Qality control.Time between specimen collection and processing.C.difficile Toxin A & B –EIAH.Pylori;EHEC(shiga toxin);Occult blood in stool.Rejection criteria.Adequate quantity and Appropriate number of specimens.





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Analytical Considerations . Specimen processing .Macroscopic Appearance.General consideration of matching the request and selecting mediaPost Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Reporting to PHD & Infection control team.

Identification and Antibiotic Susceptibility.Definitions of the test.Principle &Precautions.;Shelf life and storage of unused antibiotic.Media &Incubation;Quality control strains using to interpret the results.Frequency of QC testing.Monitoring accuracy& 0.5Macfarland standard.1.Disk Diffusion.2.Etest3.Detection of ESBL double disk4.ESBL Testing by ETEST.5.Metallo-betalactamase.6.D Test clindamycin for Staphylococci &Streptococci.7.E-test for Yeast.8.Cefinase-disk- Beta-lactamase (Chromogenic Cephalosporin Method)Catalase;Oxidase;Latex;Bacitracin;Optochin;Novobiocin;Biochemical Automated Identification & Susceptibility .Phoenix system.Phoenix AP Instrument operation ;Consumables and storage.Preperation of Panel and inoculam suspension.Phoneix quality control and principle.Vitek identification system & Malditoff





Mycology Collection of specimens.Type of specimens.Incubation . Biological safety cabinet (class IIB & class III )Selection of media.Koh preparation.Wet and Lactophenol preparation.Blankophor-p Flurocscent stain ..India ink preparation.Germ tube test.Result reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Quality control Bench & Final evalualtion.Brief idea of Policy ; Defenitions;Responsibilities;Principle&Procedure.Doccument and Records.Internal Assesment and External Assesment.(Quality indicators &Proficiency Testing.)





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Parasitology Bench.Pre-Analytical ConsiderationsSpecimen collection;Specimen transport and storage.Number of stool specimen and timings..Rejection criteria.Analytical Considerations . Specimen processing .Macroscopic Appearance.Modified formol ether concentration.Trichrome stain and Sellotape slides.Post Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Reporting to PHD & Infection control team.





Mycobacteria.Processing of TB Culturing and Identification.Mycobacteriology MGIT 960 System.Mycobacteriology Gene Xpert System.Classification of MTB & MOTTAFB stain and Florecent stain.Classification of MTB & MOTT.Niacin test.Reporting methods.Reporting to PHD & Infection control team





Enviornmental Culture Bench with PCR System.Brief idea of policy; Definitions;Responsibilities;Principle &Procedure for MRSA; VRE;MDROS..PCRGene Xpert System .Spore strip test.Air sampling.









62

SIDRA ModuleBIOM 494 – Clinical Practice in Microbiology

Performance Tasks(Includes Parasitology & Mycology)




Performance Task Evaluation DateOrientation and Laboratory Safety introduction.Components include. Hospital Fire safety/Evacuation plans manuals.MSDS Sheets(Chemical $ Infectious).Identifies location of safety devices;Emergency Exits;Fire Exitinguishers;Fire Alarms;Fire Blankets;Safety ShowersShowers;First aid kit;Eye Washes;Spill kit.Practise safety in the Laboratory including.Use of protective clothsSafe handling of specimens.Understands the procedures used for the cleaning of various spills.(Chemical,Infectious & other spills)small spills ;Big spill;Needle&sharpsrpsMedia Preperation.Sterilization and Disinfection.Methods of Sterilization.Physical Methods.Incineration or Direct flame;Moist Heat;Dry Heat;Filteration;Gas sterilization ETO or EO.;Liquid Chemical Sterilization.PH of Microbiological Media.Reagents,Buffers ;Stains and Medias.Quality controls of media by using ATCC strains and storage .





Urine analysisPre-Analytical ConsiderationIRIS Automated Urine Microscopy Analyzer.Principle of Iris ;Quality controls;Preperation of specimensProcedure.Barcode reader,Pipetting;Calculation;Autoclassification of Particles;Microscopic Particle identificationAnalytical ConsiderationsInterpretations of the result.Bacteria;Crystals; Casts;Yeast;SpermatozoaTrichomonas ;Detection of spoiled leucocytesPost Analytical ConsiderationsMicroscopy-Iris analyzer result; reporting(Turn around time -24hours)





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Urine Culture.Definitrion of Bacteriuria.Types of urine/Types of urine containers.Calibrated Loop and colony count.Cled media.Pre-Analytical Considerations.Duplicate specimens and Unaccepted specimens.Optimal time of specimen collection..Clean-catch midstream urine.Specimen transport and storage.Accessioning the specimen.Analytical Considerations . Specimen processing;Test selection;Semi quantitative screening culture.Calibrated loop/Surface streak method;Quality control;Examination ofCulture;Colony count;Identificaion and susceptibility test Legionella and Fungal culture..Post Analytical Considerations.Preliminary and Final reporting .





Genital Culture.Introduction of Lower and Upper genital tract infections.Pre-Analytical Considerations.Specimen collection;Specimen transport and storage.Type of culture Swabs.Reagents and media.Quality control.Analytical Considerations . Processing of Smears.Direct Examinations;1.Wet preparation 2.Grams stain.Culture media ,Incubation conditions and Target organisms.Chlamydiae and Ureaplasma.Post Analytical ConsiderationsReporting wet preparation for Trichomonas;PMNs;Yeasts;Clue cells.Reporting Culture.Normal flora;Insignificant and Significant





Miscellaneous Culture.Introduction of all types of fluids/tissues/wounds/abscess/pus/boils etc.Pre-Analytical Considerations.Specimen processing.Qality control.Optimal time of specimen collection.Before antimicrobial treatment started.Send specimens immediately to the laboratory.Specimen transport and storage.Principle of aerobic and an-aerobic organism associated with infectionAnalytical Considerations . Processing of specimens.Microscopy Direct Examination.Culture reading Identification and susceptibility testingPost Analytical ConsiderationsInterpretation of Cultures;Result reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Critical test and Critical value reporting.





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Respiratory Culture Bench.Upper Respiratory and Lower respiratory Tract Infections.Pre-Analytical ConsiderationsSpecimen collection of T/s ;sputum;Ett;Bronchial wash and Lavage;Pleural fluids and Pleural tissues.Transpot and storage.Qality control.Analytical Considerations.Microscopy.Evaluation of sputumCulture Procedure(Interpretation of cultures from Normal flora)Identification and susceptibility testingPost Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Blood & CSF Culture.BACTEC FX Fluroscent Technology.Intended Use.Principle of the procedure.Software and Operation Overview.Load vials and testing vials;Removal and printing Positive vials.Introduction of bacteremia.CSF –Critical test /collection procedure..Qality control.Pre-Analytical ConsiderationsTiming of blood collection.Collection procedure.Transport and storage.Types of bottles and importance of volume.Safety in specimen processing.Culture media material and reagents.Analytical Considerations . Microscopy –Gramsstain.No organism by Auramine stain.Culture investigatons.(Positive and Negative bottles)Bacterial latex test when necessary times in blood and csf.Reporting of crit and criv results.Result reporting .Preliminary report/Negative report/Positive report.Post Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Stool Culture Bench.Introduction of bacteria commonly associated with Gastrointestinal Infections.Bacteria associated with toxin-induced food poisioning.Viruses; Rotavirus and Adenovirus.Pre-Analytical ConsiderationsSpecimen collection;Specimen transport and storage.Method of collection.Qality control.Time between specimen collection and processing.C.difficile Toxin A & B –EIAH.Pylori;EHEC(shiga toxin);Occult blood in stool.Rejection criteria.Adequate quantity and Appropriate number of specimens.





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Analytical Considerations . Specimen processing .Macroscopic Appearance.General consideration of matching the request and selecting mediaPost Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Reporting to PHD & Infection control team.

Identification and Antibiotic Susceptibility.Definitions of the test.Principle &Precautions.;Shelf life and storage of unused antibiotic.Media &Incubation;Quality control strains using to interpret the results.Frequency of QC testing.Monitoring accuracy& 0.5Macfarland standard.1.Disk Diffusion.2.Etest3.Detection of ESBL double disk4.ESBL Testing by ETEST.5.Metallo-betalactamase.6.D Test clindamycin for Staphylococci &Streptococci.7.E-test for Yeast.8.Cefinase-disk- Beta-lactamase (Chromogenic Cephalosporin Method)Catalase;Oxidase;Latex;Bacitracin;Optochin;Novobiocin;Biochemical Automated Identification & Susceptibility .Phoenix system.Phoenix AP Instrument operation ;Consumables and storage.Preperation of Panel and inoculam suspension.Phoneix quality control and principle.Vitek identification system & Malditoff





Mycology Collection of specimens.Type of specimens.Incubation . Biological safety cabinet (class IIB & class III )Selection of media.Koh preparation.Wet and Lactophenol preparation.Blankophor-p Flurocscent stain ..India ink preparation.Germ tube test.Result reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.





Quality control Bench & Final evalualtion.Brief idea of Policy ; Defenitions;Responsibilities;Principle&Procedure.Doccument and Records.Internal Assesment and External Assesment.(Quality indicators &Proficiency Testing.)





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Parasitology Bench.Pre-Analytical ConsiderationsSpecimen collection;Specimen transport and storage.Number of stool specimen and timings..Rejection criteria.Analytical Considerations . Specimen processing .Macroscopic Appearance.Modified formol ether concentration.Trichrome stain and Sellotape slides.Post Analytical ConsiderationsResult reporting .Preliminary report/Negative report/Positive report.Turn around time of reporting.Reporting to PHD & Infection control team.





Enviornmental Culture Bench with PCR System.Brief idea of policy; Definitions;Responsibilities;Principle &Procedure for MRSA; VRE;MDROS..PCRGene Xpert System .









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QU-CHS BIOM Student PracticumBIOM 494 – Clinical Practice in Microbiology

Performance TasksTB lab in HMC “as per coordination”




Performance Task Evaluation DateMycobacteria. Processing of TB Culturing and Identification.Mycobacteriology MGIT 960 System.Mycobacteriology Gene Xpert System.Classification of MTB & MOTTAFB stain and Florecent stain.Classification of MTB & MOTT.Niacin test.Reporting methods.Reporting to PHD & Infection control team









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BIOM 495Clinical Practice in Immunohematology

Objectives

Course Description:Directed clinical practice in Blood Bank laboratory procedures and methods, problem-solving, quality assurance, preventive maintenance, and safety.

Reading Assignments:1. Texts from BIOM 4522. Laboratory Procedure Manual3. Handouts and/or Journal articles as provided4. Prior to entering the clinical rotation, review basic principles of the following:

a. ABO/Rh blood groupsb. Genetic principles as applied to BBc. Immunology principles as applied to BBd. Antigen/antibody characteristics and reactions of the Kell, Duffy, Kidd, P,

MNSsU, Lutheran, I, and Lewis blood group systemse. Hemolytic disease of the newbornf. Direct antiglobulin testing

5. Board of registry study guide: Clinical laboratory certification examinations by Batricia Tanabe, SIBN:97808918958796. Success! In clinical laboratory science by Anna Ciulla, SBIN: 9780135126486

Specific Objectives:Upon the completion of the rotation the student should be able to:

1. Determine acceptability of patient specimens for BB procedures and describe follow-up procedures for unacceptable specimens.

2. Describe procedures for appropriate storage of patient specimens.3. Describe procedures for discarding patient specimens.4. List and discuss QA procedures in blood bank.5. Formulate a plan of action for QA performance deficiencies.6. Interpret results of ABO/Rh typing.7. Formulate a plan of action to resolve discrepancies in ABO/Rh typing.8. Given results of follow-up tests on ABO/Rh discrepancies interpret results and give

correct type.9. Describe procedures for identification of allo and auto antibodies.10. Correlate reactions of warm and cold alloantibodies with cell panel results.11. List special techniques used for identification of allo and auto antibodies.12. Discuss purpose and principle of the following:

a. LISSb. PEGc. Enzymes

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d. Elutione. Cold/warm absorptionf. Selected cell panelg. Neutralization

13. Given initial panel results, devise a plan of action to identify antibodies present.14. Evaluate results of identification panels, including specialized tests.15. Interpret results of immunohematology tests for patients with drug-induced

autoantibodies. Formulate plan of action for identification.16. Predict results of routine testing for infants with HDN.17. Describe testing protocol for prenatal patients and outline tests used to determine

significance of an antibody detected. 18. Given prenatal results of a mother's type and screen, predict results of routine testing for

the infant including DAT.19. Describe the assays performed on amniotic fluid; interpret these results with respect to

treatment of HDN-affected fetus.20. Describe criteria used in selection of the treatment mode for a child with HDN, including

selection of blood and compatibility testing for exchange and intrauterine transfusion.21. Outline laboratory workup and criteria used to determine candidacy for RhIG, analyze

cases of HDN, and judge who should receive Rh Immune Globulin (RhIG).22. Discuss principle of tests used to detect fetal cells in maternal circulation.23. Given results of a postpartum work-up determine candidacy and dosage for RhIG

including:a. Immunosuppressive doseb. Mode of action of RhIGc. Calculation of RhIG neededd. Associated clinical lab findings

24. Outline the steps involved in compatibility testing of all techniques (IS, AHG, Gel, Pre-warm, etc).

25. Describe the collection of blood from the recipient and the precautions necessary in handling the patient specimen.

26. Select and rationalize donor blood selection when group specific blood is not available.27. Analyze the consequences of changing to group-specific blood after transfusion of a

different ABO and/or Rh type.28. Select techniques for crossmatching which will detect incompatibilities.29. Perform and interpret results for compatibility testing. Formulate plan of action for

resolving an incompatible crossmatch.30. Outline transfusion protocol (including pre + post transfusion checks on the patient).31. Outline the laboratory investigative studies to be used for a suspected transfusion

reaction; state the purpose of each procedural step.32. Discuss procedures for handling blood components including:

a. Storage temperatureb. Preparationc. Compatibility testingd. Administration

33. Discuss rationale of maintenance of blood inventory.

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34. Discuss procedures required before using blood and blood components received from blood provider agency.

71

HMC ModuleBIOM 495 – Clinical Practice in Immunohematology

Performance Tasks




Quality Assurance/Quality ControlPerformance Task Evaluation Date

With 90% accuracy, perform the following tasks:Daily

a. Reagent quality controlb. Heat block temperaturesc. Refrigerator/Freezer temperaturesd. Cell washer dispense volume





Weekly a. Change/evaluate temp chartsb. Alarm testing

Quarterly (Perform/Discuss)a. High-Low alarm testb. Centrifuge RPMsc. Centrifuge timers

Specimen Handling/Processing - Minimum of 40 clinical samples with 90% accuracySpecimen Requirements

a. Determine acceptability of submitted specimens

b. Initiate appropriate follow-up procedures for unacceptable specimens

c. Recognize and use appropriate identification procedures





Review of historical informationa. Special needsb. Unexpected antibodiesc. Autologous units





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Specimen Testing, Product Preparation and SelectionPerformance Task Evaluation Date

General - Minimum of 40 clinical samples with 90% accuracy

a. Sample/anticoagulantb. Preparation of cell suspensionsc. Use of equipment (serofuge, cell washer)d. Using a “0-4+” scale, grade macroscopic

agglutination reactionse. Reading, interpretation and documentation

of reactions (legible, correct terms/ abbreviations)

f. Identify mixed field agglutination





ABO/Rh a. Forward/reverse typingb. ABO discrepancies (use of appropriate

reagents)c. Perform ABO/Rh on a minimum of 20

specimens with 95% accuracy




Consistently fails to meet standards Antibody Screen/ Identification

a. Perform a minimum of 20 antibody screens and interpret results with 90% accuracy

b. Perform antibody identification on a minimum of 4 samples Identify antibodies (80% accuracy) Use/Discuss specialized techniques

o Enzymesc. Interpret the results of routine/selected cell

panels to determine the specificity of single and multiple antibodies

d. Perform antigen typing for unexpected antibodies on patient and/or donor units (minimum of 3 different antigens)





Blood Bank Automated AnalyzerMinimum of 20 clinical samples with 90% accuracy

a. Observe/perform pre-transfusion testing of patient samples according to established operating procedures

b. Load appropriate reagents and patient samples

c. Process and evaluate acceptability of control and patient data

d. Observe/perform routine and preventative maintenance procedures





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Direct antiglobulin testinga. Perform DAT/DAT battery on a minimum

of 2 samples Polyspecific reagent Monospecific (anti-IgG, anti-C3d)

b. Identify antibody coating cells (elution)





Compatibility Testinga. Selection of donor bloodb. Crossmatch procedure (electronic,

immediate spin, AHG, GEL, Pre-warm, saline replacement, etc)

c. Perform a minimum of 10 patient crossmatches using correct procedures

d. Interpret the results of crossmatching with 100% accuracy

e. Complete an uncomplicated 2-unit crossmatch with ABO/Rh and antibody screen testing in 60 minutes or less





Maternal and Neonatal Testinga. Fetal screen testingb. Kleihauer-Betke stainc. Rh Immune globulind. Correctly perform ABO/Rh and DAT on

neonate specimens (minimum 6)e. Determine need for follow-up procedures

(immune AB, elution)f. Evaluate Rh negative maternal specimens

for Rh Immune Globulin administration (min 3)

g. Determine/perform follow-up procedures to calculate dosage of RhIG





Plasma, platelets, cryoprecipitate, etca. Product selection (ABO compatible,

specific, etc)b. Special needs (CMV, LR)c. Thawing proceduresd. Pooling of platelets and/or cryoe. Open vs. closed





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Transfusion Reaction – Perform/Describe transfusion reaction workup on 2 suspected transfusion reactions

a. Clerical checkb. Serological work-upc. Crossmatchd. Blood cultures





Processing/Inventory of Blood ComponentsPerformance Task Evaluation Date

Receipt and Processing of Componentsa. Log in products received from blood

supplierb. Perform/Discuss special handlingc. Perform ABO/Rh confirmatory testing on a

minimum of 20 donor units with 100% accuracy





Blood Dispensing/Administration – Issue or observe issue of a minimum of 5 blood products for administration to patient

a. Clerical checkb. Visual inspectionc. Transportation of products (courier,

pneumatic tube)d. Storage (coolers)e. Return of products to blood bank

Acceptability, time/temperature limitsf. Follow a unit from the blood bank to the

patient and observe bedside checks and administration of the unit (first 30 minutes)





Blood Inventorya. Perform/Discuss daily inventoryb. Order products from blood supplierc. Observe routine paperwork for

shipping/receiving blood products






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76

SIDRA Module BIOM 495 – Clinical Practice in Immunohematology

Performance Tasks




Quality Assurance/Quality ControlPerformance Task Evaluation Date

With 90% accuracy, perform the following tasks:Daily

e. Reagent quality controlf. Heat block temperaturesg. Refrigerator/Freezer temperaturesh. Cell washer dispense volume





Weekly c. Change/evaluate temp chartsd. Alarm testing

Quarterly (Perform/Discuss)d. High-Low alarm teste. Centrifuge RPMsf. Centrifuge timers

Specimen Handling/Processing - Minimum of 40 clinical samples with 90% accuracySpecimen Requirements

d. Determine acceptability of submitted specimens

e. Initiate appropriate follow-up procedures for unacceptable specimens

f. Recognize and use appropriate identification procedures





Review of historical informationd. Special needse. Unexpected antibodiesf. Autologous units





Specimen Testing, Product Preparation and Selection

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Performance Task Evaluation DateGeneral - Minimum of 40 clinical samples with 90% accuracy

g. Sample/anticoagulanth. Preparation of cell suspensionsi. Use of equipment (serofuge, cell washer)j. Using a “0-4+” scale, grade macroscopic

agglutination reactionsk. Reading, interpretation and documentation

of reactions (legible, correct terms/ abbreviations)

l. Identify mixed field agglutination





ABO/Rh d. Forward/reverse typinge. ABO discrepancies (use of appropriate

reagents)f. Perform ABO/Rh on a minimum of 20

specimens with 95% accuracy




Consistently fails to meet standards Antibody Screen/ Identification

e. Perform a minimum of 20 antibody screens and interpret results with 90% accuracy

f. Perform antibody identification on a minimum of 4 samples Identify antibodies (80% accuracy) Use/Discuss specialized techniques

o Enzymesg. Interpret the results of routine/selected cell

panels to determine the specificity of single and multiple antibodies

h. Perform antigen typing for unexpected antibodies on patient and/or donor units (minimum of 3 different antigens)





Blood Bank Automated AnalyzerMinimum of 20 clinical samples with 90% accuracy

e. Observe/perform pre-transfusion testing of patient samples according to established operating procedures

f. Load appropriate reagents and patient samples

g. Process and evaluate acceptability of control and patient data

h. Observe/perform routine and preventative maintenance procedures





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Direct antiglobulin testingc. Perform DAT/DAT battery on a minimum

of 2 samples Polyspecific reagent Monospecific (anti-IgG, anti-C3d)

d. Identify antibody coating cells (elution)





Compatibility Testingf. Selection of donor bloodg. Crossmatch procedure (electronic,

immediate spin, AHG, GEL, Pre-warm, saline replacement, etc)

h. Perform a minimum of 10 patient crossmatches using correct procedures

i. Interpret the results of crossmatching with 100% accuracy

j. Complete an uncomplicated 2-unit crossmatch with ABO/Rh and antibody screen testing in 60 minutes or less





Maternal and Neonatal Testingh. Fetal screen testingi. Kleihauer-Betke stainj. Rh Immune globulink. Correctly perform ABO/Rh and DAT on

neonate specimens (minimum 6)l. Determine need for follow-up procedures

(immune AB, elution)m. Evaluate Rh negative maternal specimens

for Rh Immune Globulin administration (min 3)

n. Determine/perform follow-up procedures to calculate dosage of RhIG





Plasma, platelets, cryoprecipitate, etcf. Product selection (ABO compatible,

specific, etc)g. Special needs (CMV, LR)h. Thawing proceduresi. Pooling of platelets and/or cryoj. Open vs. closed





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Transfusion Reaction – Perform/Describe transfusion reaction workup on 2 suspected transfusion reactions

e. Clerical checkf. Serological work-upg. Crossmatchh. Blood cultures





Processing/Inventory of Blood ComponentsPerformance Task Evaluation Date

Receipt and Processing of Componentsd. Log in products received from blood

suppliere. Perform/Discuss special handlingf. Perform ABO/Rh confirmatory testing on a

minimum of 20 donor units with 100% accuracy





Blood Dispensing/Administration – Issue or observe issue of a minimum of 5 blood products for administration to patient

g. Clerical checkh. Visual inspectioni. Transportation of products (courier,

pneumatic tube)j. Storage (coolers)k. Return of products to blood bank

Acceptability, time/temperature limitsl. Follow a unit from the blood bank to the

patient and observe bedside checks and administration of the unit (first 30 minutes)





Blood Inventoryd. Perform/Discuss daily inventorye. Order products from blood supplierf. Observe routine paperwork for

shipping/receiving blood products





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81

Biomedical Science DepartmentCLINICAL PRACTICE EVALUATION

Instructions: This survey is designed to assist the Biomedical Science Department in evaluating the clinical practice portion of the curriculum. Please choose the response from the key below that most accurately reflects your opinion of each department and instructor. We do appreciate your constructive comments.

Circle the Content area being evaluated and use this key.

6: Strongly agree/ Excellent 3: Disagree more than agree / Fair 5: Moderately agree / Very Good 2: Moderately disagree / Poor 4: Agree more than disagree / Good 1: Strongly disagree/ Unacceptable

Clinical Rotation

Content Area 6 5 4 3 2 1

Organization Objectives were clearly stated. Written procedures were readily available. Time was well utilized.

Content Material was presented at appropriate difficulty level. Instruction enabled me to

understand & utilize procedures. There were sufficient samples available to perform, repeat &/ or practice the

required procedures.Evaluation of Student Performance

The grading system was clearly explained. Exams & assignments were fair & reflected objectives & rotation content.

Length The amount of time allotted for the rotation was appropriate.

Summary Overall, how would you rate this rotation?

COMMENTS:

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BLOOD BANK

CHEM HEM. MICRO. IMMUN

Clinical Instructor Evaluation 6 5 4 3 2 1

Instructor’s Attitude Instructor made you feel welcome and part of the laboratory team. Instructor exhibited openness to student ideas and questions. Instructor inspired me to put forth my best effort.

Command of Material/Knowledge/Expertise Instructor appeared knowledgeable in the subject matter.

Ability to Convey Knowledge and Expertise Instructor communicated the subject matter well. Instructor perceived student’s ability and adjusted pace accordingly. Instructor presented information in an interesting and thought-provoking manner.

Interest in Teaching Instructor appeared to be interested in teaching students. Instructor demonstrated enthusiasm and a positive attitude.

Summary Overall, how would you rate the instructor?

COMMENTS:

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Qatar UniversityBiomedical Science Department

Certification of Receipt

I do hereby acknowledge that I have received a copy of the current Biomedical Sciences Clinical Practice Manual and that I have read and understood its contents.

I have also been provided an opportunity to ask the Department Head and/or the Clinical Coordinator about content which I do not understand and I realize that failure to return this form prevents me from entering the practicum site.

________________________________ _____________ Signature Date

Name:_____________________________(Please Print)

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