Laboratory requisition form
a form that is used to order a laboratory test; provides essential information about the patient, billing and coding, and tests ordered
Who can order a lab test?
Doctors, Nurse Practitioners, Physician Assistants and in some states a chiropractor. Do not take lab orders from any other health care professional.
Requisition form should include
Patient's full namePatient's date of birthPatient's sexSpecific ID number (can include a medical record number)
Basal state
The resting metabolic state of the body early in the morning after fasting for a minimum of 12 hours.
Patient Labels should include
Date and time of collectionYour initialsand the patient's full name and date of birthBlood tubes should be labeled prior to the patient leaving and prior to you leaving the bedside.
The Joint Commission mandates using how many patient identifiers?
2 identifiers are needed to verify the patient identity. Examples: patient's full name, dob, home address, telephone number, or social security number. Compare what the patient states to the requisition form.
PHI
Protected Health Information
HIPPA
Health Insurance Portability and Accountability Act- You should make every effort in preventing anyone who is not involved in the patients care from overhearing any of the patient's PHI.
Patient Identifiers-Inpatient
Inpatient setting (hospital): Compare patient information with wristband and cross-check with the requisition form. Barcodes scanners can also confirm a match from the patient's wristband to the requisition form or labels. DO NOT use room number or bed number as an identifier.Have the patient state their personal information, if at all possible. If a patient is unable to communicate a patient wristband or family member is the best option. In an inpatient setting do not perform the procedure unless the patient has a wristband.
Informed Consent
The patient has received full information about the procedure in a language with understandable terminology. An informed consent form is often required for high risk, invasive and surgical procedures.
Expressed consent
The patient gives explicit consent to a procedure orally or in writing on a consent form.
Implied Consent
A patient's action indicating consent for treatment. This is the most common form of consent. For example, a patient extends an arm to a phlebotomist for a venipuncture. This from of consent is adequate for low risk procedures. It can also be necessary in emergency medical situations, with the understanding that the patient would receive full information and sign an informed consent document if time and their condition allowed them to do so.
Consent for minors
In most cases, the child's parent of guardian must give consent for phlebotomy procedures. There are some exceptions for teenagers, such as those who are married, in the military, emancipated by a court order, or otherwise self-supporting and independent.
Patient Refusal
Patient may refuse at anytime. When a patient refuses, you usually must obtain written proof of this refusal to protect both yourself and the patient. Inform the provider of the refusal.
Fasting
Some tests require that the patient fast before a test. Often, the patient may not eat or drink anything other than water for 8-12 hours prior to blood collection. Unless the patient's condition or procedure expressly prohibits it, encourage the patient to drink water to facilitate hydration, which helps with finding viable venipuncture sites. Some tests allow the patient to drink black coffee or tea.
Pre-collection Medication requirement
Some tests determine the effectiveness of a medication. Patients should take the medication at a predetermined time, or write down what time they take the medication. Patients then have specific times for the collection of blood or urine. Providers decisions regarding treatment and care often rely on the accuracy of the timing. So when performing a venipuncture for these tests, it is important to collect the specimen at the correct time.
Basal State
This is based on the patient lifestyle and overall condition. Specimens are typically collected first thing in the morning, after refraining from eating and exercising for 12 hours. This prep is necessary when the provider wants to establish reference ranges. Exercise and food can effect lab results. Take the patients schedule in mind when scheduling the procedure (example night shift workers would have inaccurate results first thing in the morning).
Patient Allergies
CHeck for patient allergies prior to performing procedures, especially latex. Frequently lab equipment, such as tourniquets and gloves contain latex.
Fainting during a blood draw
Some people are susceptible to syncopal episodes at the sight of blood. Patients who are fasting are also prone to low blood sugar levels, which can lead to fainting. If the patient does feel faint, stop the procedure. Have the patient lower their head and take deep breaths. Loosening tight clothing and applying a cold cloth to the forehead can help as well. Observe the patient for at least 15 minutes following the episode. Document the incident. If a patient looses consciousness and does not respond right away they need emergency response. If prone to fainting it may be best to place the patient in a supine (laying down, facing up) position.
Blood draws and a mastectomy
If a patient has had a mastectomy (breast removal), applying a tourniquet to the arm on the side of the surgery could affect the lymph nodes on that side, causing swelling, injury or infection. If a patient has had a mastectomy on both sides, you may have to use a vein on the back of the hand or wrist.
tourniquet contraindications
Do not use a tourniquet in the following cases; arms with central venous catheters, IVs, AV fistula or shunt (dialysis port), arm cast, scarring, burns or thrombosed veins.
Thrombosed veins
Inflammatory process that causes a blood clot to form. Feel like a rope cord upon palpation, roll easily, and are not advisable to use for venipuncture.
Anticoagulant and blood draws
An anticoagulant will make a patient bleed more easily. May require additional precautions to prevent excessive bleeding. May require more than a band aid to prevent bruising and bleeding. Anticoagulant examples; Warfarin, Coumadin, Aspirin, Heparin. May affect PT/INR lab results specifically
Acetominophen (Tylenol)
May cause elevated liver enzymes
Blood pressure medications
Can affect blood glucose levels, sodium and potassium.
Alcohol
Can affect coagulation activation and platelet reactivity, especially in patients who have diabetes mellitus.
Gum
Sugar in chewing gum can affect lab results, specifically glucose. This can effect fasting test results.
Smoking
Smoking elevated several coagulation factors
Vigorous Exercise
Can cause coagulation activation. If you think the patient has recently exercised the patient should rest for 15-30 minutes before the blood collection. Document these factors for the provider to review.
Patient Identifiers- Outpatient
For patient identification in an outpatient facility, the tech must have one piece of visual identification and two instances of verbal confirmation of identification.
accession number
Number generated by laboratory information system (LIS) when specimen request is entered into the computer
Peak of medication
Time it takes for a medication to reach its highest effective concentration. Dependent on the medication administered, but typically 30 minutes after medication administration for an optimum peak level result.
Trough
The lowest amount of a medication in a patients blood. A tech should collect a specimen before administering the next dose of medication to obtain a trough level.