2015 Version

MODULE 8
Laboratory
Testing

SLMTA Trainer’s Guide

 Overview
MODULE 8. LABORATORY TESTING

Performance Outcome
With satisfactory participation in the training and successful implementation of laboratory
improvement projects, a participant’s laboratory should achieve the following outcome:
 All laboratory tests are performed promptly and accurately
 Test results are validated and recorded before release

Checklist Items Supported by this Module

This module supports the requirements for the following items from the SLIPTA Checklist:
1.2, 1.5, 6.1, 7.10, 8.1, 8.2, 8.3, 8.4, 8.7, 8.8, 8.9, 8.12, 9.1, 9.2, 9.3, 9.4, 9.8, 10.3

Learning Objectives (Management Tasks)

By the end of this module, participants should be able to perform the following management
tasks:

1. Monitor testing to ensure SOP’s are followed and tests are performed and
reported properly and promptly
2. Cross-check test reports against test request to ensure completion of all
tests
3. Review test records and findings promptly to ensure accuracy and timely
release of test results
4. Validate assigned tests and specific abnormal results

What’s in this Module?

ACTIVITY TITLE PURPOSE DURATION

The total testing process can be divided into three

phases, the pre-analytical phase, the analytical
phase, and the post analytical phase. A problem or
Validation of Test error in any of the three phases can invalidate the
1 hour
Results results of the entire testing process. In this activity,
participants identify the potential sources of errors
or problems and create a checklist to verify patient
results before their release.

Test result reports should be complete, accurate,

Is the Test Report legible, and clinically valid. In this activity,
Ready to be participants cross-check a test report to identify 45 min
Released? errors and omissions that must be resolved before
the report is released.

TOTAL ACTIVITY TIME: 1hr 45 min

SLMTA Module 8 Overview i

 Overview

TABLE OF CONTENTS

Activity: Validation of Test Results 8-1

Activity: Is the Test Report Ready to Be Released? 8-9

SLMTA Module 8 Overview ii

TRAINER’S GUIDE (2015) 8-1

ACTIVITY Validation of Test Results Module 8

PURPOSE: RESOURCES FOR FACILITATOR:

The total testing process can be divided into
three phases, the pre-analytical phase, the  PowerPoint slides: 8.5 to
analytical phase, and the post analytical phase. A 8.7
problem or error in any of the three phases can  Tool: Validation Items
invalidate the results of the entire testing  Tape, flipchart and markers
process. In this activity, participants identify the
potential sources of errors or problems and
create a checklist to verify patient results before RESOURCES FOR PARTICIPANT:
their release. None

This activity supports the following laboratory management tasks and SLIPTA checklist items
Management Tasks 6.4 Validate new equipment, reagents, and supplies
7.3 Enforce good specimen handling and processing practices
8.4 Validate assigned tests and specific abnormal results

Checklist Items 1.2 Laboratory Quality Manual Is there a current laboratory quality manual,
composed of the quality management system’s policies and has the manual
content been communicated to, understood and implemented by all staff?
1.5 Laboratory Policies and Standard Operating Procedures Are policies and/or
standard operating procedures (SOPs) for laboratory functions, technical and
managerial procedures current, available and approved by authorized
personnel? (Purchasing and Inventory Control; Pre-examination Processes;
Validation and Verification of examination procedures / Equipment; Quality
Control and Quality Assurance)
6.1 Internal Audits Are internal audits conducted at intervals as defined in the
quality manual and do these audits address areas important to patient care?
7.10 Product Expiration Are all reagents/test kits in use (and in stock) currently
within the manufacturer-assigned expiration or within stability?
8.1 Information for patients and users Are guidelines for patient identification,
specimen collection (including client safety), labelling, and transport readily
available to persons responsible for primary sample collection?
8.2 Does the laboratory adequately collect information needed for examination
performance?
8.3 Are adequate sample receiving procedures in place?
8.4 Pre-examination Handling, Preparation and Storage Where testing does not
occur immediately upon arrival in the laboratory, are specimens stored
appropriately prior to testing?
8.7 Documentation of Examination Procedures Are examination procedures
documented in a language commonly understood by all staff and available in
appropriate locations?
8.8 Reagents Acceptance Testing Is each new reagent preparation, new lot
number, new shipment of reagents or consumables verified before use and
documented?
8.9 Quality Control Is internal quality control performed, documented, and
verified for all tests/procedures before releasing patient results?
8.12 Are environmental conditions checked and reviewed accurately?
9.1 Test Result Reporting System Are test results legible, technically verified by
an authorized person, and confirmed against patient identity?
9.2 Testing Personnel Are testing personnel identified on the result report or
other records (manual or electronic)?

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TRAINER’S GUIDE (2015) 8-2

9.3 Report Content

9.8 Test Result Are test results validated, interpreted and released by
appropriately-authorized personnel?
10.3 Is corrective action performed and documented for non-conforming work?

This activity is related to the following activities:

Cross-Cutting: Process Mapping
Module 8: Is the Test Report Ready to Be Released?

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TRAINER’S GUIDE (2015) 8-3

ACTIVITY AT-A-GLANCE
Step Time Resources Key Points

Review the 3 phases of

1 the total testing 10 min Slides 8.5 to 8.6
process

2 Introduce the activity 5 min Slide 8.7

3 Conduct the activity 20 min

Review the validation

4 checklists from both 15 min
teams

5 Debrief the activity 5 min Tool

6 Conclude the Activity 5 min

TOTAL TIME: 60 min

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TRAINER’S GUIDE (2015) 8-4

PROCESS
Preparation
 Procure 6 sheets of flipchart paper and 6 markers.
 Label at the top of 2 sheets with the heading, “Pre-analytical.” Repeat this
labeling for “Analytical” and “Post Analytical” so that you create 2 sets of 3
sheets each with one of the phases labeled at the top.

Step 1. Review the 3 phases of the total testing process 10 min

 Project  Slides 8.5 to 8.6 to introduce the activity and the total testing
process. Review the 3 phases so that each participant understands what
activities occur within each phase. If the ‘Process Table’ (from the Process
Mapping activity) is still visible in the classroom, point out the 3 phases and
their associated steps.
 Emphasize that a problem or error in any of the three phases can invalidate the
results of the whole testing process. Stress that wrong laboratory results will
negatively impact the quality of the patient’s care and treatment.
 Explain the importance of identifying all the potential sources of errors or
problems that can invalidate the patient’s results. By recognizing these
potential pitfalls, a validation checklist can be created.
 Provide an example of a potential error and a checklist item for each phase.
See the table for suggested examples.

Phase Pitfall (Error or Problem) Validation Item

Pre-analytical Specimen not labeled Correct specimen labeling
Analytical Alert value not recognized Confirm all critical results by
repeat testing
Post Analytical Alert value not recognized All critical results are called,
read back, and documented

Step 2. Introduce the activity 5 min

 Project  Slide 8.7 to provide an overview of the activity.

 Divide the class into 2 teams. Select a team captain for each group.
 Hand one set of 3 flipchart sheets (Pre-analytical, Analytical, Post Analytical)
previously prepared and 3 markers to each team captain.
 Explain that each team will create a validation checklist for each of the 3
phases. Indicate that participants may want to jot down pitfalls and transform
them into a validation checklist item before writing them onto the appropriate
flipchart page. The team captains can divide their teams as they see fit and
designate a lead person for each phase. Indicate that each team has 20
minutes to create a validation checklist.
 Explain the scoring to the participants. At the end of 20 minutes, each phase
developed by each team will be taped side-by-side.
o Points will only be awarded for each item not included by the other team.
o If the same item is noted by both teams, no points will be awarded.

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TRAINER’S GUIDE (2015) 8-5

o The team with the highest number of points wins.

o Using the table above and providing a concrete example, explain how points
would be awarded or not awarded. For example, if both teams include
“Correct specimen labeling,” then no points are awarded to either team. If
only one team includes “All critical results are called,” then that team
receives one point.
 Explain that participants may use the Framework Tasks and the SLIPTA
Checklist to brainstorm for ideas.

Step 3. Conduct the activity 20 min

 Allow participants 20 minutes to create their validation checklist.
 Provide impartial assistance and coaching where necessary.

Step 4. Review the validation checklists from both teams 15 min

 Tape each phase side-by-side and circle all common items noted by both teams
for each phase. To speed the review, have the team captains review the other
phases.
 Review each phase with the class by discussing each common element from one
team’s list and each uncommon element from both team’s list. Facilitate a
discussion regarding what policies and procedures must be available to the
staff to effectively use this checklist. For example if the following item is
listed, “All critical results are called,” then a critical list must be developed
(all glucoses < 2.8 mmol/L or >22.2mmol/L), a laboratory policy for criticals,
and a procedure for critical notification.
 Tally the score at the end of each phase. Announce the winning team.

Step 5. Debrief the activity 5 min

 Offer any suggestion of checklist items overlooked by both teams. Refer to
Tool: Validation Items for an expected list of items.
 Emphasize that for this validation checklist to be utilized, the necessary
policies and procedures must be developed and communicated to the staff.
 Explain the difference between QA (quality assessment) and QC (quality
control). Connect the term ‘QA’ with this activity.
 Explain how the cross-checking step fits into and compliments the verification
checklist.

Step 6. Conclude the Activity 5 min

 Highlight or reiterate the key messages below.
 Make certain participants achieved the objectives of the activity.

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TRAINER’S GUIDE (2015) 8-6

 KEY MESSAGES Can they:

 The assurance of quality laboratory results relies on a  Recognize that a problem or

commitment to assess all aspects of the total testing error in any of the three phases
process. can invalidate the results of the
whole testing process?
 A problem or error in any of the three phases can
invalidate the results of the entire testing process.  Identify potential pitfalls at each
phase of the total testing
 For a QA program to be effective, the necessary process?
policies and procedures must be developed and
available to staff members.  Create a checklist to verify
areas before patient results are
released?
ACTIVITY OBJECTIVES
 MET?

 Connections and Applications

 The 3 phases can be simply stated as follows:
o Pre-analytical – before testing
o Analytical – testing which includes QC
o Post Analytical – after testing

Pre-Analytical Analytical Post-Analytical

Test ordering Testing and Result reporting,
Sample collection examinations (manual distribution, and
and automated ) archiving
Sample transport and
storage Result review and Sample storage and
follow-up retrieval
Sample receipt and
processing Interpretation

 The aim of quality assessment (QA) is to create and follow policies and
procedures so that the most accurate and reliable laboratory results are
provided and to minimize errors throughout all phases of the total testing
process.
 Quality Control (QC) is a component of QA. A QC system monitors and detects
changes in the analytical performance of the test system. QC is used to validate
the analytical phase of patient testing.
 QA activities must go beyond the boundaries of the laboratory to monitor all
aspects of laboratory performance.
 The quality manual contains the laboratory’s overall quality policy, the quality
objectives, and the policies, processes, and procedures for each quality system
essentials (QSE’s). Overall, the laboratory requires two types of manuals, one
containing all the technical procedures necessary for the three phases of testing,
and a quality manual. The quality manual contains all non-technical procedures
that are integral for managing a quality laboratory. Examples of non-technical
areas include: training staff and assessing competency, defining document and
record retention schedules, investigating occurrences, and defining safety
practices, laboratory restrictions, and the use of personal protective equipment
(PPE).

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TRAINER’S GUIDE (2015) 8-7

 Connections and Applications

 Cross-checking is the final step before the release of the results from the
laboratory. It provides an additional review of the report by a second staff
member. Link this to the activity, Is the Test Ready to Be Re Released?.

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Tool: Validation Items

Expected List of Items for Validation of Test Results

Pre-analytical
 Patient identification
 Correct specimen labeling
 Proper patient preparation
 Proper sample presentation
 Requisition/order matches specimen
 Requisition has accurate contact (ordering party information)
 Specimen in acceptable condition
 Specimen transported appropriately
 Log book entry matches specimen
 Any abbreviations are confirmed
 Person collecting the samples is identified
 Date and time of collection is indicated

Analytical
 Results make sense clinically
 Results are within the linearity of the analyzer’s range
 If diluted, final results are calculated correctly with the correct dilution factor
 There were no flags on the analyzer’s results that need investigation
 QC associated with the result run was acceptable
 Reagents and test kits used are within expiry date
 Panic (critical) values are confirmed
 Confirmatory testing or established testing algorithms are completed
 Previous patient results are available to assist with interpretation of current
sample’s result

Post Analytical
 Each test ordered has an appropriate result including test and result match
 Proper concentration units for result has been used
 Decimal place is correct if result has decimals
 Person performing the test is identified
 Result release is dated and timed
 All results and documentation are legible
 Immediate notification and documentation of a Panic (critical) Value.
Submission of results and verification of the recipient’s accurate receipt of
results using a read-back-of-results mechanism.
 Report interpretative information, which assists clinician with interpretation of
test result (information is not misleading, inadequate or contradictory)

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TRAINER’S GUIDE (2015) 8-9

ACTIVITY Is the Test Report Ready To Be Released? Module 8

PURPOSE: RESOURCES FOR FACILITATOR:

Test result reports should be complete,
accurate, legible, and clinically valid. In  PowerPoint slides: 8.9 to 8.12
this activity, participants cross-check a  Tool: Laboratory Report Answers
test report to identify errors and  Tape, flipchart and markers
omissions that must be resolved before
the report is released.
RESOURCES FOR PARTICIPANT:
 Handout: Errors Noted (801)
 Worksheet 1: Laboratory Report (802)
 Worksheet 2: Report for Review (803)
 Job Aid: Cross-checking Guidelines (804)

This activity supports the following laboratory management tasks and SLIPTA checklist items
Management Tasks 8.1 Monitor testing to ensure SOPs are followed and tests are performed and
reported properly and promptly
8.2 Cross-check test reports against test request to ensure completion of all tests
8.3 Review test records and findings promptly to ensure accuracy and timely
release of test results
8.4 Validate assigned tests and specific abnormal results
9.1 Aggregate and report all test findings for each patient

Checklist Items 1.5 Laboratory Policies and Standard Operating Procedures Are policies and/or
standard operating procedures (SOPs) for laboratory functions, technical and
managerial procedures current, available and approved by authorized
personnel? (Identification and Control of Nonconformities; Authorization;
Reporting and Release of Results)
9.1 Test Result Reporting System Are test results legible, technically verified by
an authorized person, and confirmed against patient identity?
9.2 Testing Personnel Are testing personnel identified on the result report or
other records (manual or electronic)?
9.3 Report Content
9.4 Analytic System/Method Tracing When more than one instrument is in use for
the same test, are test results traceable to the equipment used for testing?
9.8 Test Result Are test results validated, interpreted and released by
appropriately-authorized personnel?
10.3 Is corrective action performed and documented for non-conforming work?

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TRAINER’S GUIDE (2015) 8-10

This activity is related to the following activities:

Module 1: Whisper Down the Alley
Module 1: What are the Benefits of a Standardized Process?
Module 1: Competency Assessment
Module 6: Using Standard Operating Procedures
Module 10: Why Was The Outdated Version Used?

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TRAINER’S GUIDE (2015) 8-11

ACTIVITY AT-A-GLANCE
Step Time Resources Key Points

Slides 8.9 to 8.10

1 Introduce the activity 5 min
Worksheet 1

2 Conduct the activity 10 min Worksheet 1

Slides 8.10 to 8.11

Job Aid
3 Review the test report 10 min Worksheet 1
Handout
Tool

Discuss how to Slide 8.12

4 document the cross- 10 min Worksheet 2
check review

Discuss the importance

5 5 min
of cross-checking

6 Conclude the activity 5 min

TOTAL TIME: 45 min

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TRAINER’S GUIDE (2015) 8-12

PROCESS
Preparation
 Verify the printing quality is sufficient for Worksheet 1: Laboratory Report and
Worksheet 2: Report for Review in the participant’s manual. If printing quality
is insufficient or English is not used in the report, then procure blank in-country
result reports. Add entries (both errors and omissions) to create Worksheet 1.
Create an acceptable report to use for Worksheet 2. If the approved report
document is missing important information (i.e. reference ranges or units),
consider facilitating a discussion regarding essential report components and the
necessary steps to revise an approved document. Link this to the activity, Why
Was The Outdated Version Used?.

Step 1. Introduce the activity 5 min

 Project  Slide 8.9 to introduce the activity.

 Explain the importance for creating a cross-checking workstation.
o Emphasize that the product produced by the laboratory is accurate and
reliable results. In order to ensure high quality results, the final step
before the release of results from the laboratory should be a cross-check.
o Remind participants about the activity, What are the Benefits of a
Standardized Process?
o Explain that standardization makes errors more difficult to commit and
more visible when committed.
o Explain that through this activity the last benefit, “absorb errors that are
committed,” will be emphasized. It is through cross-checking that errors
which slip past standardization are detected and addressed before the
results are released (i.e. the errors are absorbed within the laboratory).

 Project  Slide 8.10 and refer participants to Worksheet 1: Laboratory

Report.
o Explain to the participants that they will cross-check a test report.
Participants will work individually to identify all omissions or errors
committed by the laboratory staff members by circling them on their
worksheet.
o Emphasize that they are to review this record and not focus on the
document (approved report format for this laboratory).
o Instruct participants to complete the ‘Patient Information’ section located
in the lower right hand corner of Worksheet 1 with either their own
information or that of someone close to them (e.g., their mother, son,
etc.). Emphasize the connection between results reported and patient care
(i.e. patient care is based on laboratory results).

Step 2. Conduct the activity 10 min

 Inform the participants they have 10 minutes to cross-check the report.
 Remind participants to focus on the laboratory staff’s errors or omissions on
Worksheet 1: Laboratory Report.

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Step 3. Review the test report 10 min

 Distribute or reference Job Aid: Cross-checking Guidelines.

 Project  Slide 8.10 to refer to during the classroom discussion

 Ask each participant to provide a response for an error or omission identified
on the worksheet. See Tool: Laboratory Report Answers. Discuss and connect
each response with Job Aid. Ensure the discussion includes ways to resolve or
prevent the error or omission.

 Project  Slide 8.11 and refer participants to Handout: Errors Noted. Ensure
every error or omission was discussed. Refer to Tool for a list of errors and
omissions.

Step 4. Discuss how to document the cross-check review 10 min

 Project  Slide 8.12 and refer participants to Worksheet 2: Report for

Review.
 Indicate that this approved document does not have an area for the
technologist or supervisor who performed the cross check to initial or date the
record.
o Ask participants to suggest ways to document that the cross-check review
was performed (i.e. initials/date noted in upper right hand corner of the
report or the cross-checker initials and enters the ‘Report Date/Time’).
Discuss how this procedural step can be addressed/standardized in the SOP
and communicated to staff.
o Select one suggestion and instruct participants to perform the
documentation of their review on Worksheet 2. Indicate the report is ready
to be released to the customer.

Step 5. Discuss the importance of cross-checking 5 min

 Discuss the advantages of cross-checking reports before results are released.
 Discuss ways their laboratory can begin to implement cross-checking in their
test workflow process and to organize a cross-checking workstation.

Step 6. Conclude the activity 5 min

 Highlight or reiterate the key messages below.
 Make certain participants achieved the objectives of this activity.

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TRAINER’S GUIDE (2015) 8-14

 KEY MESSAGES Can they:

 A cross-check provides a quality step to review  Cross-check a laboratory report

accuracy and reliability of results prior to release. identifying errors and
omissions?
 Each test request should have a corresponding result
that is accurate and clinically meaningful.  Provide next steps to resolve or
prevent the errors or omissions?
 Laboratory errors and omissions are best handled prior
to their release from the laboratory. However the most
efficient way to handle errors is to prevent their initial ACTIVITY OBJECTIVES
occurrence.  MET?

 Connections and Applications

 Mistakes are best handled by first preventing them and second by addressing
them immediately. The most effective principles to achieve this are
standardization and confirmation. Standardization means the work is performed
the same way each time. Confirmation means detecting and addressing the
error which slips past standardization before the error is released to the
customer.
 Behind every result reported is a patient. A cross-check, the final inspection of
the report prior to its release, improves the quality of the laboratory and
patient care.
 Cross-checking provides additional benefits beyond the validation of results at
the individual workstation.
o With the review of a consolidated report on the patient, additional clues
may be noticed that need further investigation. For example, if the
chemistry workstation indicated the sample was moderately hemolozyed,
the hematology sample may require further investigation and review of
the RBC and hematocrit results.
o With the review of a batch of results from a workstation, patterns may be
noticed. For example, if numerous calcium results are consistently
reported for all patient types greater than the established reference
range, the validity of the results should be questioned. In hematology, if
the MCHC is consistently increased, further review of the instrument
should be investigated.
 Standard operating procedures (SOPs) must specify how to report a result for a
test. To standardize what constitutes a reportable format, the SOP should state
acceptable responses, significant figures (where applicable), units of measure,
and any other pertinent information. Link this concept to the following
activities: Whisper Down the Alley, What are the Benefits of a Standardized
Process?, and Using Standard Operating Procedures.
 All reports should have the initials of personnel who performed the tests with
the corresponding result. Acceptable responses may include: test not indicated
(NI), quantity not sufficient (QNS), or hemolyzed – unable to report. Policies
and procedures must be established for the use of standardized abbreviations
and the handling of unsatisfactory samples. If a test can not be performed
because the specimen is unsatisfactory or QNS, it must be recorded on the
report. If this information is not recorded, it will appear as if the request was
overlooked.
 Ensure staff members are familiar with the SOPs in order to standardize the
reported results. Policies and procedures should be established to address
critical results, ammended results, abbreviations, and unsatisfactory specimen

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TRAINER’S GUIDE (2015) 8-15

 Connections and Applications

reports. Consider the review of a SOP or policy during a staff meeting that
involves a common issue encountered at the cross-check workstation.
 Ensure training and competency assessment includes how to correctly complete
the test report for all phases of the laboratory. Link this concept to the
Competency Assessment activity.
 Utilize the instrument software to assist technologist with result reports.
o Instrument set-up parameters for result reports should be the same as the
SOPs specified format. For example, if a test is reported in whole
numbers, then program the instrument’s set-up parameter to only report
whole numbers on the print-out. Carefully set the instrument’s
parameters so that any additional interpretive steps required by the
technologist are removed. Become familiar with the manufacturer’s
operation manual to see if the set-up parameters are specific to non
quality control (QC) results only or if they also involve the QC format.
o Instrument set-up parameters for result reports should be in alignment
with the report format. For example, the test print-out order on the
report for a panel can be set in the same order as the instrument’s set-up
parameters. Select the same order as it appears on the report or logbook
so result inversions do not occur when results are transcribed.
 Post the Job Aid: Cross-checking Guidelines at the workstation to assist staff
members to cross-check reports.
 When questionable requests appear on the requisition, always clarify the
requests with the provider or nursing unit who ordered the test. For example, a
urine pregnancy request on a male indicates a transcription error (test never
ordered, incorrect patient information supplied, or wrong patient identity
entered on the request). It may also reflect the incorrect test choice if the
request was for the beta-HCG tumor marker.
 The information recorded on the report should be sufficient to recreate the
entire test sequence for each phase of the test process.
 Critical means ‘life-threatening’ and must be quickly acted upon. Policies and
procedures must be established that define what constitutes a critical result
and how to handle and document a critical result on the report and in the log
book. All critical results should be verified by either a repeat of the test or
verified by other means, for example, a peripheral smear review. If a test is
repeated on the same sample, it should be noted it was verified on the same
sample. If the specimen was recollected, it should be noted that verification
was performed on a recollected, second sample.
 An excellent gauge to determine legibility is to note if the result must be looked
at twice to determine its value, then it is not legible.
 The results should be aligned by using the decimal point, which makes the
report easier to scan and interpret for the provider.

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TRAINER’S GUIDE (2015) 8-16

Tool: Laboratory Report Answers

Errors and Omissions on the Laboratory Report (Worksheet)

 CBC alignment – decimal alignment makes it easier to scan and
interpret results.
 RBC result – illegible
 HCT result – illegible. If the result is 22% and not 33%, H & H does
not match
 RDW – incorrect decimal placement; should be 16.0%
 PLT (platelet)
Hematology
o Random erroneous mark on requisition could make result
Section
appear as 122
o No documentation that the critical value was confirmed or
notified to customer
 Differential
o Count - exceeds 100 cells
o Initials of tech who performed the test are absent
o Macrocytosis - indicated with a MCV of 68.9 fl
 Initials of tech who performed the test are absent
 Normal BUN with an elevated creatinine – shows an inconsistent
relationship between results and indicates a test or instrument
issue.
Chemistry  Bilirubin results -written on wrong line ( one row above)
Section
 D-Bili (direct bilirubin) - value does not have a leading zero
 ALT - reported to the tenths but reference value is reported to
the whole number
 Calcium and Phos (phosphorus) - overlooked

 Urine pregnancy - tech who performed the analysis forgot to

Additional indicate result
In-House
Testing  If the patient is a male (supplied by participant), then the request
is incorrect.

 Glucose – result is illegible

 Specific Gravity (SG) – numbers inverted, should be 1.025.
urinalysis strips measure SG in increments of 0.005
 pH- there is no decimal point
Urinalysis  Nitrite – inconsistent report format. For format to remain
consistent, the word ‘positive’ should be used
 Microscopic
o Performing tech initials absent
o WBC and Bacteria microscopic results do not correlate with
macroscopic results, possible patient mix-up
Turn-around Too long for requested tests, report date and receive date differ by 2
Time (TAT) days

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TRAINER’S GUIDE (2015) 8-17

Worksheet 1: Laboratory Report

SLMTA Module 8: Laboratory Testing Activity: Is the Test Report Ready to Be Released?
TRAINER’S GUIDE (2015) 8-18

Job Aid: Cross-Checking Guidelines

Cross-Checking Guidelines
Items to be verified prior to release of test results
Completeness Result Information
 Each test has a corresponding result  Legible
 Patient information  Proper placement of decimals
 Clinical information  Uniform result alignment with regards to decimal
 Provider information placement
 Specimen information  Format of results corresponds with SOP
 Collection information  Proper units and significant places
 Initials of staff member who performed each test  Abbreviations used from approved list
indicated  Within instrument linearity
 Date and time of report  No associated instrument codes with regard to accuracy
 Result information identical with log book  Result corresponds with correct test
Critical (Panic Values)  Diluted results multiplied with correct dilution factor
 Result verified and verification documented  No consistent pattern or trend exhibited between
 Documentation of result notification patients for a specific analyte during cross-checking
unless patient grouping under review is from the same
o On result report diagnosis/population pool (i.e. Newborn hemoglobin
o In log book and hematocrit)
Testing Priority Appropriateness
 STAT request’s communicated and documented  Test relevant to patient’s age and gender
 Delays communicated and documented  Result information makes clinical sense
Specimen Rejection o Electrolytes
o BUN/Creatinine
 Reason for specimen rejection documented
o Macroscopic with microscopic
 Clinician and / or patient notified and this notification
is documented o Instrument with smear
o RBC Indices, RBC count, Hemoglobin and
Hematocrit all show agreement

SLMTA Module 8: Laboratory Testing Activity: Is the Test Report Ready to Be Released?
TRAINER’S GUIDE (2015) 8-19

Handout: Errors Noted

SLMTA Module 8: Laboratory Testing Activity: Is the Test Report Ready to Be Released?
TRAINER’S GUIDE (2015) 8-20

Worksheet 2: Report for Review

SLMTA Module 8: Laboratory Testing Activity: Is the Test Report Ready to Be Released?