Review of labs and … some TESTS I WISH YOU’D

Transcript:Review of labs and … some TESTS I WISH YOU’D:
Review of labs and … some TESTS I WISH YOU’D NEVER ORDERED Christopher Fink, DO Duke Primary Care Medical Director for Clinical Laboratory Practice Assistant Professor of Medicine, Duke University School of Medicine Labs that should not be collected outside main lab Ammonia Semen analysis Ionized Calcium Genetic Testing( patients should be referred to Genetic clinic $$$) (depending on the clinic)blood cultures Blood film- Special Heme Sputum/Bronchial samples Blood Gases Stool samples – Can be brought into the lab but not collected in house (preferably) HEPATITIS C Goal is to screen all Americans and treat now that cure with treatment is near 100%. If we can screen and treat we will be able to mostly eradicate this disease in the US. **Hep C Antibody with Reflex to PCR LAB9369 Metabolic Panels 2 types: BMP and CMP When to order each? Make sure you have a reason for the lab you order. BMP: Na, K, CO2,CL, BUN/Cr, Ca, Glucose CMP: The above and Bilirubin, AST, ALT, ALK Phosphorus, Albumin and Total Protein. STD Screening recommendations from UptoDate Point of Care – A1c (why is it off?) Not uncommon to get erroneous results. (Should not happen but does) Why? Usually due to sampling error. Need to make sure cleansing of the finger is done with alcohol swab. Do not wipe away. AFTER dry use the lancet and collect the sample. If needed repeat sample or send in a lab draw. If still looks erroneous please place and ERS and let us know. MAKE SURE THAT PATIENTS ALWAYS HAVE A BANDAID PLACED AFTER ANY NEEDLE STICKS. WHETHER THEY WANT IT OR NOT. WE DON’T LIKE BLOOD ON THE DOOR HANDLES OR FURNITURE! Urine Culture and mixed flora Steps to decrease Mixed Flora 1. Provider education 2.Patient instructions Verbal and in Print 3.Educators looked instructions over and adapt the language to a 5th grade level. Provide instructions in Spanish. 4.Now working on poster/cartoon instructions. 5.Draw off Ucx first on all UAs, even if not ordered. Ideally within 15 minutes of urine dropping 6.Observe processes When should we not order a Urine Culture? Healthy non pregnant young women with typical of non-febrile cystitis who have no risk factors of resistant infection. When the UA shows no nitrites, blood or leukocytes (unless <2yo) AND DUH!! When the patient doesn’t have any symptoms!!! Always remember, bacteriuria does not indicate a need for antibiotics in an asymptomatic patient.