The physicians and staff at Peterson Laboratory Services

2. Welcome, and thank you for your interest! The physicians and staff at Peterson Laboratory Services

3. PLS Pathology Quality Assurance Standards And Procedures for Specimen Submission

4. Tools • PLS Reference Manual • Hard copy • Online atwww.petersonlab.com • Provided Sample Requisition • This online training module • CD by request • PLS: 1- 800-876-5522

5. Sections • Requisition • Specimen Preparation • Review

6. Requisition • Correct requisition • Patient name • Date of birth • Date and time of collection • Physician first and last name • “Additional copy to” • Clinical history • Specimen source • Diagnosis and/or “signs and symptoms” • Signature • Other

7. Correct Form • Three PLS Requisition forms: • Cytology • Non-genital Cytology • Surgical/Biopsy –Form 300 (pink)

8. Patient Name/Identifier • Stamp, attach patient label, or hand write – first and last names • Consistent name for each patient (ex: alternately using middle name on some orders – first or initials on others) • Recent name change? An attached note is helpful • Submit patient identifying SS or other number (not financial guarantor SS or other number)

9. Date of Birth • Accurate • Legible • Birthdate, not today’s date • Patient birthdate, not guarantor’s birthdate

10. Date/Time of Collection Important information for diagnosis! • Surgery Date • Time of collection

11. Ordering Physician • Many area physicians share same/similar last name • Give full first and last name, please

12. “Copy To:” • Place in the “copy to” box • Faxed? Please provide fax number • Mailed? Please provide location or mailing address

13. Patient History • Patient history is important to the diagnosis • Please include information • If more space is needed, feel free to write in the “Frozen Section” space directly below

14. Specimen Source • Record in box “Anatomic Origin of Specimen” • Write info on line after “container #x __________” • Include correct site & side of body • Example: “lesion, RT lower leg”

15. DIAGNOSIS • Record diagnosis code, or • “Signs and Symptoms” • Example for a submitted nevi: “growing, irregular borders” • Check “INPT” or “OUTPT”

16. Signature • Please provide your signature • Used for follow-up questoins if necessary

17. Other Considerations • Please do not mark in “For Office Use Only” Box • Please initial any mark outs or changes • Please include copy of insurance card/s and or face sheet

18. SPECIMEN • Packaging • Labeling • Transport

19. PACKAGING • Placed in appropriately sized, approved container • Ratio of formalin/specimen of 10:1 • Container placed in secondary container (specimen bag) • Requisition accompanying each specimen, unsoiled • Example: Specimen in biopsy bottle - biopsy bag in orange striped specimen bag - requisition in outside pocket of specimen bag

20. What Goes In What? • Tissue Biopsy Formalin • Excision Formalin • Fine Needle (core) Biopsy Formalin • Washings/Fluid Fluid Itself Alcohol if very small • Wang Needle Aspirates Alcohol • Fine Needle Aspirates Alcohol or Saccamono • Smears Spray fix immediately if head/neck/lymph 2 air-dried slides also

21. PACKAGING, Cont… • Supplies provided by PLS • 20,40, 60 ml 10% formalin containers • 5 L formalin container • Small, medium, large biopsy bags • Requisitions

22. PACKAGING, Cont… • Large specimens: • Slow penetration of formalin • Refrigerate after fixative added • Very large specimens (i.e., limbs): place in two large red biohazard bags - label with patient name, hospital and source

23. LABELING • Specimen Container Label: • Pt first and last name • Specimen source (site and side of body) • Physician name • Date collected

24. Common Errors: • Specimen & requisition have different names • Writing # on container, instead of content • No label on specimen • Requisition but no specimen • Submitted in specimen bag, instead of biopsy bag • Specimen submitted without fixative • Wrong fixative/wrong kit on special study testing. Call Client Services if questions

25. Transport • Place in hospital/clinic location for PLS pickup • Pickup times vary by location & arrangement • Patient care depends upon specimen quality – place specimens for pickup as soon as possible

26. Transport Cont.. • If Delivered Personally: • Take directly to the gross room of the histology dept

27. Quality Variance Report • If error, Quality Variance Report is sent • Please note corrective action taken, sign and return • CLIA monitors reports and action is taken

28. Review • Which form is used to order pathology testing? • Form 101A • Form 15 • Form 300 • Patient test results may be sent to other providers upon request of ordering physician • True • False • Signs and symptoms pt experiencing is sufficient under “Diagnosis Code.” • True • False

29. Review, cont… • The ratio of formalin to specimen is: • 7:1 • 9:1 • 10:1 • Content, or container number, is required for specimen labeling. • Content • Container Number • Refrigerate large specimens until courier pickup. • True • False

30. Questions? We are always standing by to assist you

31. Thank you for participating… We appreciate your business!