The page below is a sample from the LabCE course Concept and Construction of a Laboratory Individualized Quality Control Plan. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Example-- Documenting Observations

Each step in the process should be recorded as it is being observed. Two examples of how to record the information are shown below. Example 1 is the table that was presented previously. The first column in the table lists all the required steps in the process. The second column can be used to document any deviations that are observed in the process. Example 2 is a simple listing of the steps as they are observed. This list will be compared later to the list of required steps.
Example 1

Process Step
Comments
Ammonia test is ordered by provider

Test's priority is determined
This is determined by the provider
EMR transmits the order to the phlebotomist

Phlebotomist prepares supplies for collection, including cup of ice

Phlebotomist identifies patient
Phlebotomist checked ID band but did not ask patient to state name
Phlebotomist applies tourniquet to locate vein

Phlebotomist releases tourniquet before collecting sample
Phlebotomist performed venipuncture with tourniquet in place
Phlebotomist collects and labels sample

Phlebotomist places labeled sample into zip closure bag and places bag on ice immediately
Phlebotomist checks venipuncture site and applies bandage before placing sample on ice. (5 minutes elapsed from time of collection)
Phlebotomist transports sample to lab immediately

Lab assistant documents receipt in LIS
Lab assistant removes sample from ice before documenting receipt in LIS.
Lab assistant centrifuges sample, separating plasma from cells within 15 minutes of collection
Time lapse before centrifugation is 8 minutes
Lab assistant delivers sample to chemistry for testing
Chemistry testing personnel notice STATSpin lid is closed and investigate (4 minutes elapse)


Example 2
Ammonia Testing Process
  1. Ammonia test is ordered by Provider
  2. The test's priority is determined
  3. EMR transmits the order to the phlebotomist
  4. Phlebotomist reviews the order
  5. Phlebotomist prepares supplies for collection
  6. Phlebotomist travels to patient room and performs patient identification
  7. Phlebotomist applies tourniquet to locate vein
  8. Phlebotomist performs venipuncture with tourniquet in place
  9. Phlebotomist completes venipuncture and sets blood sample on bed
  10. Phlebotomist labels blood sample
  11. Phlebotomist checks venipuncture site and applies bandage
  12. Phlebotomist places sample in reclosable biohazard bag
  13. Phlebotomist places bag containing sample into bag of ice (5 minutes elapses between steps 9 and 13)
  14. Phlebotomist transports sample to laboratory
  15. Lab assistant receives sample on ice
  16. Lab assistant removes sample from ice
  17. Lab assistant documents sample receipt in LIS
  18. Lab assistant walks sample to STATSpin centrifuge
  19. Lab assistant spins sample for 5 minutes (8 minutes elapse between steps 15 and 19)
  20. Chemistry testing person notices STATSpin lid is closed and investigates (4 minutes elapse)