All laboratory testing requires the creation and completion of a visit for the date of the sample collection. If laboratory testing is to be completed on the day of the visit, the submitting department is responsible for creating a visit for the checking-in the patient prior to the collection of the laboratory sample. If a sample for laboratory testing is received after a patient visit and sent to the laboratory for testing, the submitting department is responsible for creating a visit for the date that the sample was collected.

1. Patient Care Areas using Epic order entry: Complete and sign laboratory orders within the Epic clinical information system. [Skip to item #3 below.]



2. For areas not live on Epic Orders and during Epic down-time: Complete requisition for appropriate laboratory:
• Form: A-1a General Lab (Pathology Doctor's Orders)



• Form: A-1a Therapeutic Drug Assay (TDA) (Pathology Doctor's Orders)



• Form: A-1a Clinical Microbiology Laboratory (Pathology Doctor's Orders)
     Requires list of antibiotics patient is receiving.
     Requires diagnosis, testing varies according to suspected clinical diagnosis.



• Form: A-1a Immunopathology Laboratory (Pathology Doctor's Orders)
     Requires diagnosis, testing varies according to suspected clinical diagnosis.



• Form: A-1a Critical Care/Special Care Nurseries Laboratory (Pathology Doctor's Orders)



• Form: A-1a Molecular Pathology/Diagnostics Laboratory (Pathology Doctor's Orders)



• Form: Blood Center Request (Pathology Doctor's Orders)



• (Please refer to the tables for complete forms listing).



• Information required on A-1a forms:



1. Label the form/requisition with an Epic label or print the full name (last, first, middle initial), medical record number, birthdate, and current date on the requisition.
   


2. Nursing station or clinic.
   


3. Ordering physician's name, code and signature. Clinic codes are unacceptable.
   




3. All requisitions (both Epic generated and non-electronic) require the date and time of collection and the collector's initials be recorded. Microbiology also requires the collectors title.



4. Determine correct tube type and blood volume for tests ordered (e.g. anti-coagulant, additive, phlebotomy tubes and order of draw). The correct sequence to draw blood specimens or to transfer from a syringe is:
   
   >>>Blood cultures, light blue top, red top, light green (PST) green top, lavender top and/or pink, white top, gray top, yellow top, and Fibrin Degradation Products (FDP) top.


NOTE:

1. If a light blue top tube is drawn with a holder and butterfly needle, prime the tubing with a discard tube before filling the sodium citrate tube (light blue topped).


2. Specimens for Blood Bank require a specific patient identification and collection process. Refer to "Blood Center Services" additional information.



5. Identify the patient using two identifiers. On in-patients compare the name and hospital number from the arm band to that on the requisition and labels. If patient is an outpatient, ask them to state their full name and date of birth. If patient is an infant or confused adult, check arm band or ask person accompanying the patient for identification. See Patient Identifiers (UIHC Policy V.35)



6. After drawing, but before leaving the patient, label the tube(s) with two patient identifiers (PID) labels. Transport to the appropriate laboratory. Consult the Epic requisition or the Pathology Laboratory Services Handbook for appropriate transportation requirements, e.g., "on ice".



7. Intravenous Fluids: If possible, draw blood from the arm/hand that does NOT have intravenous fluid being administered. Tests results may be altered by dilution and/or content of the intravenous fluid, resulting in misleading laboratory values.


For samples that MUST be collected from an arm with an active I.V., the best option is to collect the sample distal (below) the intravenous site. The infusion must be turned off for a MINIMUM of 2 minutes, before drawing the sample. If the only available site is proximal (above) to the I.V. site, turn off the I.V. for at least 2 minutes and draw from a vein other than the vein with the I.V. line. Record "drawn distal/proximal to I.V." in the patient's chart. Follow the same procedure if a sample must be drawn during blood products transfusion. Best practice is to wait one hour after the transfusion is completed before drawing the sample.