Week 1 SIP (Ernest)

Hello

I am posted to Histopathology department of a hospital. (Hospital name is confidential). This department involves everything we're learnt in Histological Technique, taught to us by Dr. Khin in year 2. My classmates who are in the same department as me are Ying chee and Athirah.

The whole process starts from obtaining the tissue, storing it in formalin, "passing" it into cassettes, stored in formalin again, processed, embedding, microtomy, staining, and finally sorting and sending out the glass slides. Is it confusing? I will go through it over the next few weeks. I haven't touched on everything yet in the lab.

-------------------------------------------------------
Ok, the first week, we have done fishing, labelling, heating, and staining.

Fishing is when the block is cut into 4um thin pieces, and placed on 40-50deg Celcius water bath. The slice of sample is then "fished" out using a glass slide. The first few times, it was hard to scoop up the tissue. But after 2 days of practising, we can easily fish it up easily, maybe even blind-folded. Haha.

Next the glass slide is labelled using a pencil. We need to write the biopsy number, batch number, year, and medical technologist's initials. It is important to label as it will be used for sorting, according to the doctor's request.

Heating the glass slide on a hot plate to remove the wax and to dry the specimen. The glass slide must be removed of all water first, otherwise the tissue will smudge when heated. To remove all the water on the slide first, we must place the slide only partially on the hot plate. So that the slide won't be too hot. The temperature of the hot plate is above 60 deg celcius, I'm not sure what is the exact temperature.

Then the glass slides are stained using an automated staining machine. However, this machine can only stain tissues with Haematoxylin and Eosin. If you want to stain with other types, you have to use other machines, eg to stain PAS, Perl's stain etc. The slide holder can hold 30 slides, and the machine can hold about 5+ holders. That means it can stain over 150 slides at a time! It can also mount a glass cover slip for you automatically. Very amazing machine, it saves the time of the med techs by staining alot of glass slides at any point of time.

After it is stained, it is sorted according to the batch number and biopsy number and sent to the doctor's in charge for microscopy. The glass slide is attached to the doctor's form.
-------------------------------------------------------

We have also assisted pathologists in trimming organs. Most of tissues or organs have tumours. The organs/tissues we have seen so far are breast, rectum, iluem, liver, uterus, prostate, and pancreas. We stand beside the pathologists while they cut. We assist them by labelling, giving them cassettes and showing them the patient's forms. Very interesting to see them dictate what they see.

Dictate means saying out the observation into a micophone. For example, the pathologist will say "Cyst measuring 6cm by 2cm by 3 cm is located at the upper quadrant of the right lobe". It is recorded into a computer, then sent to LIS (Lab information system - we learnt this in LMQA). An admin staff will then download the dictation and type it out and attach it to the patient's form.
-------------------------------------------------------

Histopathology department is rather fast paced as we handle about 500-700 slides in a day. Some are urgent while some are routine. Thus eventhough there are quite a number of staff, we need to work very fast.

By Ernest Lim
TG01 0606330I
5.45pm
29 June 2008 (Sunday)

Introduction to CAP (college of American pathologist)

CAP, the most recognized organization boasting board-certified pathologist. Its mission is to promote, assist and to be a proponent in achieving excellence in the practice of pathology and clinical medicine so as to aid in serving patients, pathologist and the public. [1] Established in 1947, it is the world largest association of pathologist which assist in Proficiency Testing and Accreditation Programs. [2] CAP follows stringent inspection procedures, examining everything involving in conducting and maintenance of laboratory before accreditation is done. [3] On March 3, 2008, CAP further offers International Organization of Standardization (ISO) 15189:2007 Accreditation so as to enhance patient safety and minimize laboratory-associated risks. [4] CAP is to ensure patient receives best health care and to protect pathologists license to practice. [5]

References

1.http://www.cap.org/apps/cap.portal?_nfpb=true&_pageLabel=about_cap

2.http://www.pathologytraining.org/frontMatterPDF/CAPFM.pdf

3.http://www.af.mil/news/story.asp?id=123035849

4.http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=laboratory_accreditation%2Fiso%2Fnewsrel_iso.html&_state=maximized&_pageLabel=cntvwr

5.http://www.cap.org/apps/cap.portal?_nfpb=true&_pageLabel=advocacy

Note: [1] represents reference 1, [2] represents reference 2, [3] represents reference 3,[4] represents reference 4 and [5] represents reference 5.

By: Ivan Ng

Class: TG01

Group 2

Word Count: 112 words

Date of submission: 16 June 2008

The Laboratory Accreditation Manual of CAP and CAP’s Safety Regulations

The manual is published by CAP to include comprehensive inspection guidelines[1, 4] and procedures[1, 4], ensuring quality standards are met. It employs the use of checklists[1] aimed at assessing participating lab’s compliance[1] with quality standards[1] and OSHA[2, 3] inspection processes. Eighteen[1] to Twenty[1] checklists consisting thousands[1] of different questions are used for the laboratories’ assessment. The checklist is handed[1] to the laboratories that are applying for accreditation[1] before the inspection[1, 4] process commences.

Some examples of checklists questions are presence of safety[2] policies, procedures for radiation[2] safety, personal protective[2] equipment, assurance of personnel’s vaccination against Hepatitis B[2] and policies regarding recording and documenting[2, 4] injuries[2].

References

1. Judith A. O’Brien. 2000. Common Problems In Clinical Laboratory Management. Surviving Inspections And Attaining Accreditation 11: 251-257.

2. College of American Pathologist and Applicable Clinical Laboratory Safety Regulations PART III. Retrieved 16th June, 2008 from http://www.iupui.edu/~cletcrse/370/cap.htm

3. Occupational Safety and Health Administration. Retrieved 16th June, 2008 from http://www.osha.gov/

4. Collage of American Pathologist - CAP Accreditation New Initiatives Frequently Asked Questions. Retrieved 16th June, 2008 from http://capstaging.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=laboratory_accreditation%2Finitiative_faq.html&_state=maximized&_pageLabel=cntvwr


Note: Subscript [1] represents reference 1, subscript [2] represents reference 2, subscript [3] represents reference 3 and subscript [4] represents reference 4.


By: Ma Xianwei Benjamin
Class: TG01 Group 2
Word Count: 100 words
Date of submission: 16 June 2008

Aim of College of American Pathologists (CAP) Accreditation & Proficiency Testing (PT)

When hospital and reference laboratories[1] achieved CAP accreditation, they are being recognized as high quality[2] by being able to produce accurate patient results by constantly assessing their performance through PT[1] and provide patient care at lowest possible cost[2].

PT assesses the accuracy of results and is part of quality control[3]. Participating laboratories report results to CAP for assessment after carrying out necessary tests on blind samples of unknown values given to them[1]. PT results obtained allow detection of analytical, clerical and interpretation errors and they must be investigated and documented[3]. A target standard deviation index (SDI) of 0 is desired.

References

1. College of American Pathologists – What is Proficiency Testing. Retrieved 16th June, 2008 from http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=proficiency_testing%2Fsurveysintro.html&_state=maximized&_pageLabel=cntvwr

2. College of American Pathologists. Retrieved 16th June, 2008 from
http://www.pathologytraining.org/frontMatterPDF/CAPFM.pdf

3. ClinLab Navigator – Proficiency Testing. Retrieved 16th June, 2008 from http://www.clinlabnavigator.com/proficiencytest.html


Note: [1] represents reference 1, [2] represents reference 2, [3] represents reference 3


By: Tan Han Yang
Class: TG01, Group 2
Word Count: 100 words
Date of submission: 16 June 2008

PT tests conducted for Clinical Laboratory Improvement Amendments (CLIA) waived tests

CLIA waived tests are tests that are "simple lab examinations that are cleared by the Food and Drug Administration (FDA) for home use; employ methodologies that are so simple and accurate as to render the likelihood of errorenous results negligible; or pose no reasonable risk or harm to the patient if test is performed incorrectly"(http://www.fda.gov/cdrh/clia/cliawaived.html). E.g. of tests: Dipstick, Urine Pregnancy Tests. The PT Check Up is carried out to decrease errors, ensure correct tests results are used appropriately to the benefit of patients with regards to treatment by "training staff, evaluating instrument and methodology, troubleshooting and assessing staff competency in CLIA waived tests"1.

1:(http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=proficiency_testing%2Fsurveysintro.html&_state=maximized&_pageLabel=cntvwr)
Proficiency testing for CLIA Waived Tests. What is the "PT Check Up" Program?

By: Johan
TG01 Group 2
Word Count: 104 with citation.

Enrollment into PT program by Ernest

To attain CAP accreditation, the laboratory must first enroll itself in a formal proficiency testing (PT) program. Some laboratories may be required to be inspected 3 times a year such as Centers for Medi-care/aid Services (CMS). [1]

If a laboratory fails to enroll in PT, it will receive a Proficiency Testing Exception Summary (PTES). Failure to enroll will require the lab to document corrective actions and required to perform off-cycle PT or an alternative assessment to maintain accuracy. [2]

For tests that CAP does not require enrollment to PT, the lab must perform an external assessment to ensure reliability of the test. [2]

References

[1.] College of American Pathologist - Applying for Laboratory Accreditation. Retrieved on 15 June, 2008 from http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=laboratory_accreditation%2Fapplying_accreditation.html&_state=maximized&_pageLabel=cntvwr

[2.] College of American Pathologist - Laboratory Accreditation Program. Retrieved, 15 June, 2008 from http://www.cap.org/apps/docs/laboratory_accreditation/2008_pt_enrollment_guide.pdf

By Ernest Lim
TG01
Word count: 100 (without citation)
Handed in on 15 June 2008