Hospital Corpsmen who can perform blood and urine tests and interpret the results are better equipped to determine the cause of illness or request assistance. Since they can provide a more complete clinical picture to the medical officer, their patients can be treated sooner.

In this chapter, we will discuss laboratory administrative responsibilities, ethics in the laboratory, the microscope, blood collection techniques, and step-by-step procedures for a complete blood count and urinalysis. Also included are basic testing procedures for bacteriologic, serologic, and fungal identification.

THE HOSPITAL CORPSMAN AND THE CLINICAL LABORATORY

LEARNING OBJECTIVE: Recall clinical laboratory administrative procedures and ethics policy.

The Hospital Corpsman is not expected to make diagnoses from test findings or to institute definitive treatment based upon them. However, with the availability of modern communications facilities, having the results of these tests available will greatly assist the Corpsman in giving a clearer clinical picture to the supporting medical officer.

Needless to say, accuracy, neatness, and attention to detail are essential to obtain optimum test results. Remember also that these tests are only aids to diagnosis. Many other clinical factors must be taken into consideration before treatment may be started.

ADMINISTRATIVE PROCEDURES AND RESPONSIBILITIES

The ability to perform clinical laboratory tests is a commendable attribute of the Hospital Corpsman. However, the entire testing effort could be wasted if proper recording and filing practices are ignored and the test results go astray. As a member of the medical team, it is your responsibility to make sure that established administrative procedures are followed with regard to accurate patient and specimen identification. It is your further responsibility to ensure laboratory reports in your department are handled and filed properly.

Since the test results are a part of the patient's clinical picture, their precision and accuracy are vital. Test results have a vital bearing upon the patient's immediate and future medical history. They are, therefore, made part of the patient's health record (inpatient or outpatient). Laboratory reports of inpatients are placed in the inpatient health record, while laboratory reports of outpatients are placed in the outpatient health record.

Laboratory Request Forms
The armed forces have gone to great lengths to produce workable, effective laboratory forms that serve their purpose with a minimum of confusion and chance for error. These forms are standard forms (SF) in the 500 series. Their primary purpose is to request, report on, or record clinical laboratory tests. With the exception of SF-545 (Laboratory Report Display), SF laboratory forms are multicopied and precarbonized for convenience. The original copy of the laboratory report forms are attached to the SF-545 (located inside the patient's heath record), and the carbon copy becomes part of the laboratory's master file. For a complete listing of SF forms and their purposes, refer to the Manual of the Medical Department (MANMED), NAVMED P-117.

SF laboratory request forms are not the only means by which healthcare providers can order laboratory tests. Many of today's naval medical facilities have computerized laboratory systems. Computerized laboratory systems enable healthcare providers to enter laboratory test requests into computers located in their spaces. Once healthcare providers enter their test requests, patients may report immediately to the Laboratory Department, where specimens are obtained and tests are performed.

Use of Laboratory Request Forms
Write information on the SF laboratory request forms in black or blue-black ink. Use a separate SF laboratory request form for each patient and for each test. Document the patient's full name, family member prefix and social security number, rate/rank, dependency status, branch of service, and status in the "Patient Identification" block. Also identify the ward or department ordering the test in this block. See figure 7-1 for an illustration of the Urinalysis request form, SF-550. Computer-generated laboratory test requests require the same patient identification data as SF laboratory requests.

Since the results of the requested laboratory test are usually closely associated with the patient's health and treatment, the requesting healthcare provider's name should also be clearly stated in the "Requesting Physician's Signature" block on the request form (fig. 7-1). The doctor requesting the urinalysis should sign in this block. Alternatively, you may type/print the doctor's name in the block and initial the entry to authenticate it. This practice ensures that the report will get back to the provider as soon as possible.

Enter the requested test in the "Remarks" block (e.g., "Clean catch midstream to R/O urinary tract infection"). Because the data requested, the date reported, and the time of specimen collection are usually important in support of the clinical picture, these pieces of information should be clearly written on the request in the areas provided for them (fig. 7-1).