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Stepwise Success

Thinking About Rainbows
February 18, 2015 9:40 AM by Scott Warner
Hospital acquired anemia can be an issue if multiple tubes are collected several times a day. Over time, small amounts of blood (5 mL is a teaspoon) add up. I’ve developed a “short draw” protocol to use low volume tubes and chart the amount drawn for Read More...
Do You Look At Charts?
February 4, 2015 5:45 AM by Scott Warner
When I blogged about looking at inpatient charts in 2012, we had implemented CPOE (Computerized Physician Order Entry) to a limited degree. Now that it’s commonplace and there are few written physician orders, it’s still useful to look at charts. Each Read More...
The Old and the New
January 12, 2015 6:03 AM by Scott Warner
Many years ago when I was taught to run a Monospot, I was instructed in the fine art of rotating the card in a figure 8. The goal was to equally rotate the mixtures in all circles while scanning for agglutination. But in case that was too difficult, vendors Read More...
Does It Matter What It Is?
January 7, 2015 6:03 AM by Scott Warner
As a profession, we are used to having the answers: glucose values, compatible units of blood, pathogens in a urine culture. As simple as this seems to outsiders who see lab techs as mere button pushers, we know there is a lot of judgment involved. In Read More...
Order Entry Errors
December 19, 2014 6:04 AM by Scott Warner
One of our more common complaints is that we didn’t do the correct test. We missed a test because it was not seen, illegible, or written on the back of a two-sided form; we assumed an abbreviation meant something unintended by the physician; we entered Read More...
December 15, 2014 6:03 AM by Scott Warner
Hematuria, or blood in the urine, is distinct from microhematuria . The latter isn’t visible to the naked eye and is detected under the microscope. (The prefix micro is from the Greek mikros , meaning “small.”) It isn’t unusual in urinalysis to see a Read More...
Do Disclaimers Add Value?
November 12, 2014 6:44 AM by Scott Warner
Our tendency to comment results with disclaimers is strong. Examples: Reporting pathogens in a urine culture with many skin flora and adding “possible contamination” Reporting a potassium on a hemolyzed sample and adding “hemolysis may increase results” Read More...
More Sample Lookback
October 1, 2014 6:00 AM by Scott Warner
In 2011 I blogged about using a binary search algorithm to find a point of failure when performing a sample lookback with a large number of samples. In dealing with sample lookback and revising our own policies since then, we’ve hit a few snags: How should Read More...
Fast Facts About Diabetes
August 29, 2014 6:03 AM by Scott Warner
The more I hear about diabetes, the worse it sounds. The statistics on the disease, recently updated by the CDC, are alarming: 29.1 million people have diabetes (9.3% of the US population) 8.1 million people are undiagnosed (about 1 in three with the Read More...
Rarely Ordered But Critical Tests
July 23, 2014 6:05 AM by Scott Warner
The bread and butter of labs are those tests ordered on most patients: chemistry panels, blood counts, urinalysis and culture, and to an extent coagulation and blood bank. These are often ordered serially on patients admitted to your hospital, creating Read More...
A Better Marker for DKA
June 25, 2014 6:04 AM by Scott Warner
The nitroprusside test typically performed with a Bayer Acetest tablet is a laboratory classic. It’s one of the first tests I learned. In the nitroprusside reaction, acetoacetic acid, a serum or urine ketone, reacts with sodium nitroferricyanide and glycine Read More...
Better Counting
June 20, 2014 6:11 AM by Scott Warner
We do a lot of counting in the laboratory: white blood cells, abnormal red cells, urine formed elements, and microbiology colony counts. I’ve worked in labs where these are precise, for example, reporting urine microscopic red cells as rare, few, 0-1, Read More...
It’s All About Technique
April 30, 2014 6:14 AM by Scott Warner
Running lab tests can look easy but often isn’t. Consider a common serology test, the heterophile screen. The OSOM Mono Test is one random example. The package insert lists the following with pictures: For serum, plasma, or whole blood samples in tubes: Read More...
Are Mistakes Systemic?
April 25, 2014 6:14 AM by Scott Warner
The more I deal with process design, the more I suspect human error is systemic. Not that we are flawless workers -- one author parses mistakes and slips by intention or outcome -- but we give the system a pass too often and blame human error. We work Read More...
Revisit Your Kits
April 7, 2014 6:01 AM by Scott Warner
Our laboratory uses many “plop plop fizz fizz” tests for qualitative screening, like most labs. These quick and easy tests have been in labs as long as I can remember with a few enhancements over the years that have made them even easier e.g. internal Read More...


About this Blog

    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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