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From benchtop to desktop: creative forms for organizing and presenting laboratory data.

It was not that long ago that our microbiology laboratory had to rely on a somewhat clumsy set of tools for managing our laboratory's data. Many of us had to spend our time creating forms to record quality control (QC) results using rulers, pens, and graph paper. We had to hunt and peck at the keys on a typewriter, frustrated by being limited to one font size or by having to retype whole documents. Modifications and additions were difficult - crusty bottles of correction fluid abounded. In addition, if someone accidentally used the original document for recording data, it was a disaster.

Fortunately, the personal computer has greatly improved our management of data. Whether the platform is Windows or Macintosh, use of the PC improves accuracy, neatness, organization, instruction, retrieval, and presentation. Applications of various software programs for creating forms are numerous, ranging from sheets for recording QC results, to flow charts, to antibiograms.

The first step is choosing the most appropriate type of form for the function you wish to perform. A spreadsheet document is well suited to a form that contains many rows and columns, such as a form to record QC results. A word processing document should be created when text is the major component. In such a case, elements such as a table or spreadsheet document can be inserted into word processing formats. A drawing program should be used to create graphic elements, which may include clip art, individual blocks of text, drawings, lines, and scanned images.

Although most, if not all, laboratories already use their own computer-generated forms, our microbiology laboratory has created some methods of presenting and managing information that we think are innovative. Following are samples illustrating how PC use improved our laboratory's image and function.

Automated susceptibility testing: Instrument QC

QC is one area where we have found the use of spreadsheets to be invaluable. Because no forms were created or supplied by the manufacturer for recording antibiotic susceptibility testing QC results, we needed to create a record of our QC results on a weekly basis, using specified control organisms.

Therefore, we devised a spreadsheet to accommodate 31 days in a month [ILLUSTRATION FOR FIGURE 1 OMITTED]. The product (in this case a susceptibility card, which is run on the instrument) is listed, as well as the QC organism name and American Type Culture Collection (ATCC) number. The antibiotics are listed along with the expected range. Spaces for recording lot number, expiration date, and technologist's initials are also included. Enough space must be allotted to record the result manually, while still being able to fit 31 days on one sheet of paper. Allowing room for a three-hole punch for placement in a notebook should also be considered. Once the first document is created, it can then be saved as a template for use with subsequent organisms or updated instrument products. A template is the original form of the document in question, which allows the user to modify a copy of the original without having to recreate it. This form organizes the data neatly and instructs the technologist as to which QC tests to run for which organisms, which drug results to record, and the acceptable result range.

In this spreadsheet document, a header was inserted to accommodate title information; and a footer was inserted to accommodate information such as creation/revision date. The organism name was created with the type tool, and the selection was moved to its desired position. A tool is an icon or button in the toolbar usually shown at the top of the document, which allows the user to perform a specified function. In this spreadsheet software, for example, the type tool, allows the placement of text anywhere in the document. Certain cells were then filled with a dot pattern or shading both to make the document easier to read and to indicate which boxes need to be filled in. Most spreadsheet programs include a feature that allows the user to display or to hide selected columns or rows. To avoid confusion, it is possible to display only the data in those columns or rows that you need to work with at any given time.

Labels for stock QC organism culture tubes

We maintain an inventory of stock organisms on agar slants that are used for performing QC on a wide variety of products and media. Messy handwriting and altered or omitted ATCC numbers became a problem. We needed to create a means for achieving consistency, speed, and accuracy in the labeling of QC organisms.

A word processing document was created and formatted for printing on laser labels [ILLUSTRATION FOR FIGURE 2 OMITTED]. Many word processing programs include a function for making labels. Often, this task is accomplished by using the Page Setup function under the File menu. Here, you can designate the paper output to be labels rather than plain letter paper. Most software programs offer a wide variety of label formats that correspond to those found in office supply stores. Each organism label contains the organism name, the ATCC number, and the QC usage for the organism. A place for writing in the date at the time of subculturing the organism is also included. A folder containing several sheets of the each organism label is kept at the QC bench. Again, this one simple computer-generated form greatly increased neatness and readability as well as served as a good organizational tool.

Antibiogram report

Our laboratory serves multiple hospital campuses and uses multiple laboratory information systems (LISs). The direct antibiotic susceptibility pattern report from each LIS is not suitable for presentation. In addition, one of our campuses uses a different antibiotic formulary, so the generic document form needs to be modified. A more complex problem than creating labels, we had to find a means for presenting antibiogram data in an attractive and concise format.

A spreadsheet was created and kept as a template. From this document a second template was created to accommodate a different campus, modifying the institution name, the organisms, and the antibiotics. We wanted to place the organism names horizontally as column heads, but because most of the names are so long, we had to stack them vertically [ILLUSTRATION FOR FIGURE 3 OMITTED]. To do this, the organism names were created using the type tool and then rotated vertically 90 degrees. After all the organism names were created and rotated, they were set to align at the bottom. After adjusting the spacing between names, all of the organisms were grouped and locked, which can be done to prevent users from altering elements or entering data in the wrong cell. The row height was adjusted to accommodate the longest organism name. The antibiotics were then listed as horizontal rows.

Each template contains a header and a footer. Unused cells were filled with a shaded or dot pattern both to avoid filling in the wrong cell and to indicate to the recipient that the data was not applicable or relevant. Borders were turned off or hidden as desired for readability. In addition, any cell can be locked for the reason described earlier. If necessary, formulas can be used in this document to calculate susceptibility percentages. These templates save a great deal of time each quarter, and provide a definite presentation asset [ILLUSTRATION FOR FIGURE 3 OMITTED].

Quick reference

There are many important facts to remember in microbiology for daily bench processing, results interpretation, culture inoculation, and other activities. One example of difficult-to-memorize information is the various generations of cephalosporins. This knowledge is important, however, when reviewing susceptibility patterns or answering a physician's question during a phone call. To make this task easier, we wanted a readily available visual means for reminding workers of important information. In other words, a tip sheet that stands out, doesn't get lost, and is there where you need it!

To fill this need, we created a colorful sign specific to the cephalosporin drugs dealt with at our various institutions. These cephalosporin drugs are categorized by generation. From a design point of view, certain colors stand out to the human eye: especially red and yellow. For this reason, red was used for the first generation, yellow for the second, and blue was chosen for the third generation [ILLUSTRATION FOR FIGURE 4 OMITTED]. To prevent these signs from getting lost, we use acrylic stands as display tools, such as the kind you might see on a restaurant table. We have placed these signs in convenient locations, and they have become valuable reference tools.

To create this sign, we used design software, which allowed the incorporation of the artistic elements we wanted to include. A header was inserted for the title of the sign. The circle tool was used to create the circles. Other drawing tools available in this kind of sortware include those for creating rectangles, lines, or other pre-made shapes. Colored or shaded boxes can be placed behind text for emphasis. In our document, the circles were filled with the desired color, and no outline was selected. The type tool was used to place type on and below the circles. The line tool was used to separate the generations.

Bench assignments and department schedules

Every department supervisor needs a template for scheduling technologists to designated benches. A schedule template can be quite basic, or it can be designed to be more aesthetic. Either way, the creation of a schedule template requires evaluation of department organization. In our lab, we have divided the work into benches based on criteria such as specimen type, microscope work, and so on. Certain tasks that are performed once per week instead of daily are also indicated. A blank area is also included to indicate special projects or administrative duties. The schedule is filled out weekly to indicate workers' bench assignments.

To create this schedule, we created the original document using design software to provide ourselves with more artistic choices. Then, we inserted a table into the original document. That way, we were able to fill the cells with various shades, patterns, type, or drawing elements.

LIS training

During the process of implementing a new paperless LIS, one-on-one training sessions were conducted in a classroom setting where potential laboratory pathogens or biohazards are not allowed. In the lab, the procedure had been to study culture plates and write any observations on a paper work card. However, for the new paperless LIS, workers had to be trained to study the plates and enter all documentation into the computer. So, because we couldn't have culture plates in the classroom setting, we needed to simulate this growth in the clean area for training purposes.

To represent the necessary items, we created a computer-generated document with pictures of culture plates containing bacterial growth. This method allowed the visual representation of an actual culture without the biohazard element [ILLUSTRATION FOR FIGURE 5 OMITTED]. To create this document, a circle tool was used to form the various culture plates, as well as the individual bacterial colonies. The duplicate command speeded up the process of creating multiple colonies. Appropriate colors were chosen, and plates were labeled accordingly.

About spreadsheets

The spreadsheet format is a helpful and flexible tool that can be used to manage, collect, and manipulate data for many different purposes (see Table). In its simplest form, the spreadsheet can be used to create a table or grid. In addition, statistical data can be analyzed using the program's formulas for a given need or calculation. Charts and graphs can then be generated to visually represent the statistical data.

Included is an example of a small study involving turnaround time for rapid beta Streptococcus group A testing. Simple formulas were used in some of the cells to calculate information such as specimen processing time. Pie charts and graphs can be created using the a spreadsheet's chart-making feature that uses the data in the spreadsheet to size various elements of bar charts, trend plots, and pie charts [ILLUSTRATION FOR FIGURE 6 OMITTED].

The obvious reasons for taking advantage of the personal computer as a valuable and flexible tool for laboratory organization include increasing accuracy; neatness; organization; and ease of retrieval, modification, and adaptation; as well as making a good impression on those receiving your documents. In addition to the examples provided, our laboratory has used the PC to design Kirby-Bauer QC charts, work cards for culture workup, flow charts, media QC, and, of course, the inevitable procedure manual. The only requirements to making the most of your computer are to know your platform(s) and your applications. Perhaps the most difficult part of creating such forms is finding that little block of time with some peace and quiet.


Laboratory uses for spreadsheets

* Budgeting

* Test cost analysis

* Employee overtime analysis

* Order/supply inventory

* Blood culture contamination rates

* Validation studies

* Turnaround time studies

Liz Stanley is assistant supervisor of microbiology, Providence Saint Joseph Medical Center, Burbank, CA; and Ellen Jo Baron is director of clinical microbiology/virology laboratory, UCSF Stanford Health Services, Stanford, CA.
COPYRIGHT 1999 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1999 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Stanley, Liz; Baron, Ellen Jo
Publication:Medical Laboratory Observer
Date:Sep 1, 1999
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