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Guidelines for laboratory adminstration - Part 1.

The modern clinical laboratory is a complex and challenging workplace. It takes expertise in organization, management, and communication to direct it successfully. On the supervisory level, those same skills are needed to implement laboratory policy through delegated tasks and responsibilities. These guidelines, which highlight basic topics and provide references for further study on each subject, will be the most useful if passed along from the director to supervisors at every level.

I. Organizational structure

Laboratories traditionally operate as a hierarchy, with multiple lines of authority leading to one position at the top. Although these guidelines follow that tradition, it is also acceptable to develop other, more innovative approaches. Any system, however, must establish accountability. Every employee should be directly answerable to someone else in the chain of command. In most laboratories final responsibility lies with the director.

A. An organizational chart is essential to document each employee's position in the laboratory's administrative structure.

1. It provides a blueprint for lab action and communication by clarifying areas of authority and responsibility.

2. It defines functions and emphasizes various activities and programs.

B. The chart is dynamic, and must be kept current. Make it flexible enough to allow change when needed, but rigid enough to withstand updating and redrafting.

C. Don't ignore individual personalities and abilities in the laboratory's organization, but remember that the work itself must take top priority.

D. Keep reporting relationships within the organization as simple as possible to avoid misunderstandings.

1. Each laboratory department or section should be self-contained, with all action and communication following established lines of authority.

2. Avoid an overly complex organizational structure, which can isolate workers from direct supervisory contact.

3. Make each staff member responsible to only one supervisor. In turn, don't overload supervisors or managers with an unmanageable number of subordinates.

4. Those responsible for auxiliary activities like fiscal services, personnel, and data processing should report to the organization head.

E. There is no ideal structure for a laboratory organizational chart. It will vary with each work-place's size and complexity. Skeletal charts show only the lab's major units; personnel charts show individual names as well; and functional charts describe the purposes, responsibilities, and activities of each unit.

II. Facilities and services

A. Location is the first consideration in planning laboratory facilities and services. The lab should be in a strategic centralized area with easy internal and external access. Plan for:

1. Individual functions like blood drawing, specimen processing and testing, research, and teaching.

2. Functions that may be consolidated to share space, equipment, or personnel.

3. Accessibility of critical areas like surgery and trauma units. When these areas are distant from the laboratory, develop transport methods for fast service or consider establishing satellite laboratories.

4. Traffic patterns and power requirements.

5. Equipment requiring special attention due to size, weight, vibrations, or noise.

B. Design is the next major factor. Planing must be flexible enough to allow for expanded or diminished services. Consider these factors in designing facilities:

1. Awareness of traffic patterns. Keep work areas self-contaied to minimize movement. Everything a worker needs to perform a test should be within easy reach.

2. Existing equipment and anticipated purchases over the next several years.

3. Utility connections. It shutdowns are required, they should affect as small an area as possible.

4. Floor and bench-mounted equipment and any special electrical or ventilation requirements.

5. Other special requirements for floors, bench areas, cabinets, and other surfaces.

6. Conformity to building codes and standars.

7. Centralized computerization or modification of any existing data management system.

8. Location of safety equipment.

C. Determine what facilities to allow for, and the space each requires. Most clinical lab facilities include:

1. Technical laboratories (chemistry, hematology, microbiology, etc.).

2. Administrative areas (offices, meeting rooms).

3. Teaching space (research areas and audiovisual and other educational equipment).

4. Support areas (media and glassware preparation, storage, and disposal areas, records, mail, data processing).

5. Special areas like sterile and temperature-controlled rooms, a dark room, animal facilities, and lounges, lockers, and rest-rooms.

D. Work flow is another major consideration. A laboratory cannot run smoothly without prompt processing of specimens and results. Plan work flow patterns to optimize efficiency of specimen arrival, total workload, staffing, and task assignments.

1. Planning requires a thorough knowledge of lab services, including volume, frequency, and complexity of testing.

2. Provide for night, weekend, and holiday service.

3. Develop back-up procedures.

4. Investigate the feasibility of longer daily shifts, staggered hours, or multiple shifts.

5. Prepare staff members for interruptions in service in the event of an emergency, and familiarize them with appropriate procedures to follow.

E. The laboratory work environment, a vital aspect of facilities, is strongly affected by certain types of service and equipment, such as lighting; ventilation, including exhausting of noxious materials; heating and air conditioning; piped services (gas, water, vacuum, air); refrigerators and freezers; and electrical and communication systems.

1. When possible, eliminate undesirable conditions such as drafts, dust, vibration, waste, and power fluctuations, or otherwise keep them under control.

III. Materials, supplies, and equipment

A. Design and maintain an inventory control system for the management of materials and supplies. It should include:

1. Low and high stock purchase and maintenance levels.

2. Available storage space.

3. Shelf life of item and rate of usage.

4. Vendor and alternate, quantity discounts, and acceptable substitute products.

5. Date ordered and received.

6. Anticipated delivery time.

7. Criteria for choosing standing orders versus drop shipments.

8. Assignment of responsibility for checking inventory levels, receiving supplies, and issuing requisitions and purchase orders.

9. Bid purchasing guidelines.

10. Purchase schedules that prevent accumulation of toxic or hazardous materials.

B. Develop a protocol to review, schedule, and record preventive maintenance on lab instruments. (See NCCLS Approved Guideline for Clinical Laboratory Procedure Manuals, GP2-A, for details on procedure design.)

1. Each instrument's preventive maintenance protocol should include:

a. Function checklist, including checkpoint and frequency.

b. Initial and subsequent calibration.

c. Acceptable performance parameters.

d. Maintenance schedule and repair record.

2. Maintain a periodic inspection schedule for every machine or instrument in use, including record of dates and inspectors' signature or initials.

3. Assign maintenance duties to specific personnel levels and establish communication between them.

a. First level: technologist (daily or weekly maintenace)

b. Second level: field service representative or local repair person (annual, semiannual, or quarterly)

c. Third level: major repairs, usually done at manufacturer's facility (as needed)

4. Review maintenance contracts annually, updating them if necessary.

5. Take inventory of lab instruments and assign an identification number to each, preferably on engraved metal tags.

6. On separate file cards, record each instrument's name, manufacturer, serial and model numbers, vendor, purchase date and price, warranty period, location, schedule maintenance date, and the name and telephone numbers of repair persons. Also include a description of repairs.

7. Keep records current. (Refer to the current JCAH Accreditation Manual for Hospitals for recommendations.)

C. Specifications for equipment and supplies should clearly delineate the precise items or components to be included in a proposed acquisition.

1. Make specifications concise, informative, and detailed, and adequate to the item's intended life span and use. Note necessary addenda, such as allowable substitutions.

2. If possible, include as specifications a few features unique to the equipment desired, and be prepared to justify them.

3. Prepare acceptance criteria. When the system or equipment arrives in the lab, it should pass rigorous on-site tests before purchase.

D. Define any special handling requirements.

1. For reagent storage, establish a written protocol for identification, storage, and other requirements for chemicals and biologics.

a. Include content, source, date of receipt or preparation, lot number, first use and expiration date, storage requirements, safety hazards, and relevant regulations.

2. Take inventory of all materials listed as hazardous or carcinogenic by the Occupational Safety and Health Administration.

a. Identify known potential toxic and biologic materials and establish policy to minimize danger.

b. Post hazardous materials warnings in accordance with OSHA regulations, and explicit first aid instructions for contact or contamination.

c. Designate areas for emergency flushing or rinsing, convention to reagent preparation and other high-risk areas.

e. Eduate personnel in safe handling of toxic or caustic materials.

3. Establish written protocols for laboratory equipment requiring special handling. Explain the reason for precautions, and describe the requirements.

E. Every laboratory develops its own protocol for ordering and receiving materials. Set down each step of the process in writing, including specific authorization for purchase approval. All ordering systems should include the following steps.

1. The laboratory unit supervisor or designee initiates an order. Order forms should list the item needed, standard package, unit ordering number or cost center, date requested and amount desired, vendor or manufacturer, and acceptable expiration date.

2. The lab office checks the order, transcribes it to a hospital or lab purchase request form, and files order form until item is received.

3. The purchasing department seeks the best price from various vendors, confirms acceptability, and generates a purchase order.

4. The institution's receiving department signs in items and delivers them to the lab.

5. A laboratory staff member signs in items to the lab--in the presence of the receiving department clerk, if there is one.

6. The unit supervisor initials and dates the packing slip, verifies the order, and stores or distributes items.

7. The packing slip is filed for one year, and the original order form is dated and filed.

F. Investigate alternate purchasing methods, such as lease or rental agreements that include reagents.
COPYRIGHT 1984 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1984 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Bender, James L.
Publication:Medical Laboratory Observer
Date:Jun 1, 1984
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