CLINICAL LAB SCIENEC

48
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
To be prepared for any differences in required credentials, some medical
technicians and technologists decide to take different registry examinations
from each of the several registering agencies in case they move from one state
to another or from one facility to another. Potential employers may subjectively
view one of the professional organizations with more favor than any of the others
and may hire only those who possess registry credentials from one particular
professional body. Most of the registries and state licensing agencies require a
formal period of formalized on-the-job training, and some allow for a “grandfather
clause” that grants certification to personnel who were working in a particular
capacity before an arbitrarily established date. The “grandfather clause”
sometimes enables those who have no training or academic credits to perform
medical laboratory work, even at a supervisory level.
Laboratory Testing by Those Other Than Professional
Laboratory Workers
Laboratory procedures may be legally performed in both hospitals and medical
offices by those with minimal training. And even with the availability of situations
where certain tests may be performed by other than laboratorians, there are
still occasional attempts by some pathologists, physicians, and hospital officials
to remove the often minimal constraints currently placed on the appropriately
credentialed technician-level worker. This is explained more thoroughly in the
section dealing with efforts to gain state licensure. The menu of laboratory tests
that may be performed in POLs or by hospital workers for monitoring inpatients
by those with no formal training in laboratory medicine has broadened from
only 11 low-complexity tests to a somewhat wide range of tests as technology
improves and becomes more foolproof. These tests are called waived tests and
they are not required by CLIA 88 regulations to be performed by credentialed
personnel.
Point-of-care testing (POCT) includes a menu performed by nurses and in
some facilities even by patient care technicians to monitor a patient’s condition,
such as the measurement of a finger-stick glucose to determine if insulin should
be administered. Certain laboratory tests for patients by other than medical laboratory
workers in the home or in a hospital bed are possible due to these rules
allowing low-complexity testing by minimally trained personnel. These training
requirements must be documented, however, before a non–laboratory worker is
allowed to perform even these waived tests. And in some hospitals and clinics,
noncredentialed personnel performing POC testing must be monitored periodically
by a laboratory professional. It is common in many facilities for the laboratory
to provide technical expertise in calibrating the instruments used for POC
testing on a daily basis and to document and record quality control results.
These are areas that may be examined by site visitors performing facility inspections
for continued accreditation of the health care facility.
POLs represent an area where non–laboratory personnel may perform
certain laboratory tests. In some cases, to their credit, a POL with several physicians
who practice in a large clinic may insist on a laboratory that is established
with high standards and that performs more than tests of the “waived” variety.
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