The TMC Lab Experience Tarrah Oliver MT Donna

The TMC Lab Experience Tarrah Oliver, MT Donna Talker, Lab Manager

TMC Experience � Initiated May 10, 2016 � Trained everyone ◦ Generalist MLT’s, MT’s, and students � Ways to order the test: ◦ Initially, verbal request from Providers ◦ Lab Reflex, IM flag for platelets <120 (thrombocytopenia) ◦ Later, became an orderable test on RPMS Photo by Kiliii Yujan, 2019

Results of Screen and Lab Reflex � ~300 patients screened (May 2016 to Present) � 9 patients scored 4 or 5 ◦ 5 Ab positive - confirmed serologically ◦ 4 Ab negative –chronic medical conditions that contributed to their scores (COPD, cirrhosis) � 8 were Lab Reflexed (88%)! ◦ Recognized and ordered by the lab ◦ No provider’s order needed � 6 transferred to UNM, 1 to RMCH for observation

Performing the Screen � Takes about 30 mins to perform entire screen ◦ Run CBC (complete blood count) ◦ Smear and stain slide ◦ Perform differential counts ◦ Fill out worksheet � No extra time, materials, disruption in patient TAT Photo by Kiliii Yujan, 2019

Limitations � Providers ordering for asymptomatic patients, “I saw mouse droppings”, no flags in CBC � Lack of confidence in identifying Immunoblasts and Plasma cells from techs ◦ Practice, practice! ◦ Annual competencies – one of each level � Hand delivering results to Providers ◦ Couldn’t find them in hospital, patient transferred to another ward/Provider ◦ Moved test to RPMS with the built-in comments and interpretation of scores

Outcomes � All of our staff is trained to perform this screen � NO interruptions in TAT’s for STAT specimens ◦ If CBC is abnormal, slide is made already. So if a request is added, all you need is the worksheet. � Lab has been a first responder when the flags are recognized ◦ Helping patients get immediate treatment for prolonged life!

Hantavirus Peripheral Screen Community Outreach � 2016 ◦ CDC came to TMC and learned about our Hantavirus 5 -Point screen which was implemented. � 2017 -2018 ◦ Workshops developed with CDC support to share information with surrounding laboratories and public health organizations.