A SYSTEM OF LABORATORY REQUISITIONS AND REPORTS

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1 A SYSTEM OF LABORATORY REQUISITIONS AND REPORTS IAN MAXWELL, M.B., CH.B. Royal Columbian Hospital, New Westminster, British Columbia, Canada In a busy hospital laboratory receiving large numbers of requisitions daily, problems frequently arose that were poorly solved by means of our accepted methods. Appreciable time was being wasted in copying personal data from the requisitions onto the report forms and, not infrequently, such data were inaccurate names being incorrectly spelled, initials or hospital numbers being omitted, and so forth. It was necessary (1) to stock a large number of various sorts of report forms and, if laboratory records were to be maintained, (2) to detach these in pairs and insert carbon paper a time-consuming procedure. On occasion, there were disputes between the ward staff and the personnel of the laboratory, with regard to the receipt or exact nature of a requisition or the time elapsing between the ordering of the test by the clinician and the completion of the laboratory report. Some centers use combined requisition-report forms on which are listed various groups of tests. The physician checks off the tests he requires and the staff of the laboratory then fills in the relevant findings on the same form. We avoided this method because, in our opinion, it is unwise to detail a multiple choice of tests on a single requisition; this practice seems to invite unnecessary requests for laboratory work. Furthermore, inasmuch as several different forms are required, the nursing staff may use the wrong form. In addition, the several forms that pertain to a certain patient may be received in different sections of the laboratory and result in repetitive venepunctures that not only inconvenience the patient, but also cause unnecessary waste of technicians' time. The expense of printing several, different, multiple-part forms must also be considered. DESCRIPTION OF SYSTEM In designing a new system, we held the following features as our objectives: (1) complete simplicity, (2) avoidance of copying, (3) maximal flexibility, and (4) the provision of a complete record, from the time the requisition is received in the laboratory until the report is sent out. These objectives have been satisfied by the introduction of a combined, simple, requisition-report form, comprising a 3-part business form with "snap-out" carbons. The form is perforated across the center of the short axis in such a manner that 3 copies of the requisition and 3 copies of the report are available in instances when they are required. The first copy of the report-half of the form is gum-stripped, so that it may be conveniently attached to the clinical chart. The portion for the report is 3% in. in width and h x /i in. in length, the upper \Yi in. being used for recording personal Received, June 17, 1957; accepted for publication July 15. Dr. Maxwell is Pathologist, Royal Columbian Hospital, Clinical Instructor in Pathology, University of British Columbia, Vancouver, and Director of Clinical Laboratories for Lower.Frasor Valley. 509

2 510 MAXWELL Vol. 28 FIG. 1. Photograph of the Addressograph imprinter and the plates for printing. FIG. 2. Requisition-report form after the completion of the requisition and the stamp-recording of the time.

3 Nov LABORATORY REPORTS 511 BLANK FORM NURSE STAMPS DOCTOR COMPLETES -* MESSENGER TAKEN TO LAB LAB OFFICE 1 III 1 II 1! TECHNICAL OEPT 1 lil 1. II 'il t 1 DATE STAMPED 1 III 1 ii 1! TEST PROFORMA IMPRINTE D ilr^=i TEST COMPLETED 1 Ii 1 II'i zz TO LAB OFFICE COPIES I&2 COPY 3 RETURNED TO WARD TO TECHNICAL DEPARTMENT OEPT STAMP 4 SIGNATURE L=[ ii '1=3 II ->. LAB OFFICE TO WARD COPY I REPORT LAB OFFICE TIME STAMPED lii Hf=E ii '!L=E SEPARATED ACCOUNTING COPY I REQUISITION V LAB RECORDS COPY 2 INTACT In 'IS FIG. 3. The "flow" of the form from the beginning of the requisition to the completion of the report. data. Below this is a minimum of printing, flexibility being provided by means of imprinting different test pro formae, using a commercially available addressing machine. The Addressograph model 100 (Fig. 1) will accommodate plates that are 1^ by 3J^ in., and these have proved to be more than adequate for our test data. Furthermore, there is a space approximately 2 by 3^ in. at the bottom of the form for the insertion of comments. Graphotype plates of the requisite dimensions may be obtained from Ad-

4 512 MAXWELL Vol. 28 FIG. 4. Photograph to illustrate the distribution of the copies: top third copy of requisition returned to the ward; center, left completed report; center, right statistical copy for the accounting department; bottom copy of the requisition and of the report, for the files of the laboratory.

5 NOV LABORATORY REPORTS 513 FIG. 5. Sample test pro formae dressograph-multigraph Corporation for a few cents, but we have preferred Linotype cuts for most of our printing plates, inasmuch as these result in a somewhat neater report. There is space on the form for the date and stamping of the time "in" and "out." With triplicate copies of the requisition and the report, the form fully satisfies the usual statistical and accounting purposes. The desired distribution of the copies may be different in various laboratories; for this reason, individual variations of the basic form could be made. In our own hospital, the nursing staff and the personnel of the statistical department wished to have copies of the requisition. Accordingly, after the requisition-half is completed on our wards, it is delivered to the laboratory and timestamped (Fig. 2), the third copy being detached and returned to the ward as their record of delivery. During the first year the form was used, the clerks in the laboratory had to transcribe the personal data of the patient on the report-side of the form, but the value of the system was eventually increased by the institution of the Addressograph "Charge-a-Plate" procedure throughout the hospital. With this procedure, a plate of personal data is prepared for each patient (by the Admitting Department) at the time of admission to the hospital. This plate is taken to the ward with the patient. An Addressograph Imprinter model 11 is used on each ward for the purpose of imprinting personal data on all of the patient's clinical records, including laboratory requisitions. Owing to this refinement, it is not necessary for laboratory clerks to transcribe personal details, but the success of the system is by no means dependent on the general use of the "Charge-a-Plate" procedure for all of the hospital records. The "flow" of the forms is diagrammatically illustrated in Figure 3. The requisite test pro forma is imprinted by the laboratory clerks on the blank report form; extra forms are imprinted at the same time if several categories of tests are

6 514 MAXWELL Vol. 28 ordered. The tests are then processed by the staff of the laboratory, and the date and time of completion are stamped on the report. The department that performed the test {i.e., hematology, bacteriology, and others) is indicated by means of a rubber stamp and ink of a distinctive color, and the form is separated into its various components (Figs. 4 and 5). The first copy of the report is returned to the ward, the first copy of the requisition is available for statistical or accounting purposes, and the carbon copy of the requisition and report are retained for the files in the laboratory. The system is flexible and the number of test-plates has been considerably increased since the procedure was first started. It may be profitably applied to various tests that are routinely requested at the time of admission, inasmuch as it is a simple matter to stamp a number of such routine requisitions to be held on file in the Admitting Department. The method has also proved particularly satisfactory for the recording of the results of cultures for tubercle bacilli and Kahn tests, which are usually processed in groups. The work of our file clerks has been reduced to half, and personnel on the wards state that reports are received much more promptly than previously. The question of receipt or nonreceipt of requisitions no longer arises, and the system of time-checks has frequently resulted in the staff of the laboratory being exonerated from the charge of delayed reporting. SUMMARY Laboratory documentation is greatly improved by means of a simple, 3-part business form that consists of a combined requisition and a blank space for a report. Using an addressing machine, it is possible to imprint several different forms, for laboratory reports thereby combining flexibility with clarity and economy. This system has been in continuous use for more than 3 years, and the original Linotype plates are still in good condition. The suggested procedure has recently been adopted in 2 other hospitals in this region. SUMMARIO IN INTERLINGUA Le documentation laboratorial es meliorate grandemente per medio de un simple tripartite formulario que combina un spatio pro le requisition con un spatio blanc pro le reporto. Un machina adressographic es usate pro le insertion de varie schemas de reportos laboratorial, con le resultato que flexibilitate es combinate con claritate e economia. Iste systema ha essite in uso continue durante plus que 3 annos, e le matrices de Linotypo es ancora in bon condition. Le methodo hie proponite esseva recentemente adoptate in 2 altere hospitales de iste region. Acknowledgment. The author wishes to thank the Administration of the Royal Columbian Hospital for permission to publish this report. Acknowledgment is also made to Mr. C. E. Ripley, Moore Business Forms Limited, and to Mr. J. Morgan, Addressograph-Multigraph of Canada Limited, for their interest, enthusiasm, and cooperation.

Effective Date: June 21, 2007 SUBJECT: LEGAL REQUIREMENTS FOR NURSING DOCUMENTATION

COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Nursing Care POLICY NUMBER: 310 Effective Date: June 21, 2007 This Policy replaces NPP 310 dated August 31, 2006 SUBJECT: LEGAL REQUIREMENTS