General Laboratory Flashcards
(13 cards)
Describe the structure of your laboratory
- Our lab receive >60,000 referrals per year
- Lab has >200 scientific and technical support staff
- Management team (clinical director / deputy clinical director) oversee the overall running of the laboratory
- 3 main programmes (Germline, Cancer, Technical)
- These programmes encompass different subsets of teams
- Germline: Prenatal/repro med/ rare disease / dev. Delay
- Cancer programme: Familial cancer / Haemato-oncology / molecular pathology
•Within the scientific teams, there are a number of clinical scientists who oversee and manage different disease services.
- Technical programme: 8 hubs (array, analysis, culture, extraction, fragment, NGS, qPCR, sequencing)
- Different teams and hubs communicate frequently, essential for running of the lab
- We have individual programme meetings every 2 months and full laboratory meetings once a month
Describe the sample pathways in your laboratory
- Sample is received into the laboratory
- Unpackaged by specimen reception (check details on referral match tube, record type and quantity of specimens received on referral form, date stamp)
- Referral is then given to duty scientist (assess referral, determine urgency, triage, record extractions / cultures required)
- Referral is given to DT for booking in (check details with SCR and create patient record with unique lab identifier and a storage packet) DT also assigns relevant extractions / cultures
- Specimen is then labelled with unique lab identifier and given storage location
- Specimen passed to extraction / culture hubs for DNA extraction and/or cultures as an example
- Following extraction, concentration information recorded on database
- Referral packet is passed to disease scientist for them to assess referral and assign relevant testing
- Disease scientist creates worksheets and passes these to the relevant technical hub
- Technical hub perform the testing
- Most cases disease scientist will then perform analysis, interpretation of results and write report
- Senior / principal scientist will then sign out the report
- Storage packet is then filed away
What is the role of specimen reception
- Receive specimens
- Determine if information on referral matches the tubes
- Records type and quantitiy of specimens received
- Determine which duty scientist needs to receive the referral (haem onc, mol path, germline etc)
- Alert duty scientist of any problems (leaking / unlabelled tubes etc)
What is the role of duty scientist?
- Receive referrals from specimen reception and triage
- In our laboratory, this role is performed by both pre-reg and registered clinical scientists
- Have to have a certain level of knowledge, and therefore Haem-Onc have their own duty scientist, germline programme have their own and familial cancer team have their own duty scientist.
- Germline duty scientist triages referrals including prenatal referrals (requiring trisomy testing / prenatal arrays / NIPT), Repro med (urgent sexing), Dev Disorders (karyotyping / arrays), germline referrals for rare disease
- Main roles in DS:
- Determine sample priority
- Determine whether specimen requires DNA / RNA extraction / cells culturing
- Determine what tests are required and assign relevant disease indication so the referral is passed to the relevant disease scientist
- Liaise with germline DT regarding extractions / cultures
- Identify and rectify potential problems (obtaining further information, advising on missing information, leaky tubes, unsuitable samples etc)
- Answering queries over the phone
How would you deal with Leaky tubes?
- Leaking samples should be kept in their packaging and placed into leak proof receptacle
- Request form soiled- photocopy in a clear plastic bag
- If leak is minor- transfer into another tube
- If substantial – can try to remove sample for DNA extraction or request repeat sample
- If the sample is urgent, we would try and rescue as much of the sample as possible and attempt an extraction
- If sample not urgent, and it is easy to obtain a repeat, we would likely request a repeat sample.
Name incorrect on tube?
- Check all other identifiers and determine if name is incorrect due to typo/simple error
- Confirm with clinician that they are willing to reassure this is from correct patient
- If they can establish this is the correct patient, we can proceed and add rider to report to state this.
- At DS stage would therefore ensure this information is clearly marked on system and disease scientist is made aware.
- If there is a risk that this sample is not from the patient we expect, then we would discard the sample and request a repeat sample
Unlabelled sample received for an urgent baby, and no repeat is possible. What would you do?
- Check all identifiers on referral form, and book in using these
- Make very clear on booking in that tube was unlabelled
- Inform clinician that we would proceed with testing, but we would not be able to guarantee the results without confirming identity
- Rider the report to state that the tube was unlabelled .
- Obtain either a parental sample or a repeat sample from the patient to confirm identity of unlabelled sample at a later date.
You receive an urgent referral received but testing unclear.
- Would contact referring clinician to establish what testing they would like
- If unable to contact them, I would ensure all bases were covered by extracting DNA, and assigning cultures.
- I would then ensure all the information was booked into the system as soon as possible so that the patient information was available on the system in case clinician phoned up and another scientist answered
Unsuitable sample received
- Most of the time, I would phone up the referring clinician to let them know the sample was unsuitable and request a repeat
- Determine whether sample can be used at all (sometimes DNA can still be extracted)
- If for DNA extraction and sample is very urgent, we could always attempt an extraction, but I would be clear that it may not give the best yield of DNA
- In some situations, the sample is completely unsuitable for testing, and we would usually only attempt to test if extremely urgent and a repeat was not possible.
- If not urgent or cannot be used at all, dispose of unsuitable sample and write report requesting repeat sample.
- Ensure all patient information is booked on to system – record
How would you deal with an angry phone call
- Politely try to understand what the problem is
- Try to see if it is anything I can help with
- Take down all of their contact details
- Try to identify the best person to take the call.
- If nobody is available, tell them that I will look into this straight away and have someone call them back.
Tell me about the awards for NIPD. What is NIPD and what awards have been won?
*Non invasive prenatal diagnosis
o NIPD for parents with previous affected child with SMA can undergo NIPD to establish risk that their fetus is carrying highrisk/low risk alleles.
o Linkage analysis of affected child, mother and father, and as many other relatives as possible to establish which allele is high risk and which is low risk
o Through cell-free fetal DNA circulating in mother’s blood, can separate mother’s DNA from fetal DNA and identify highrisk/lowrisk allele and therefore determine risk of being affected with SMA.
*In July 2017, WMRGL won West Midlands Academic Health Science Network award in: Advanced diagnostics, genomics and precision medicine award
Describe the assessment process in your laboratory.
End of year review:
• 1 hour discussion
• Assess knowledge of pre-reg scientist and quality and content of training delivery
• No pass or fail – only competent / needs development
• Two assessors (who have had assessor training) question the pre-reg and take notes on performance for each question
• Set of action points may be produced for trainee to address next rotation
Why is it important to complete mandatory training every year?
- Ensures all NHS staff are up to date with any changes in information
- Provides reassurance to the trust that all of their staff understand the importance of upholding confidentiality
- Ensures safety of patients and staff (in event of fire for example)
