Case Studies; write a brief solution to the following scenarios, locate and include the statement related

to the act, regulation and or standard of practice that relates to the solution is applicable

1. You are working in a laboratory of a regional centre. You are currently

alone in the lab. The telephone rings and it is an old friend, Jill. Jill is quite
distressed, and asks you if you could give her pregnancy test results, which
is yet to be done. You end the call and do the test. You know the MLT will be
returning immediately. The test result is positive, but the negative control
shows some background reaction. The MLT observes the results. The phone
rings and it is Jill again and she is almost hysterical, begging you to tell her
what the result is. What should be the next step related to the test and Jill.

The next step related to the pregnancy test and Jill should be that the MLT goes over the results
of the test and properly analyzes the sample themselves to re check with the negative control.
The test shouldn’t have been done in the first place ASAP, as Jill is not more important because
she is a friend. I would advise Jill to call her doctor and hear the results from them, as we can
not give patients results over the phone or in general. Depending on the SOP for the lab, they
would have clearer instructions what to do in this situation. As per Reg 682 number 4(1) 4., you
also can not perform a pregnancy test if the person requesting the test indicates that the test is
for fetal assessment, which in this case I don’t believe she is. Do the test again and check the
reagent and make sure it is not expired, provide another sample from pt to be sure. As for
informing the pt about the result you can’t give results to pts.

2. The MLA practicing phlebotomy, sample receiving, sample

sorting and preparation has a request for gloves. The supply is
constantly depleted well before the next order is received. The MLT
approached by the MLA pertaining to the lack of gloves implies that it is a
management problem. What should the MLA do and how should she go
about it.

The MLA should request to speak with management or HR regarding the quantity of supplies
and explain the situation going on, as it is an unsafe work condition to be out of supplies
especially sorting samples in case of spills. Under number 7 in Worker Education in WHMIS it
states that the employer is responsible for the safe handling and storage of samples for any
worker who will encounter the product. In OSHA under Duties of Employers number 2(d) there
is further information about your right as an MLA, and the responsibilities of your employer. You
have a right to know your rights as an MLA, and your employer should be keeping your safety as
a priority.

3. While cover slipping Hematology slides, the MLA working with xylene,
splashes the clearant on the label. This is not the first time this has
 occurred, and the label is now obscured, rendering it illegible. The MLA
cleans the outside of the container of xylene and returns it to storage.
Which regulation was violated and why?

The MLA knows that under WHMIS they have responsibilities as does the employer, but the
MLA handling the product and making the mistakes must notify their manager or employer of
what has happened and should not hide their mistake. Under WHMIS and Worker Education
number 7 (a) the MLA should have been informed that the contents required on labels must
show their significance and risks, as well as section Labels number 8 (3) “If a label applied to a
hazardous product or a container of a hazardous product becomes illegible or is removed, an
employer shall replace the label with either a supplier label or a workplace label.”

4. Mary, an MLA who has been employed by Lab A for 14 years, is separating
and sorting samples with Sally, an MLA newly employed for 6 months at
Lab A. There is one sample not labeled and one requisition remaining
without a sample. Mary begins to label the unlabeled sample with the
information from the remaining requisition. Mary does not want to
complete the procedures required to obtain a new sample. How should Sally
handle this situation?

Sally should lightly remind Mary of her responsibilities and due diligence as an MLA regardless of
the number of years she has been working, Sally also needs to do her due diligence in stepping
forward and saying something to Mary. There are proper steps you need to take regarding
situations like this in the SOP. This situation could be fatal to the patient Mary is assuming the
remaining requisition is for. If the situation is approached with respect it should be handled
accordingly, but if there are any issues then it is Sally’s responsibility to say something to her
superior to prevent something like that happening again, and it should be brought to their
attention in case it has been an ongoing situation. Call patient and recollect the sample

5. Jan an MLA is working the evening shift with Sam an MLT at a Local
Hospital Laboratory. There are two fecal occult blood tests that have
arrived in the lab to be developed and interpreted. Sam is ready to go on
break and suggests that Jan develop the FOB test. Jan does not have the
experience to accurately read the results. Describe a possible solution and
explain why.

Sam should practice her ethics and respect that Jan doesn’t know how to do the test. Sam is also
the MLT and Jan is the MLA so she should respect her duties as an MLT. However an FOB is not a
stat test and could wait until Sam gets back from her break, if she absolutely needs to take it
right that second. Sam should also help train Jan to better understand the procedure in case
anything like this comes up again in the future.
6. Terri a MLA Phlebotomist receives a requisition from Mr. Jones a 92 year
old gentleman that is hearing impaired. It is near the end of the shift and
Terri has not had time for a break all day. Mr. Jones is very independent and
is not accompanied by anyone. Mr. Jones’ test requires an explanation of
his recent medication dosage. Terri begins to become angry with Mr. Jones
due to his inability to understand Terri’s request for his medication
information. Are there established standards of behaviour that are being
violated? How could Terri have handled the situation differently?
Terri should take into consideration the age and abilities of Mr. Jones, and most definitely
should not be taking out his frustrations on the patients at any time regardless of age and
abilities. Terri must practice his ethics always but with patients who need more understanding
especially. In the CSMLS SOP in Standard 1, it says you must follow the Professional Conduct, the
CSMLS Professional Conduct states “The welfare of the patient and respect for the dignity of the
individual shall be paramount at all times.” “Medical laboratory professionals shall practise
within the scope of their professional competence” Terri could have handled the situation with
patience, care and understanding that this situation is different because of the hearing loss.

7. When a reagent used in testing is transferred to the instrument reservoir,

the question of the guidelines related to labeling is raised by Greg the MLA
student to Rose the MLT mentor. Rose suggests that Greg refer to WHMIS
guidelines and return with the answer. What guideline did Greg find?

Greg would find the Labels category under the WHMIS sections 8-13

8. A group of MLA students are debating the meaning of a “controlled act”.

One MLA student defines a controlled act as a procedure performed by a
regulated health professional. Since any procedure on tissue below the
dermis is a controlled act, the group of MLA students are concerned with
performing a venepuncture. According to the regulated health professions
act, should they be concerned?

They should not be concerned because according to the Regulated Health Professions Act under
Prohibitions section 27 and 28, under section 27 it states “No person shall perform a controlled
act set, unless the person is a member authorized by a health profession act to perform the
controlled act or the performance of the controlled act has been delegated to the person by a
member” it does say under section 27 that a controlled act is “Performing a procedure on tissue
below the dermis, below the surface of a mucous membrane, in or below the surface of the
cornea, or in or below the surfaces of the teeth, including the scaling of teeth.” So venipuncture
would fall into this category. MLAs are certified to do these procedures so they should not be
concerned
9. MLA Jane is employed by a private laboratory. Jane is leaving work and
decides to discard her coffee cup and lunch bag in the large garbage bin
outside the building. Jane notices some patient records from the private lab
in the garbage bin. These records not only include personal health
information, but some of that information concerns tests performed at the
lab. What privacy facts should be of concern to Jane and the laboratory she
is employed at? Who is responsible for the patient records?

According to the College of Physicians and Surgeons of BC, FIPPA does not apply to personal
information collected and stored in private laboratories PIPA does. In the “BC Physician Privacy
Toolkit, A guide for physicians in private practice”, it states “Under PIPA, physicians have
custody of the personal health information they have collected and physical control of the
documents/electronic data. They are accountable for any privacy breach that occurs to personal
health information in their custody and control, including any breach committed by an
employee under their authority” Jane should bring it to the attention of her supervisor but
should not go into the trash and collect it. She should be doing her due diligence and thinking
about the patients and the information that can identify the patient. The patient information
should still be treated as confidential, shredded, and not be thrown into the trash as a common
courtesy.

10. Mark a 10 year old boy arrives at the lab with his mother to have
some blood work performed. Mark is not cooperating. Jess, the MLA, tries
to convince Mark to allow her to collect his blood. Mark continues to refuse
to allow Jess to perform a venepuncture. Mark’s mother is becoming angry
and insisting Jess complete the task. What should Jess do and how should
she go about it?

Jess should explain to the mother that she cannot perform venipuncture on her child while he is
in distress and should offer the solution of coming back once the child is calm. The age of
consent in Canada for medical is 14 so the child’s mother does have the say, but we have an
obligation to follow our duties, and practice our ethics and due diligence as an MLA, and not
force a procedure upon anyone regardless of age. Jess can explain this to the mother and may
also suggest that she goes to see a pediatric phlebotomist who may handle the situation better
and apologise for any inconvenience.