General Test Request Instructions

Requisition Form

• All tests shall be accompanied by the standard laboratory requisition form (PER.PAT-301) or specified form related to the test.

• All requisition form must be filled in completely and clearly especially patient biodata. This is to assist in tracking of results from Laboratory Information System (LIS) by ward/clinic/hospital staff at a later date.

• All requisition form must be signed and stamped by medical officer/house officer/specialist. Outsource test require minimum medical officer for signature/stamp and some may require specialist signature/stamp only, please kindly refer test list under each unit.

• Clinical history and diagnosis must be provided and clearly written.

Blood Collection Procedure

To ensure consistent and accurate result, follow strictly the volume of  blood  required  for the type of test specified or fill blood till the mark on the tube’s label.

To prevent haemolysis:

• Avoid collecting blood from area of haematoma and drips.

• Do not leave the tourniquet on for longer than one minute; prolonged tourniquet time causes the interstitial fluid to leak into the tissue, promoting hemolysis.

• The site of blood collection should be allowed to completely air dry after cleansing with alcohol

• Ensure smooth venipuncture and steady flow of blood into syringe

• Do not force blood through needle while transferring blood into collection tube

• Mix additives with the specimens gently by inverting several times;  vigorous mixing or shaking can break the cells.

To prevent lipemic specimen:

• Avoid collecting blood immediately from patient who after meals with high fat content

Strictly aseptic technique should be practiced when performing blood collection for culture and sensitivity.

Video Guide For Venepuncture

Order of draw

Please refer to order of draw for multiple tube phlebotomy according to CLSI  recommendations.

Specimen

• Specimen should be collected from patient in ward or  clinic in  appropriate  container and properly labeled - AT LEAST 2 UNIQUE FACTS ARE REQUIRED: Name and full identification number – IC or RN.

• All specimens for medico-legal and drug of abuse testing cases shall be labeled  and sealed according to Ministry of Health guideline.

• Specimen containers for each patient must be put into a biohazard plastic bag and stapled with laboratory requisition form.

• All specimens must be sent to the laboratory reception counter as soon as possible after collection except specimen for histopathology/cytopathology and drug of abuse testing which these specimens shall be kept under storage condition and sent directly to the relevant labs during Office Hours only.

• The ward/clinic/hospital staffs that send the specimen are required  to  stamp  the time on the requisition form at the counter.

• All requests from wards and clinics should be accompanied by dispatch book.

Urgent Request

• Urgent requests must be justified by clinical history, diagnosis and reason for urgency.

• The word “URGENT/STAT” must be stamped or written in red ink on the upper right  hand corner of the request form.

• Urgent request must be separated from non-urgent tests.

• The ward/clinic staffs that send the urgent specimen are required to stamp the time on the requisition form at the counter and inform the laboratory staff in charge.

Result / Reports

• All test results from Pathology Department will be released to LIS after verification. Results can be view by authorized ward/clinic/hospital  personnel  through  web-based LIS except result from DOA Lab and HIV cases.

• For result from DOA Lab and HIV cases, reports shall be collected by the respective requesting clinic/ward/hospital at respective lab.

• All laboratory test results are personal and confidential. Notification of results  by  verbally is strictly prohibited except for the critical test results listed  in  the  Patient Safety Goal.

• Laboratory personnel will only inform the critical value test as listed in  the  Patient  Safety Goal to the ward and Department of Emergency & Traumatology only. All notification will be recorded according to the MOH reporting  format. 

 (Reference: Pekeliling Ketua Pengarah Kesihatan Malaysia Bil. 3 Tahun 2016: Penambahbaikan Malaysian Patient Safety Goals No.8: To Improve Clinical Communication by implementating critical value programme, 4 Jan 2016)

Rejection

For result accuracy & reliable, test request which do not fulfill the laboratory/test  requirement will be rejected. Criteria for rejections are:

1. Incomplete data of request form:

   • No name, incomplete identification number or registration number

2. Requesting hospital/unit/ward/clinic not identified

3. No date or time of specimen collection

4. No requesting doctor’s name/rubber stamp

5. No clinical summary or diagnosis are written

6. Specimen collected in a wrong/broken/leaking container

7. Mislabeling of specimen or form

8. Specimen grossly hemolysed, lipemic or clotted

9. No form or specimen received for the request

10. Specimen collected not according to the standard volume or collection procedure

11. Test is not available in HDOK or reference laboratory

12. Test is not suitable for outsource due to sample stability

13. Any other reasons appropriately identified based on requested test requirement.