INTERNSHIP PROGRAM - ACADEMIC YEAR 2015- 2016MONTHLY SUMMARY OF CLINICAL INTERNSHIP EXPERIENCE REPORT

Name of Interns: Group Leader:Padolina, Wilcen John V.

Alves, Carlos Jose I.

Cano, Earl Adriane A.

Caringal, Jejomar Emmanuel C.

Chiong, Arveec C.

Lina, Jan Alyssa C.

Macaspac, Jasmin Bien C.Manalo, Alfred Ryan C.

Manapat, R-Jay J.

Najera, Maybelle Colyn U.Ng, Raissa Steffie Y.

Nierva, Rancez Lorraine S.

Olaguer, Antonio E. II

Penalba, Kathy Mae ClarisseSalamat, Kristine Grace A.San Andres, Raphaela Angela L.

Valena, Carmelo Miguel O.Hospital Assignment: Rizal Medical CenterMonth of May and JuneMedical Technology Internship (please encircle): (1) (2)

Lab SectionActivities/Tasks/ResponsibilitiesProblem(s) EncounteredAction(s) TakenPersonal Reflection(s)

BACTERIOLOGY Process specimens such as blood, stool, urine, exudate, sputum, etc

Manual logging of all the specimen received and results released

Media preparation

AFB and gram staining, KOH analysis, biochemical tests and culture and sensitivity

Clean and disinfect your workplace before and after the shift

Finish all the assignments given to you by the staff on duty Some of the media are contaminated

Mislabeled specimen

Unclear tests request

Specimens not processed because it was over looked

Patients and doctors who request for the result immediately Observe proper procedures in making culture media, avoid exposing them to environment to avoid contamination Dont accept specimen which are mislabeled and not properly labeled specimen

Ask the staff on duty to revise the request form in this section to avoid confusion

Always inform the patients, nurses and doctors Bacteriology is an enjoyable post, we are able to apply what we learn theoretically because we are allowed to process all types of specimens. Some of the complains I heard with this section is that interns at times go home late because either there are too many items to be finished or the staff on duty gave their respective task late. Others said that after being assigned in bacteriology section they obtain pimples.

HEMATOLOGY

Perform test such as CBC, ESR, Reticulocyte Count, and other hematologic techniques

Ward test such as Peripheral blood spear, malarial smear, Bleeding time, Clotting time and Clot Retraction time

Prepare smears of specimens to be rechecked and read manually

Logging of specimens and results Machine fails to aspirate and analyze clotted specimens Hard to extract adequate amount of blood on patients requesting peripheral blood smear

Machine usually is out of control range

Double check if the specimen is clotted using an applicator stick Massage the finger before you prick, make your prick deep and apply pressure well Practice smearing to make sure there is no wasted blood specimen

Report to staff on duty so they can repeat the controls and troubleshoot the machineHematology section is fully automated so you just need to feed the sample to the machine and wait for the results. Interns experienced being reprimanded by patients because of pain in pricking when there is a request for peripheral blood smear.

CLINICAL MICROSCOPY

Perform test such as Urinalysis, OGTT, Pregnancy Test, Fecalysis and Occult Blood

Logging of results in the logbook

Census of laboratory equipments Breakage of test tubes Machine malfunction

Insufficient urine submitted by patients

Using dirty test tubes

Properly balance the test tubes in the centrifuge Be ready to read the reagent strip manually

Ask the patient to submit another sample of urine

Properly clean test tubes used after every shiftWe were surprised that even reading the reagent strip is automated in this section. We are not allowed to read the specimen microscopically. Complains I heard are: foul odor in this section and unorganized logging of specimens.

HISTOPATHOLOGY

Numbering and logging of specimens received Release and receive cadavers in the morgue

Perform test in aspirates and exudates

Staining of specimens

Perform histopathologic techniques such as mounting, fixing, etc.

Assist pathology residents in cutting and needle aspiration biopsy Risk of mislabeling and loss of specimen which could lead to 1 month demerit Tissues are over stained Be careful in labeling specimens, always double check the request and the specimen to avoid demerit Re-staining tissuesHistopathology section is one of the most delicate post in the lab. Because histopathology specimens is very valuable in a sense that it cannot be re-extracted, making sure it isnt lost and properly labelled with its accession number is the most important thing in this section. The workflow in this section is slow, and takes a lot of time before specimen is ready for reading and will probably take weeks before a result is available from the pathologist. Making sure the specimens is in good condition and slides are prepared properly is a must.

CLINICAL CHEMISTRY Logging, labelling & census of specimens

Maintaining proper workflow

Centrifugation of specimen

Checking for Chyle and hemolysis

Feeding the specimen into the machine

Knowing when to use sample cups and manual operation of the machine.

Keeping track of OGTT specimens

Preparation of reagents for troponin I

Warding of Amylase, Troponin I and ABG analysis results

Measurement of 24-hour urine specimens. Hemolyzed/Insufficient specimen

Chylous serum

Incorrect barcode

Clotted specimen for ABG

Failure to remove the cap from the specimen before feeding to the machine

Inform the ward that the patient with hemolyzed or insufficient specimen must be re extracted Remove chyle before feeding the specimen

Manual operation of the machineMaintenance of proper workflow is a must in the chemistry section considering that numerous different tests is done routinely in it. This section receives probably the most no. of specimens in a day, and losing track of the progress isnt rare. Having a plan before the shift starts between your co-workers is a must to establish a good workflow.

BLOOD BANKING Screening of blood donors

Bleeding of blood donors

Receiving specimens

Checking-in of specimens and releasing of results

Blood typing of patients

Cross-matching of blood units with patients blood

Performing Coombs direct and indirect test

Assigning of blood units to patients

Releasing of blood units to nurses/ doctors

Releasing of blood units to other hospitals

Packing the Red cells of blood units

Receiving blood units from outside the hospital

Receiving calls from other sections, department of the hospital regarding the results or confirming of the test/s done

Receiving calls inquiring the availability of blood units

Charging tests fees and blood units

learing patients from blood bank

There is no label in the tube, mismatched of information in the request form and specimen

Forward blood typing and Reverse blood typing doesnt match

Weak reactions in reverse blood typing

Blood unit is missing or does not match with the stock blood listed in the logbook and blood unit tag

No blood units available/ there is no blood donor for the patient

Packing the blood unit prior to releasing and having an expiry date after 24 hours

Mismatched blood unit serial number

Explain to the donor why she/ he got deferred

During bleeding ask for staffs assistance when you find it hard to bleed

During unsuccessful extraction explain to the donor what happened, transfer to the other arm if patient agree

When donor starting to be uncomfortable and experience headache stop the bleeding immediately and apply pressure to the site then after a while apply cold compress elevate the leg to regulate blood flow let the donors drink juice and eat to restore glucose and carbohydrate level

To first time donors reassure donor by talking to them and letting them calm down

Confirm the blood units to the staff or assign new blood units to the patient

Prepared by:

Noted by:Wilcen John V. Padolina

Prof. Julius Eleazar Jose , RMT

Hospital Leader- Rizal Medical Center

Clinical Instructor

UNIVERSITY of SANTO TOMAS

Faculty of Pharmacy

Espaa, Manila

DEPARTMENT of MEDICAL TECHNOLOGY

AA:10-02-FO07