I. Purpose

To define the Soft computer process when resulting Urinalysis tests.

II. Procedure

Orderable Tests:	Reflex Tests:

UFMIC-UF microscopic

UMAC – Urine Macroscopic	UMIC – Urine Microscopic

UEOS –Eosinophils	USSA – Sulfosalicylic Acid

UMYO –Myoglobin	UCLIN – Clinitest

URED – Urine Reducing Substances

Transplant Patients – UMIC always reflexed when UMAC is ordered

URN – Resulting Template for Main Lab Urinalysis

*Call pending report for the past 7 days every 2 hours to check for old order numbers and ahead 7 days.

Canned Messages:

@SPG - Result double checked by dilution

@HYPH - Hyphae present

@CWBC - WBC’s clumped

@COL	- Color may interfere with results

@ABCO - Unable to report. Abnormal color obscures test result.

@STCO - Stool contamination

Cancellation Comments:

|X#02 Quantity not sufficient

|X#04 Laboratory accident

|X#05 Accessioning error

|X#08 Does not meet clinical time requirements

|X#10	Broken/spilled in transit

|X#11 Duplicate test

Samples to be run and verified on the Atlas:

Sample arrives at bench. Click Specimen Tracking icon. Scan

Barcode of urine specimen. Save.

Sample is in conical tube or preservative tube – place on Atlas/Clinitek and run.

-If urine color is abnormal run the sample on the Clinitek so color doesn’t

obscure test result. If sample is very bloody, test after specimen is spun.

-If barcode is not read and has to be manually entered: enter the first 9

digits of the SPM (NOT the 28)

Ex. SPM # is 711700219-28, enter 711700219 into the Atlas

Open Resulting Worklist

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default to see yesterdays and todays

pending orders (or can adjust date and order numbers).Should

call pending past 7 days and ahead 7 days to check for old and

new orders. Call pending list every 2 hours.

Look under Tests in Order Info to see what tests are pending

UMAC is pending – Sample has not been run on Atlas or there’s an instrument error (no results will be on Resulting Worklist – refer to “To look for instrument errors”)

UMIC and UFMIC is pending – Microscopic is needed (UMAC results will be on Resulting Worklist)

USSA and UCLIN pending – confirmatory test needs to be performed and entered before the sample is spun (see below to enter results)

UEOS, UMYO or URED pending – tests need to be performed

Confirmatory tests: USSA, UCLIN

-Tests get automatically reflexed onto the order when appropriate

To enter confirmatory tests, urine eosinophils, myoglobin and urine reducing substances results

-Select the result box of the test to be resulted

-Choose the corresponding result from the resulting keypad in the upper

right hand corner then click on Verify and click on the Save icon

-A Lab Results Entry box will appear-Click Yes to save order results

Click No to go back to results

Click Cancel to go back to results

Click on the Refresh icon to refresh data order to see what tests are pending

-UMAC will no longer appear as pending when the macroscopic is resulted unless there is a problem with the sample or the instrument

-Confirmatory tests that are resulted will no longer appear as pending

-If there is any kind of error, UMAC will remain on the pending list (see below to rerun error samples).

Sort pending list by Name to search for pending microscopics off the instrument

The tests UMIC and UFMIC will reflex onto the order when a microscopic is required.

Appearance will always be reported from the Atlas since it’s a measurement of transmitted and scattered light that is more accurate than reporting by eye.

Normal urines which autoverify can be placed in the completed rack; they are not run on the UF 1000i.

If a microscopic analysis is required, run samples on UF 1000i. If the UF 1000i is not operating, then all microscopics will be performed manually.

Samples to be run and verified on the Clinitek:

Scan sample with barcode scanner OR

Enter specimen 9 digit order number on Clinitek

-Enter the first 9 digits of the SPM (NOT the 28)

Ex. SPM # is 711700219-28, enter 711700219 into the Clinitek

Dip sample with dipstick and run on Clinitek

Perform Specific Gravity on Refractometer

Open Resulting Worklist

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default

Find order # for sample being run and select the order

To enter specific gravity

-Select (left click) on the USPG result box and enter result

-Select result box, click on Verify and click on the Save icon (rest of the

results will autoverify with the exception that UBIL will have a default

result of .)

To enter opacity and color

-Select (left click) on the UAPP result box

-A keypad will appear in the upper right hand corner of the screen

-Hit C for clear and O for cloudy

-Click on Verify

-Select (left click) on the UCOLR result box

-A keypad will appear in the upper right hand corner of the screen

-Choose the letter that corresponds with the color of the urine

-Click on Verify and click on the Save icon

UBIL will have a default result of “.”

Look under Tests in Order Info to see what tests are pending (same method as described for Atlas)

If a microscopic analysis is required, sample will be racked to process on the UF 1000i.

*If a result of @BL is seen in UBLD from either the Atlas or Clinitek:

-The result from the instrument was either Trace-Lysed or Trace-Intatct. Those

Instrument results are translated into a comment of @BL. @BL = SMALL.

To cancel a UMAC:

Go into Order Entry

Click on Test ID UMAC

Click the Cancel button

Click YES to cancel the UMAC

Click on CanMesg and choose the correct cancellation comment

Click OK

Click

Click YES to “Do you want to save the changes made to order #”

Go back into Order Entry

Enter called to comment in OrderComm using CanMesg |O#01: Cancelled

test called to. Make sure to include Test ID of the test being cancelled.

Click

Click YES to “Do you want to save the changes made to order #”

-Follow the same steps as described above to cancel other urinalysis tests, choosing the proper Test ID to be cancelled

If only a UMYO is ordered:

Open Instrument Menu

-Double click Instrument Menu on main screen

-Under Select Instrument: Choose either ID# 17-Atlas #1 or ID# 18-Atlas #2

or ID#26-Main Lab Clinitek

-Under Select Date: Choose Loadlist and today’s results

Find order # and select the order

UMAC tests will not be in bold since it was not ordered

Look at the result of UBLD

-If UBLD is negative then result UMYO as NEGATIVE in the Resulting Worklist

-If UBLD is positive then follow the procedure for performing the myoglobin. Result in Resulting Worklist.

To look for macroscopic instrument errors:

Open Instrument Menu

-Double click Instrument Menu on main screen

-Under Select Instrument: MUIST (Hematology Urine Instruments)

-Under Select Date: Choose Loadlist and today’s results

Find order # of sample with an error and select the order

-The result box(es) will have an “ERROR” result if there’s an error

If there is an instrument error and the sample needs to be repeated:

-Delete and rerun sample on instrument.

Samples that require a comment:

Select the result box of the test that requires a comment

Click on Comment and a Results comment box will appear

Click on CanMesg to open a drop down of result comments that correspond to the selected test

Highlight the message to be added and click OK

Click OK

An M will appear in the M column meaning that there is a message attached to the test result

Deciding which samples are run on the UF 1000i:

Only samples that reflex UMIC and UFMIC:

Open Resulting Worklist

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default

UMIC and UFMIC will be under Tests column and in Order Info: Tests meaning that the microscopic is pending

Samples pending for microscopic analysis are then racked and run on the UF 1000i( refer to UF operational procedure).

Rbc(URBCI), Wbc (UWBCI),Epithelial cells(UEPII), Hyaline casts(UHYAI) and Bacteria(UBACI) are enumerated on the analyzer. Only samples that flag will need a scan or manual microscopic (copy of UF results will print automatically).

Samples with no flags will autoverify.

HOW TO ORDER/PERFORM A MANUAL MICROSCOPIC:

Ordering a Manual Microscopic (sample was run on the UF)-

After sample is run on the UF, open Instrument Menu: MUIST (Heme Urine Instruments) to result samples that did not autoverify.

Look for flags on the Instrument Tab. A “>” (out of range) or “A” (analysis error) will appear in the error column if a flag is present. A “N” will appear in the error column if the sample has NO flags. If there is a flag on any measured parameter, a manual microscopic needs to be performed. In addition, if there is a flag on any measured parameter as well as a flagged parameter, a manual microscopic needs to be performed.

Click on Lab Results Tab and click on Scop2. A keypad will appear. Select Manual Microscopic or type in M. Verify All and click Instrument Tab or Click Instrument Tab, and save changes.

On Instrument menu Click Part Post. Test MMICR will now appear on the order.

Performing a Manual Microscopic (sample was run on the UF)

Open Resulting Worklist:

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default

Manual Microscopic will be performed as current procedure, where results are reported as a range. There will now be 5 open parameters that need to be reported: UWBCM,URBCM, :UHYAI,UEPIM,UBACM. These 5 tests must have a result entered or else the UF instrument results will autofill instead.

If a result is entered in the wrong resulting field: must enter a default result (Def Res)”.”

or the test will show as pending. All other significant findings should be resulted.

Hit enter to move down to each test included in the microscopic.

A resulting keypad will appear with all possible results for that test.

Choose the key that corresponds with the result to be entered.

Result is entered and the cursor automatically goes into the next test field.

When finished resulting, Click Verify All.

Ordering/Performing a Manual Microscopic (sample was NOT run on the UF)

Open Resulting Worklist:

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default

Click on Scop2 and select manual micro from keypad. Verify All and save changes. Refresh Worklist. Test MMICR is added to the order and UF instrument

results are now dotted out.

Result all 5 open manual tests: UEPIM,UHYAM,UWBCM,URBCM,UBACM.

If any of these 5 tests are not resulted the order will remain on the pending list.

If a result is entered in the wrong resulting field: must enter a default result (Def Res)”.”

or the test will show as pending. All other significant findings should resulted.

Hit enter to move down to each test included in the microscopic.

A resulting keypad will appear with all possible results for that test.

Choose the key that corresponds with the result to be entered.

Result is entered and the cursor automatically goes into the next test field.

When finished resulting, Click Verify All.

Ordering a scan-

After sample is run on the UF, open Instrument Menu: MUIST (Heme Urine Instruments) to result samples that did not autoverify.

If there are NO flags on the measured parameters, and only flags on a flagged parameter, FPACA,FSRC,FYST,FXTAL,FSPERM,FMUC, then a scan is required. On the Instrument Menu, you will see a “>” in the error column and the word “ERROR” in the result window next to the flagging parameter .If there is no flag on the flagging parameter you will see “none” in the result window.

Click on Lab Result Tab and click on Scop2.Select Scan from the keypad. Verify All and click Instrument tab or Click Instrument Tab, and save changes.

On Instrument Menu Click Part Post.

Performing a Scan-

Open Resulting Worklist:

-Double click on Resulting Worklist on main screen

-Result Worklist box will appear:

Template: type in URN or URNS

Status: Pend and Nonver

From order # - leave as default

There are no open tests which need to be resulted with a scan. UF instrument values are resulted along with any flagged results, FPACA,FSRC,FYST,FXTAL,FSPERM,FMUC if present. If not present these tests will not need to be resulted leaving the default of “.”Follow above mentioned procedure to enter results.

When finished resulting, Click Verify All.

Reporting Crystals not on the keypad

-Select (left click) the result box of test UOTCR

-Delete the “.” by Clicking Backspace

-Type in how many crystals are being reported into the result box (Example: FEW, MODERATE or MANY)

*Result should be in capital letters

-Click on the Comment box

-Type in the type of crystal seen (Example: Bilirubin Crystals)

-Click OK

When all results are entered correctly on the Resulting Worklist click on Verify All and click on the Save icon

-A Lab Results Entry box will appear-Click Yes to save order results

Click No to go back to results

Click Cancel to go back to results

When sample is complete there will be a blue checkmark and a pencil by the order #

To update the resulting worklist refresh the page and samples that are complete will be removed from the list

How to correct microscopic components that were entered incorrectly:

-Select (left click) the result box of the test to be corrected

-Delete the incorrect result by hitting Backspace

-Type NONE into the result box **NONE should be in capital letters

-Type in the reason for changing the result in the “Enter reason change reason for test”

-Click OK

-Click Verify All

-Follow lab policy for calling corrected results

UMAC Components:

UAPP = Opacity

UCOLR = Color

USPG = Specific Gravity

UPH = pH

UPRO = Protein

UGLU = Glucose

UKET = Ketones

UBLD = Blood

UBIL = Bilirubin

ULEU = Leukocyte Esterase

UNITR = Nitrites

UMIC Components:

UFGC = Fine Granular Casts

UCGC = Coarse Granular Casts

UWBCC = White Cell Casts

URBCC = Red Cell Casts

UWXYC = Waxy Casts

UMUC = Mucus

UAMOR = Amorphous Material

UCAOX = Calcium Oxalate Crystals

UURAC = Urate Crystals

UTPHC = Triple Phosphate Cyrstals

UYST = Yeast

USPRM = Sperm

UTRIC = Trichomonads

UREN = Renal Epithelial Cells

UOTCR = Other Crystals (A keypad will appear in the upper right hand corner.

Choose the corresponding number to the crystal you want and then choose

the quantitation)

*Requires a result

Test Comments (automatically get added when specific tests are reflexed):

TCLIN	Positive result confirms presence of reducing substance.

Negative result confirms absence of reducing substance.

TSSA	Positive result confirms protein is present.

Negative result confirms protein is absent.

UFMIC Components:

URBCI= UF instrument rbc

UWBCI= UF instrument wbc

UEPII= UF instrument Epi cells

UHYAI=UF instrument hyaline casts

UBACI=UF instrument bacteria

Manual Microscopic (MMICR) Components:

UEPIM= manual epi cells *

UHYAM=manual hyaline casts *

UWBCM=manual wbc*

URBCM=manual rbc *

UBACM= manual bacteria*

UF INSTRUMENT FLAGS:

FPACA=pathological cast flag

FSRC=Small round cells flag

FYST=yeast flag

FXTAL=cyrstals flag

FSPERM=sperm flag

FMUC=mucus flag

FBACT=bacteria flag

FCARR=carryover flag

FCAST=cast flag

FEC=epithelial cells flag

FLERR=error flag

FLRBC=rbc flag

FLWBC=wbc flag

FREV=review flag

FREPI=renal epi flag

III. HISTORY

H-1	This procedure was written by Jessica Kaul on 3/7/2010.

H-2	This procedure was revised by Jessica Kaul on 3/5/2011

H-3	This procedure was revised by Mary Stegina on 2/26/2014..