MAJOR DUTIES The primary purpose of this medical technician position is to perform a variety of clinical laboratory tests and examinations in the Department of Pathology in support of direct patient care (inpatient and outpatient). Works under the general supervision of a Hospital Laboratory Supervisory Medical Technologist who provides initial guidance on areas of responsibility and priorities. Performs a wide variety of testing in the areas of STAT/routine hematology, coagulation, chemistry, urinalysis, serology, immunoassays, Blood Bank, microbiology, specimen processing and phlebotomy. Tests are not always covered in detail by instructions and guidelines or in the laboratory procedures because of the difficulty, the great number of variables, and the variety of instruments and equipment. Uses knowledge of specific clinical laboratory procedures, general good laboratory practices, and scientific principles underlying the measurement or analytical methodologies employed, basic math, and health and safety concerns in the performance of the position's responsibilities. Interprets test results when inconsistencies are noted. Participates in prescribed quality control procedures. Operates complex semi automated and automated equipment and performs calibration procedures, periodic operator maintenance tasks, troubleshooting procedures to identify the cause of malfunctions, and corrective actions to resolve the identified malfunctions. Many of the tests performed are complex or highly technical and require professional judgment and knowledge to ascertain the best manner in which to proceed. The tests and examinations are typically covered by laboratory manuals and written instructions but require subjective interpretation, estimation, and judgment calls. Requires knowledge of control values, critical results, and criteria for supervisor/pathologist review. During the course of the tests and examinations, there is often a need for the performance of a number of additional tasks or tests because of the results of the early phases or stages of the analysis. Incumbent is expected to recognize when these additional tasks or tests are required and to perform them without prompting from the section supervisor. Incumbent resolves most technical problems, referring only the more complex problems to the senior technologist or supervisor. Independently performs a wide variety of testing in the areas of STAT/routine hematology, coagulation, chemistry, urinalysis, serology, immunoassays, Blood Bank and microbiological testing in accordance with the College of American Pathologists (CAP), Standard Operating Procedures (SOPs), instrument manuals, manufacturer's instructions and technical references relating to said testing. The incumbent works with considerable independence to carry out testing, setting priorities based on STAT, ASAP or routine classification, exercising sound judgment and interpretation. Incumbent releases results without supervisor review; however, results are reviewed after the fact to identify handling of abnormal findings against established quality control (QC values). Incumbent resolves most technical problems, referring only the more complex problems to the senior technologist or supervisor. Completed work is reviewed from an overall standpoint of ensuring completion, accuracy, precision and timeliness. The supervisor places great reliance, trust, and confidence in the technician and in the accuracy and dependability of the results of the work. Makes personal contact daily with fellow employees, supervisors, physicians, and nursing personnel to accomplish the work and report results. Interacts with hospital and manufacturer maintenance personnel when trying to resolve malfunctions in analytical equipment. Interacts with personnel at reference laboratories as required to investigate specimen requirements and special handling guidelines. Interacts with individuals on accreditation teams at the time inspections are conducted. Assists in the instruction of newly assigned civilian and military technicians who rotate through the section for training purposes. Maintains comprehensive knowledge of accreditation standards applicable to the sections operations. Interacts with accreditation agencies when questions arise concerning required standards of performance. Will function as section leader in the absence of the supervisor. Renders advice and assistance as required to both subordinates and superiors. More specifically, performs the following: Duty 1. 1a. QUALITY CONTROL PROCEDURES: Conducts necessary quality control procedures. Maintains accurate records utilizing Levy Jennings charts and ensures all QC results fall within established control limits prior to releasing patient results. Properly documents all corrective action taken for any discrepancies and out of range controls. Records new lot of reagents and ensures QC results are acceptable before putting into use. Performs external proficiency surveys as directed by supervisor. Records temperatures of refrigerators and freezers daily. 1b. BLOOD BANK: Duties include performing a variety of immunohematologic tests and examination; blood typing, cross matching, antibody detection and identification, serological latex testing for many disease states, enzyme immunoassay testing for Hepatitis, and other specialized Blood Bank confirmation testing. Performs a variety of immunohematologic tests and examinations which individually and collectively are difficult and complex in the Blood Bank field; blood typing, cross matching (compatibility testing), antibody detection and identification, red cell phenotyping, antibody enhancement procedures, antibody absorption tasks elution procedures, etc. Recognizes and identifies unusual results, i.e., conditions of test performance, reaction systems and/or test procedures used, etc. Performs antibody studies with one or more red cell panels, elution techniques, etc., referring results to the supervisor for review of further studies. Enters test results which requires knowledge of an alphanumeric keyboard and practical knowledge of computer system. Performs serological latex testing for many disease states and many different assays using enzyme immunoassay technique for Hepatitis diagnosis testing. Prepares, stains, reads and gives interpretation for Klienhauer-Betke testing for determination of fetal-maternal hemorrhage. Investigates transfusion reactions involving blood component and performs all required studies. Prepares components for exchange transfusion of neonates. Receives, issues, prepares and stores blood and blood components in accordance with established procedures and directives. Prepares different blood components to include splitting products for neonate transfusions using sterile welding procedures into special syringe components bags. Single platelet concentrates are routinely pooled together and prepared for transfusions. Performs evaluation of material sensitization and similar test in the study of transfusion reaction of other cases of incompatible blood matches. Monitors the cell-saving equipment from the surgical ward. Utilizes the Laboratory Information System and the Defense Blood Standard System for Blood Banks. 1c. CHEMISTRY: Selects, performs and monitors the performance of a wide variety of tests using complex automated analytical systems. Performs high complexity tests including Total Iron-Binding Capacity and High Density Lipoprotein Cholesterol as part of Lipid testing. Follows established procedures for testing biological fluids such as whole blood, serum, urine, cerebrospinal fluid and other body fluids. Performs dilutions accurately and uses them judiciously. Recognizes, responds to, and troubleshoots error codes, conditions, and malfunctions of the analyzers by using manufacturer operator manuals and via telephonic support assistance when necessary. Uses various computers to perform work via the onboard data management systems utilized by most analyzers. 1d. HEMATOLOGY/COAGULATION: Performs a wide variety of hematology and coagulation testing involving the use of complex automated instrumentation and cell interpretation utilizing microscopic techniques. Performs highly complex analyses of peripheral smears by classifying white blood cells, morphological evaluation of red blood cells, platelet slide estimates and reticulocytes. Requires identification of normal and abnormal cell populations. Performs and calculates manual cell counts on body fluids. Identifies and classifies cells on body fluid smears and crystal analysis on synovial fluids utilizing polarizing microscopy. Performs special coagulation testing including mixing studies and bleeding times. 1e. URINALYSIS: Performs urinalysis testing utilizing macroscopic and microscopic techniques. Performs and interprets urine chemistries manually and automated. Evaluates urine sediment utilizing microscopic techniques. Interprets the number of red and white cells present, distinguishes between squamous, transitional or renal epithelial cells, various types of casts, crystals and other urine cellular components. Performs HCG evaluation, interpretation of cells and urine sediments utilizing microscopic techniques. 1f. MICROBIOLOGY: Inoculates, cultivates, isolates, classifies and identifies bacterial and other microorganisms present in body fluids, exudates, surface, or autopsy and surgical specimens as well as performs various bacteriological, virological and parasitological procedures to provide data that can be used for the diagnosis and treatment of cause and progress of disease. These diagnostic tests are performed using instrumentation for the monitoring of blood cultures, biochemical panels for proper identification of organisms according to genus and species, Kirby-Bauer sensitivity and Immunoassay procedures. Macroscopic and microscopic examinations of cultures of numerous species of bacteria for the purpose of positive identification, employing cultural, serological, morphological and biochemical means. Performs gram stains from various sites and fluorescent stains primarily for acid-fast bacterial studies. Performs macroscopic and microscopic procedures in Parasitology (direct, concentration and trichrome studies), performs special stains for the identification of blood parasites and cryptosporidium. Performs complete qualitative, morphological and chemical examination for semen analysis infertility workups and post-vasectomy evaluations. Is available for attending physicians to consult concerning pathogenic organisms, techniques and antibiotic reactions. 1e: TECHNICAL REVIEW AND TRAINING Reviews results of routine work for technical accuracy or obvious errors. Repeats test and examinations where obvious test errors are apparent, results achieved trigger such action (as identified by internal SOP), or when departures from the expected are experienced. Determines the reason for inconsistencies. Provides assistance when required and, when tasked, reviews the work of medical technicians to insure accuracy and completeness prior to the results being reported to the physician. If patient reports have been released and an error has occurred, corrects the error in a timely manner and ensures that all patient care personnel are notified and that all paperwork has been corrected (up to and including the patient's chart). Mathematical calculations are required. In the performance of the above procedures operates the analyzers and other equipment of the section according to manufacturer's recommendations and existing departmental SOPs. Performs start up and shut down procedures (if applicable), routine periodic maintenance procedures, troubleshoots to identify malfunctions, takes necessary actions to correct the malfunctions identified or notifies the section supervisor of the need for assistance and/or maintenance support if correction of the malfunction is beyond operator's capability/responsibility (may routinely work telephonically with vendor hotline personnel in an effort to correct analyzer problems), and performs calibration of the equipment if calibration of the equipment or instrument is required. Records the performance of these tasks per established policy for the supervisor's review. Performs daily (or as required) quality control procedures for ensuring the acceptability of all testing systems. Evaluates control data to ensure the data is within acceptable norms and meets other screening criteria as specified before releasing patient results. If controls are not acceptable, repeats the procedure. If procedure is still not in control, begins troubleshooting procedures to identify the cause of the problem. Reports action taken to the section supervisor or seeks assistance if unable to satisfactorily resolve the out of control condition. Maintains records, graphs and charts for daily or other periodic quality control of all laboratory functions within the section per established policy for the supervisor's review. Observes and records function verification parameters on support equipment and records observations according to established policy for the supervisor's review. Directs the work of lesser-trained or lower grade employees in routine to complex clinical laboratory procedures. Provides assistance as required. In the absence of the section supervisor, assumes technical control of the section. Ensures quality control procedures are performed and recorded, and that the results are acceptable; ensures periodic maintenance tasks are performed and recorded; reviews work of other technical personnel within the section for acceptability and compliance with internal procedures prior to distribution (may accept, amend, or totally reject the work performed based on this review). Duty 2. ADMINISTRATIVE DUTIES 2a. Performs routine administrative functions; observes incoming workload and determines priority sequences of individual cases. Assists in monitoring routine and special work assignments for newly assigned personnel. Maintains log books/log sheets for all testing procedures performed within the section, recording the pertinent information required by section guidelines. Monitors the timely processing of special and routine work to ensure the diagnostic needs of all patient care services are met. Monitors turn-around time of routine, ASAP, and STAT lab requests to ensure turn-around times as established by departmental policy are met. Assists in the collection of workload figures and the entry of the information into the Uniform Chart of Accounts database. 2b. Assists in maintaining a running inventory of equipment, reagents, biological and consumable supplies. When required by the supervisor determines the need for replenishment and/or replacement of these items and submits a periodic inventory list of items needed to the Supply NCO for ordering. Receives and labels all materials in accordance with section SOPs and stores the same in a manner which maintains the integrity of the material. Performs necessary quality control procedures to ensure media performs as specified. Rotates supplies to maintain the longest possible shelf life. 2c. Assists the supervisor in monitoring the processing of external proficiency tests. Helps to ensure that all testing personnel participate in the proficiency tests, that the proficiency tests are handled in a manner which mirrors the handling of a patient specimen (as close as is feasibly possible), that the proficiency tests are completed within the required time frame, that appropriate documentation of all steps in the processing of the proficiency test is maintained, and that the report form is completed and mailed within the allowed time. Helps the supervisor to review the evaluation report and investigate any discrepancies noted, and aids in identifying and correcting any deficiencies which may have played a role in the generation of the noted discrepancy. 2d. Recognizes and notifies section supervisor of problem areas. Assists in performing tests and procedures during developmental stages until validity and reproducibility are established. Performs modified/revised test procedures under controlled/supervised conditions prior to performing test/procedures unsupervised. Keeps current on developments in the medical technology field by reading professional journals and publications and participating in prescribed quality control procedures. Makes suggestions regarding changes in existing procedures to the technologist in charge of the section. Duty 3. PERSONNEL TRAINING Assists in training/instructing untrained personnel on hematology related procedures. Documents the training of O.J.T. personnel and keeps the supervisor informed concerning the progress of the trainee. Performs other duties as assigned.