SPLIT  SAMPLE  RECORD

DATE

TEST

OUR RESULT

COMM. LAB RESULT

CRITERIA

+/- (____%)

ACCEPT/ REJECT

TECH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPLIT SAMPLE PROCEDURE

 

Our laboratory uses the split sample method to verify the accuracy of the following tests when an approved proficiency test program is not available.

 

                                                                                            *CRITERIA FOR

                                                 TEST                                   ACCEPTANCE

 

___________________________      ______________

___________________________      ______________

___________________________      ______________

___________________________      ______________

 

PROCEDURE:

Twice a year, select a patient for whom the physician has ordered the test required for split sampling. Collect enough sample to perform testing in-house and at a commercial laboratory. Be sure that specimen collection and transport methods meet the commerical laboratory’s requirements.

 

Perform the test in your office. Record result on the SPLIT SAMPLE RECORD. When the patient test report is returned from the commercial laboratory, record results on the SPLIT SAMPLE RECORD. Compare results for percent deviation from the acceptance criteria listed above for each test. Calculate percent deviation by using the following formula for quantitative tests:

office lab result minus commercial laboratory result

____________________________________               x  100  =   % deviation

                        office lab result

 

Retain the commercial laboratory result with this SPLIT SAMPLE RECORD. Keep all records for at least two years.

 

*NOTE: Many laboratories use +/- 10 to 15% as their criteria for acceptance for quantitative tests. For qualitative tests, such as microscopic tests for trichomonads or urine sediment exams, percent deviation cannot be calculated. Consult with the laboratory director or technical consultant to derive appropriate acceptance criteria that satisfies your needs for clinical decision making in your practice. Samples for microscopic tests such as urine sediment and trichomonas preps may deteriorate in transit to a commercial laboratory. If this is the case in your laboratory, perform split sampling in your office by two separate individuals and record results on the SPLIT SAMPLE RECORD.

 

PROCEDURE REVIEWED AND APPROVED BY:

 

____________________________________________________                __________________

Laboratory Director                                                                                                                             Date