Transcription of Urine Dipstick Visual Quality Control Log (Outpatient ...
1 Title (with LTR): Urine Dipstick Visual Quality Control Log Outpatient sites (LTR5271)Revised: 2/19/2013 11:16:10 AM1 Urine Dipstick Visual Quality Control Log (Outpatient sites) using Siemens Multistix 8 SG Urinalysis StripsMultistix Strip Lot # _____ Expiration: _____ Site/Location: _____Sentry Urine Dipstick ControlNORMAL Control Lot # Exp _____Sentry Urine Dipstick ControlABNORMAL Control Lot # Exp _____ Posted Range:Date testedGlucoseKetoneSpecific GravityB l o o dp HProteinNitriteLeukocytesGlucoseKetoneSp ecific GravityBloodp HProteinNitriteLeukocytesCorrective ActionOperatorIf one or more of the tests listed exceed the posted range, repeat the test.
2 If the repeat test result also exceeds the range, refer to the troubleshooting table on this page and enter the Corrective Action (CA) Code in the CA column Codes:R = Retested within rangeO = Retest still outsideS = New test strips or lotC = New controlsT = Adjusted technique to reflect procedureM = QC/strip lot not matchedE = Expiration dates exceededP = Contacted POCT Coordinator
