Integrating POCT In the ED
POC Connectivity Concepts,
Advance for the Administrators of the Lab, Vol. 17 •Issue 2
• Page 9
By
Valerie L. Ng, PhD, MD; R. Clayton Hooper, RN; Ruth
Pfeiffer, RN; Mary N. Clancy, MS, CLS; and Eberhard Fiebig,
MD
You can't get much more
diametrically opposed cultures than that of the ED and the
laboratory. The laboratory culture is one of careful and
methodical processes and quality systems designed to ensure
high-quality results and meet regulatory requirements. The
ED culture is one of speed, algorithmic medical practice and
rapid reflexive actions necessary to save lives in
emergencies; regulatory compliance tasks are often an
afterthought.
Ironically, many ED
interventions rely on accurate laboratory test results.
Point-of-care testing (POCT) results in the ED must, by
definition, be of the highest quality and always correct
because clinical action will be taken immediately based on
the test result.
Why has POCT become so important
for the ED? The backdrop is the unraveling of the healthcare
system, driving many uninsured and sick patients without
primary care access to the ED for routine or urgent (but not
emergency) medical care.
Click here for more >
Nurses on
Point-of-Care IT Usage: Study
By: Jean DerGurahian/ HITS
staff writer; Modern Healthcare Online Posted: January 4,
2008 - 5:59 am EDT
An
increase on patient safety issues, higher healthcare costs
and labor shortages are driving hospitals to use more
information technology at the point of care; however, some
devices and technology are more cumbersome than helpful,
according to a new study of nurses and their bedside
treatment practices.
The Point
of Care Computing for Nursing study, conducted by Spyglass
Consulting Group, shows that healthcare facilities are
making "significant investments" in clinical information
systems so that nurses and other practitioners can access
patient information near or at the point of care.
Nurses are
using fixed or mobile devices to search different
applications that help them treat their patients, according
to the report,
Spyglass spent four months interviewing more than 100 nurses
across the healthcare fields for its study.
It found
that 86% of acute-care nurses and 94% of home health nurses
interviewed are using devices to access reference
materials—including drug databases, manuals and medical
calculators—and make informed patient decisions.
While
nurses spend nearly half their time documenting their
treatments, 78% of nurses record their care at the patient's
bedside through IT applications, in efforts to cut down on
first writing the information on paper and then transferring
it to electronic reports, according to the study.
Another timesaver has been the use of automated products to
capture vital signs data for high-acuity patients, immediately
present it for nursing review and automatically upload it to the
patient’s electronic record, with 36% of nurses adopting this
practice.
Bar coding
also has helped nurses reduce medical errors. More than half the
nurses interviewed—53%—said that they use devices to ensure
positive patient identification, medication administration,
blood transfusion verification and laboratory specimen
collection, according to the report.
Nurses are
spending time on the Internet as well to stay up-to-date on
nursing trends and new treatments, according to the report.
"Nurses discovering online nursing communities and resources
enabling them to communicate and collaborate with colleagues
more effectively," Spyglass said in its report. While nurses
seem ready to embrace point-of-care technology, they also say
devices currently available are cumbersome and difficult to move
with, and networks are unreliable, according to the report.
"Point-of-care
solutions need to evolve to provide higher levels of
synchronization and integration of hardware, software and
infrastructure to streamline nursing workflow process and
improve communications amongst care team members," Spyglass
said.
Content for
Point of Care Computing for Nursing was derived from more than
100 interviews with nurses working in acute-care and ambulatory
environments nationwide. Spyglass conducted the telephone
interviews over a four-month period beginning April 2007.
Wireless glucose
results - latest on real-time data
More than a
decade after tight glycemic control made its debut in the
early 1990s, numerous studies, and recommendations from
organizations such as the American Association of Clinical
Endocrinologists and the American Diabetes Association, have
affirmed its ability to decrease everything from mortality
and comorbidity to the risk of heart failure and organ
damage. But from a point-of-care testing coordinator's point
of view, tight glycemic control increases a few
things, too.
A few? Make
that 1,000—the approximate number of glucose results that
point-of-care staff at University of North Carolina
Hospitals, Chapel Hill, manage every day. After UNC
implemented a TGC protocol a few years ago, "the first thing
that I noticed as a point-of-care person was that it
required more glucose meters and testing strips, and more
data was being generated," says Beverly Robertson, MPH, MT (ASCP),
until recently UNC's point-of-care testing coordinator and
now a technical service representative for Somerset,
NJ-based in Ventiv Health and an authorized installer of
LifeScan equipment. In addition to reviewing and charting a
greatly increased number of glucose results, the new TGC
protocol meant that Robertson was faced with managing more
frequent data downloads and data flow bottlenecks. Not only
were there more results to deal with, but "all those results
were being hand-charted," Robertson says. "And the only way
that physicians could review them was to be physically at
the nursing locations." In a large institution like UNC,
which has 750 beds, 100 units, and nine ICUs, that meant
relying on what Connie Bishop, MT (ASCP) SH, UNC assistant
administrative director of core laboratories and
point-of-care testing, laughingly terms the "sneaker
network."
Click here for more>
The
Challenges of Point-of-Care Connectivity
How A New Tool Can Aid Labs
with Device and Data System Purchasing
By Deborah Levenson,
Clinical Laboratory News, July 2007
Point-of-care testing (POCT)
devices with the ability to link to each other and lab
information systems (LISs)—known as connectivity—can help
reduce medical errors, improve staff compliance with
regulatory requirements, boost revenue from testing, and
track wasted supplies.
In most labs,
POCT connectivity has come a long way from the 1990s, when many
POCT devices lacked essentials such as ports that allowed them
to transfer results to a lab data management system or ports
with keypads for data entry. In those early days, a few
manufacturers offered instruments that allowed labs to move data
from the device to a patient’s chart, but each had its own suite
of products, necessitating multiple computers to handle data.
Today, while issues with POCT connectivity are not as
troublesome, labs often fall short of the ultimate goal of using
such devices: fast, complete transfer of accurate information.
Click here for more >
Utilization of a Computerized Intravenous Insulin Infusion
Program to Control Blood Glucose in the
Intensive Care Unit
Rattan Juneja, Corbin Roudebush,
Nilay Kumar, Angela Macy, Adam
Golas,
Donna Wall, Cheryl Wolverton, Deborah
Nelson, Joni Carroll, Samuel J. Flanders.
Diabetes Technology &
Therapeutics.
Jun 2007, Vol. 9,
No. 3:
232-240
This proof of concept study was designed
to evaluate the safety and effectiveness of an intravenous
insulin dosing calculator, the Clarian GlucoStabilizer™
program, and to determine the feasibility of its use as part
of a glycemic control program. This paper discusses the
impact of the GlucoStabilizer program on the glycemic
control of intensive care patients with hyperglycemia.
Patients admitted to the intensive care unit
(ICU), requiring intravenous insulin, were treated using the
GlucoStabilizer program. This program calculates an insulin
drip rate based on the low and high blood glucose (BG)
levels of the desired target range, the patient's current
and previous BG levels, and an insulin sensitivity factor,
with a goal of safely and expeditiously achieving and
maintaining the patient's BG in the target range.
From October 2004 through March 2006, the
GlucoStabilizer program has been used to treat 2,398
patients in the ICUs, with 177,279 BG measurements in its
database.
For
more on this study, or to request a copy,
click here.
Intensive Insulin Protocol
Improves Glucose Control and Is Associated with a Reduction in
Intensive Care Unit Mortality
Charles C Reed, BSN, Ronald M Stewart, MD, FACS, Michele
Sherman, BSN, John G Myers, MD, FACS, Michael G Corneille, MD,
FACS, Nanette Larson, BSN, Susan Gerhardt, MSN, Randall Beadle,
BSN, Conrado Gamboa, MS, RPh, Daniel Dent, MD, FACS, Stephen M
Cohn, MD, FACS, Basil A Pruitt Jr, MD, FACS. American College of
Surgeons, 2007
Intensive insulin therapy to maintain serum glucose levels
between 80 and 110 mg/dL has previously been shown to reduce
mortality in the critically ill; recent data, however, have
called this benefit into question.
In addition, maintaining
uniform, tight glucose control is challenging and resource
demanding. We hypothesized that, by use of a protocol, tight
glucose control could be achieved in the surgical trauma
intensive care unit (STICU), and that improved glucose control
would be beneficial. During the study period, a progressively
more rigorous approach to glucose control was used, culminating
in an implemented protocol in 2005.
We reviewed STICU patients’ blood glucose
levels, measured by point-of-care testing, from 2003 to
2006.Mortality was tracked over the course of the study, and
patient charts were retrospectively reviewed to measure illness
and injury severity.
For
the results of this study,
click here to access the pdf file.
Glucose Test
Frequency Spawns
New Analyzer Needs
Anne
Ford
In dieting—as in so much else—good
intentions aren’t enough. To lose weight, calorie-counters can’t
stock up on carrot sticks and hope for the best; they have to
actually monitor their diet via a food diary or some other
method. (Hence the saying: “If you bite it, write it.”) But if
the monitoring method becomes too cumbersome, it’s likely to go
by the wayside, and any new, healthier eating habits will
probably follow.
Conversely, making the monitoring
process as painless as possible is a major step toward success.
And that’s a lesson that applies to many endeavors, including
tight glycemic control.
“Because
of the increased testing frequency mandated by most tight
glycemic control protocols,” says LifeScan marketing manager
Grant Choe, “anything we can do to increase ease and simplicity
is going to be welcomed with open arms.” Harlan Polishook, Nova
Biomedical marketing communications manager, agrees: Under tight
glycemic control protocols, he says, some nurses find themselves
performing bedside glucose testing “as frequently as every half
hour for some patients.” In turn, “more frequent bedside testing
has driven the demand for faster, easier testing and smaller
blood volumes.”
The
makers of the
bedside glucose testing systems featured in this month’s
instrumentation survey have responded to that demand
with new and forthcoming instruments and features, from multiple
measuring wells to wireless capabilities.
Click here for more >
Industry Overview
Surprise, We’re Here!
Gearing up for
unannounced inspections
By
Renee DiIulio
In 2004, deficiencies at Maryland
General Hospital (MGH) in Baltimore brought oversight attention
to the process of laboratory accreditation and inspections. The
title of a resulting Government Accountability Office (GAO)
report, published in June 2006, summarizes the result: “Clinical
Labs: CMS and Survey Organization Oversight Is Not Sufficient to
Ensure Lab Quality.” Something had to change. Congressmen called
for a switch to unannounced inspections. At the same time, the
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), Oakbrook Terrace, Ill, was in the process of altering
its accreditation process, implementing a plan named Shared
Visions—New Pathways, which became effective January 1, 2004.
“In 2004, JCAHO announced its intent
to implement unannounced surveys in 2006 as part of our Shared
Vision—New Pathways effort,” says Margaret Peck, MS, MT(ASCP),
the organization’s director of the lab accreditation program.
The goal was to provide a more accurate picture of a
laboratory’s day-to-day function. “It would allow our
accreditation process to be used as a systems improvement tool,”
Peck says.
College of American Pathologists
(CAP) followed suit, influenced, says R. Bruce (RB) Williams,
MD, pathologist and head of CAP’s accreditation committee, by
the concern of the GAO and Congress. “We are continually
improving our lab accreditation process, and we underwent a
systemic review following MGH,” he says. A subsequent bill—HR
686: Clinical Laboratory Compliance Improvement Act of 2005,
introduced by Rep Elijah Cummings (D-Md)—aims to make
unannounced inspections a requirement if passed.
Click here for more >
When
POC Connects the Data, Everyone Wins
The
story of point-of-care connectivity is quickly becoming one of
laboratory medicine’s twice-told tales: POC setups have come a
long way, and hospitals are reaping the benefits. For Debra
Norkett, MT (ASCP), education coordinator for the laboratory and
point-of-care coordinator at NorthEast Medical Center, a 457-bed
hospital in Concord, NC, incorporating POC test data into an
electronic patient record system is the ultimate goal. “Our
hospital is working toward having electronic patient records,
and theoretically, point-of-care connectivity has been set up to
support such a system,” she says.
NorthEast Medical Center
implemented POC connectivity about three years ago, beginning
with the installation of a positive patient identification
system that uses bar-coded patient wristbands in conjunction
with bar-coded POC instrument operator badges to capture the
data from each encounter that involves a POC test. “The success
of our POC connectivity is tied into our bar-code system. The
bar-coded wristbands and badges have enabled us to reduce
patient misidentification errors, as well as automate POC test
ordering and result reporting,” Norkett says. Since bar coding
became part of the POC process at NorthEast, patient
identification errors have dropped to below one percent.
Because NorthEast installed its
vendor-neutral Rals-Plus POC data-management system at the same
time it implemented its positive patient identification system,
POC connectivity has always been enabled by the bar-code system.
“I took the job of POC coordinator a few years before we
implemented POC connectivity. Then, we had about 30 glucose
meters and I would carry a laptop from unit to unit and actually
download the information,” Norkett recalls. “At the time, it
took so long to gather the data that report generation was
always about a month after the fact.”
Click here for more >
CAP Today, March 2006, Cover
Story
Nearing High Tide on Low Blood Sugars
By Anne Paxton
Since its emergence in the early 1990s, tight
glycemic control could almost have been called an orphan
protocol. Despite evidence that it sharply lowers patient
mortality and morbidity and hospital length of stay, the use of
insulin to keep patient's blood glucose at or near normal levels
has spread slowly beyond a few pockets of fervent support, and
has yet to sweep the nation's hospitals. As Curtiss B. Cook, MD,
associate professor of medicine in the Division of Endocrinology
at Mayo Clinic Arizona puts it: "A lot of people haven't quite
bought into the concept yet."
But in recent weeks, with a major new
controlled study and a public statement from leading
professional associations in diabetes care, tight glycemic
control may have reached its tipping point. The American
Association of Clinical Endocrinologists and the American
Diabetes Association are now advocating widespread adoption of
tight glycemic control protocols not only in intensive care
units but also in other areas of the hospital. Their position
statement, released Feb. 1, calls for implementing "structured
protocols for aggressive control of blood glucose in both
intensive care units and other hospital settings."
One day later, Belgian researchers led by
Greet Van den Berghe, MD, PhD, reported in the
New England Journal of Medicine (354:449-461)
that intensive insulin therapy, or tight glycemic control,
significantly reduced morbidity among all patients in the
medical ICU—a benefit that was demonstrated earlier on patients
in surgical ICUs.
Click here for more >
Avoiding
Glucose Monitoring Errors in Patients Receiving Other Sugars
FDA issued a reminder about the potential for falsely elevated
glucose readings in patients who are also receiving products
that contain other sugars. These products include oral xylose,
parenterals that contain maltose or galactose, and peritoneal
dialysis solutions that contain icodextrin.
A patient recently died because of this problem. His glucose
readings were very high, so he was given aggressive insulin
treatment. The glucose readings were falsely high, however, and
too much insulin was administered. The patient suffered
irreversible brain damage and died. In this case the glucose
meter was reading the patient's actual blood glucose level, plus
the maltose that was contained in the IV immune globulin he was
receiving. The readings were falsely elevated because the
glucose monitoring device couldn't distinguish between glucose
and other sugars. All glucose meters don't suffer from this
problem. There are four kinds of enzymatic glucose monitoring
methods that are used, and only one of those has this problem.
This problem occurs only with the monitoring method that uses an
enzyme called GDH-PQQ. This method is employed in some glucose
monitoring devices used by diabetics at home and in
point-of-care settings.
The other three test methods currently used in glucose
monitoring systems are called GDH-NAD, glucose oxidase, and
glucose hexokinase, and they are capable of distinguishing
between glucose and other sugars. The test method used in
glucose meters is identified in the package insert that comes
with the glucose test strips. The package insert is also
available from the manufacturer. The most important thing to
remember is not to use the GDH-PQQ method if the patient
recently received other sugars. That includes oral xylose for a
D-Xylose absorption test, or an IV solution containing maltose
or galactose, or a peritoneal dialysis solution containing
icodextrin.
Click here for more >
Additional
Information:
FDA MedWatch Safety Alert 2005 - Parenteral Maltose/Parenteral
Galactose/Oral Xylose-Containing Products:
Major
Medical Associations Call for Better Blood Glucose Management in
Hospitalized Patients
WASHINGTON, DC – February 1, 2006 –
The American Association of Clinical Endocrinologists (AACE),
American College of Endocrinology (ACE – the scientific and
educational arm of AACE) and the American Diabetes Association
(ADA) have joined forces to develop strategies for management of
adult patients with high blood glucose (sugar) in hospitals.
Co-sponsored by ten other major medical associations, AACE and
ADA released a new position statement today on improving
inpatient glycemic control at a joint consensus conference.
Awareness about the
importance of glycemic control in the hospital setting has
increased as result of the ACE Consensus Development Conference
on Inpatient Diabetes and Metabolic Control in 2003. In order
to suggest a plan for better care, AACE and ADA came together to
conduct the “Improving Inpatient Diabetes Care: A Call to Action
Conference - Consensus Development Conference,” January 30 and
31, 2006 in Washington, DC.
Click here for more >
Tight Glucose Control Cuts
Heart Disease by Half in
Type 1 Diabetes
Published by the U.S. Dept. of Health and Human Services - NIH
News
Intensive
glucose control lowers the risk of heart disease and stroke by
about 50 percent in people with type 1 diabetes, researchers
report in the
December 22, 2005, issue of the New England
Journal of Medicine. Their findings are based on a
follow-up study of patients who took part more than a decade ago
in the Diabetes Control and Complications Trial (DCCT)
www.diabetes.niddk.nih.
gov/dm/pubs/control/index.htm,
a major clinical study funded by the National Institutes of
Health (NIH).
“We see a greater reduction in
cardiovascular events from intensive blood glucose control than
from drugs that lower blood pressure and cholesterol,” said Saul
Genuth, M.D, of Case Western University. Genuth chairs the
follow-up study of DCCT participants, called the Epidemiology of
Diabetes Interventions and Complications (EDIC) study, which is
examining the long-term effects of prior intensive versus
conventional blood glucose control.
“The benefits of intensive
control strongly reinforce the message that this therapy should
begin as early as possible and be maintained as long as
possible.”
Click here for more >
Opening up the throttle on
POC-hospital connectivity
CAP
Today, December 2005, Feature Story
By Anne Paxton
For point-of-care testing managers,
true connectivity is now within reach, which means tantalizing
efficiencies lie ahead. POC departments are aligning their
connectivity solutions with hospital wide moves to sharpen
treatment protocols and become paperless and wireless. For many
POC testing programs, the integration of it all is complicated by
the demand for bedside testing—and its brisk growth.
Six hospitals, three outpatient
clinics, and seven nursing homes make up Sentara Healthcare in the
Hampton Roads area of Virginia. Employing 300 glucose meters and
about 170 i-Stats, the Sentara system now does well over 1 million
POC tests a year, says Lou Ann Wyer, MT(ASCP), POC testing
clinical specialist with Sentara Laboratories. Like many other
health systems, Sentara has seen a sharp increase in glucose
testing because all units are using tight glycemic protocols.
Wyer's chief project now is rolling
out troponin testing in the emergency department. "For this test
there was a lot of up-front work to be done. It's been a long
process, including extensive evaluation of the cartridge—an i-Stat
product—and making sure physicians are comfortable with the method
and how to interpret results, because they don't match the main
laboratory results. They have different cutoff values."
Click here for more >
Connective issue: Linking POC
with Wireless Hospitals
CAP
Today, November 2005, Feature Story
By Anne Paxton
Most point-of-care
testing managers are thrilled with the new devices and software
available to streamline their operations. But with connectivity
becoming standard operating procedure, POC testing programs are
facing a new challenge: making sure that connectivity meshes
with hospitalwide initiatives to adopt new treatment paradigms,
eliminate patient ID errors, and eventually say goodbye to
cables and wires, as well as to paper. Whether their programs
are in a state of steady expansion or extreme makeover, POC
testing managers say the possible efficiencies now in view or
just around the corner are tantalizing.
How are they
turning the visionary schemes into smooth-functioning routines?
At Lewis-Gale
Medical Center, Salem, Va., connectivity is fairly well
established. “We have three different connectivity
solutions,” says point of care coordinator John La Rosa, MA,
CLS (NCA). “Biosite Census connectivity for cardiac
markers has been in place since 2001, we’ve had the Roche
Diagnostics glucose meters on RALS-Plus since 2002, and
Abbott Central Data Station for the i-Stats just started
this summer.”
The laboratory
and hospital information systems are from Meditech. The
software updates are included in the hospital’s three- to
five-year contracts with the vendors, and may be carried out
remotely if the vendors have access to the hospital’s
network.
“The big plus of connectivity is it allows us to capture
billing that wasn’t captured before, and make sure we are
billing to the correct account or patient. We are billing
and getting reimbursed wherever we can,” La Rosa says.
Tight glycemic
control is the hot topic of 2005 in his region, he says,
because the evidence shows that keeping patient blood sugar
under a certain benchmark prevents some infections, raises
postoperative wound healing rates, and reduces length of
stay.
“This year we kicked up tight glycemic control where we
monitor blood sugars every hour on patients on insulin drip.
Right now we just have TGC in critical areas, but when we
move it out to the whole hospital, we expect glucose testing
to go up quite a bit.”
Click here for more >
Outpatient Setting:
Alternatives to Connectivity
Vol. 14 •Issue 11 • Page 10 November 2005 Advance for
Administrators of the Lab - AT THE BEDSIDE
By
Peggy Mann, MS, MT(ASCP)
Maintaining
a unified point-of-care (POC) program across a university-based
hospital system can prove challenging to coordinators
responsible for compliance oversight. If a process is designed
without regard to the differences between in-patient,
campus-based, out-patient clinics, and remote off-site provider
offices, it increases the chance that the target or goal will
not be met.
One striking disparity between on- and off-campus sites is how
campus-based services are delivered. An example at our
institution of how distance complicates standardization of POC
across an enterprise is delivery of reagents from a campus
materials department. Another example is the impracticality of
operators traveling to campus for observation check-offs
available to on-campus operators. A third example is
establishing the need for connecting the POC devices in use
across the enterprise.
In light of
the financial burden to connect, what benefits make it worth an
off-site clinic finding the money if they have to fund their
participation? Are there alternative ways to manage a POC
program?
Click here for more >
A Tight Glycemic
Control Initiative
June 2005 • Advance for Administrators of the Lab
• At the Bedside:
By
Nicole Woody, MT(ASCP)
Tight
Glycemic Control (TGC) should qualify as the 2005 phrase of the
year. TGC is everywhere in the health care literature, Web
casts, listservs and continuing education programs. A Google
search of the term yields over 30,000 hits. My experience with
TGC began in November 2004, when a glycemic taskforce convened
to discuss glycemic control in the hospital. The taskforce was
made up of physicians, nurses, dietitians, laboratory
professionals, information services employees and pharmacists.
Four Basic
Groups
The taskforce's first assigned duty was to identify existing
patient safety issues with glycemic control and prioritize those
issues. To accomplish this, the task force was broken into four
work groups. The groups included nursing, laboratory/devices,
dietary and pharmacology. Nursing looked at the various issues
concerning TGC and its impact on the staff. Dietary looked at
the food we were serving our patients. Pharmacology looked at
many issues, including the types of insulin we use and dextrose
concentrations used for intravenous drips. Finally, the
laboratory/devices group looked at our existing point-of-care (POC)
glucose testing meters, who uses the meters, staff education and
the number of meters in use.
The first
phase of the task force went relatively well. There were
meetings every other week to discuss and work through the issues
that arose. A protocol was developed for use in the
Cardiothoracic Surgical Intensive Care Unite (CT SICU) and its
related step-down unit. Unfortunately, everyone wanted TGC to
work without looking at the reality of the protocol.
Click here for more >
POCT Compliance with JCAHO's National Patient Safety Goals
Point of Care:
The Journal of Near-Patient Testing & Technology:
Vol 4(2)
June 05,
Ehrmeyer, Sharon S PhD, MT(ASCP); Darcy, Teresa P
MD, MMM.
Today, ensuring
patient safety through error prevention is a priority for
healthcare organizations. In response to the Institute of
Medicine report that 98,000 deaths annually in US hospitals
result from preventable medical errors, the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) disseminated
its first national patient safety goals (NPSG).
On January 1,
2005, JCAHO began surveying accredited healthcare organizations
for implementation of applicable 2005 goals and requirements. It
is essential that point of care testing (POCT) sites in the
approximately 4500 US hospitals accredited by the JCAHO
understand these goals and create the necessary policies and
procedures for achieving them. This report addresses the
relevant NPSG identified by JCAHO for its Laboratory Program and
a total quality management strategy for POCT to follow to ensure
compliance with the relevant goals.
For 2005
JCAHO identified 12 NPSG for its 10 healthcare programs. These
programs are ambulatory care and office-based surgery, assisted
living, behavioral health care, critical access hospital,
disease-specific care, home care, hospital, laboratory, long
term care, and networks (integrated delivery systems, managed
care and preferred provider organizations).
Click here > for
the rest of this article.
Access does require a subscription to
Point of Care: The
Journal of Near-Patient Testing & Technology.
POC Connectivity Takes
Hold
CAP Today, June 2005,
Feature Story, by
Anne Paxton
Point-of-care testing
connectivity presents POC coordinators with a dilemma:
Should they let other hospitals be the early adopters while the
bugs are ironed out? Or should they rush to take advantage of
the streamlined, comprehensive data capture that connectivity
has to offer?
Both choices have their pluses and
minuses, but point-of-care testing coordinators who have taken
the leap into POC connectivity say once they got past the
learning curve blues, the payoff was worth it. With the array of
POC vendors and diverse analytical profiles, POC data can’t be
handled by the laboratory information system or HIS without a
local data-management system that connects them on a single
platform.
Helped by the industry-wide POC
connectivity standard approved in 2001, POC data-management
systems are gaining a foothold in the nation’s hospitals, but
obstacles remain before point-of-care results glide swiftly,
seamlessly, and accurately into hospital records.
Connectivity solutions from
Abbott POC (PrecisionWeb), Lifescan (Datalink), Medical
Automation Systems (RALS), Telcor (QML) are referenced
throughout this article.
Click here for more >
Glucose Testing Variability and
the Need for an Expert Oversight Committee
CAP
Today, May 2005, Feature Story,
Joyce G.
Schwartz, MD, Samuel B. Reichberg, MD, PhD
Raymond S. Gambino, MD
In 1979 a work group of the
National Diabetes Data Group1
established the criteria, later endorsed by the World Health
Organization Committee on Diabetes, that patients with a fasting
or 2-h postprandial glucose concentration greater than 140 or 200
mg/dL, respectively, were to be considered diabetic.
In 1997, the Expert Committee
on the Diagnosis and Classification of Diabetes Mellitus was
convened to reexamine the classification and diagnostic criteria
for diabetes based on the 1979 publication of the National
Diabetes Data Group. As a result of its deliberations, the
committee recommended several changes to the diagnostic criteria
for diabetes and for lesser degrees of impaired glucose
regulation.2
The use of a fasting plasma glucose, or FPG, test for the
diagnosis of diabetes was recommended, and the cut point
separating diabetes from nondiabetes was lowered from a FPG >
140 mg/dL to > 126 mg/dL. This change was based on data
that showed an increase in prevalence and incidence of diabetic
retinopathy beginning approximately at a FPG of 126 mg/dL, as well
as on the desire to reduce the discrepancy that existed in the
number of cases detected by the FPG cut point of > 140 mg/dL
and the 2-h value in the OGTT (2-h plasma glucose) of > 200
mg/dL.
Click here for more >
Improving Patient Care With Blood Gas Connectivity
By
Michael Dalton, Advance for the Administrators of the Lab,
Vol. 14 •Issue
3 • POC Connectivity Concepts
The intensive nature of a critical care environment requires
physicians to respond quickly to the needs of a patient to
accurately diagnose and treat him. In this diminished state of
health, a patient's condition can change rapidly, so a more
efficient system enables a physician to obtain arterial blood gas
results rapidly. This enhanced turnaround of patient information
allows the physician to assess the patient's status and implement
therapeutic measures within a very short timeline.
One way to ensure rapid and accurate
blood gas diagnostic test results is to utilize
point-of-care (POC) instruments in the critical care setting
linked with connectivity management solutions. There are
several ways connectivity in the POC setting can bring real
advantages to hospitals and laboratories and help enrich
patient care in crucial areas such as system efficiency,
patient security, data management and equipment and staff
support. All of these workflow benefits ultimately deliver
improved patient care.
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ICUs Tighten Belts on Blood Glucose
Levels
CAP Today, February 2005,
Cover Story
by
William Check, PhD
Tight glycemic control shows growing evidence of improving
morbidity and mortality
As George and Ira
Gershwin famously wrote, "Love is sweeping the country!" including
"All the sexes from Maine to Texas." True, "tight glycemic control
in critically ill patients" doesn't have the instant emotional
appeal that love evokes, but it too has been sweeping the country,
becoming routine in intensive care units from Oregon to
Connecticut and many places in between. And whereas love is often
blamed in song with making people feel blue and brokenhearted,
tight glycemic control actually makes people feel better and live
longer, with some of its strongest health benefits seen in
patients with cardiac conditions.
Most important, growing evidence
indicates that tight glycemic control improves morbidity and
mortality not just in diabetics, but in all critically ill
patients, setting the stage for comprehensive blood glucose
protocols to be adopted in ICUs.
Click here for more >
January
1, 2005
Bringing New POCT Equipment on Board
Advance for the Administrators of the Lab,
Vol. 14, Issue 1 POC Connectivity
Concepts,
by Matthew T.
Patton
When
point-of-care testing (POCT) is to be implemented on a large scale—involving
multiple clinics and units or even multiple hospitals—pre-planning by
multidisciplinary teams is essential. Equally important is to incorporate
instrument vendor expertise into the training process. Involvement at all
levels can help ensure that labs stay in regulatory compliance and remain
competent users of POCT equipment.
Staff
Involvement
When dealing
with quality control for employees new to the instrumentation, Lou Ann Wyer,
MT(ASCP), clinical specialist, POCT/QM, Sentara Laboratory Services, Norfolk,
VA, tells ADVANCE that her facility conducts precision, reportable
range or calibration validation and method comparison studies during the
pre-planning phase. Statistical
analysis is performed on each set of data and the method's
performance is approved prior to implementation.
Click here for the complete
article >
Breaking it Down POCT:
The Salary Dilemma
Advance for
Medical Laboratory Professionals,
Vol. 17, Issue 3, Page 14,
by
Kerri Penno
Point-of-care testing professionals often have a difficult
time obtaining compensation for additional duties.The
scenario is familiar across the healthcare field: lines of
responsibility are blurred, expectations are high and
compensation and recognition decidedly are not.
Point-of-care testing (POCT) professionals are being
stretched too thin and wearing too many hats. POCT
coordinators (POCCs) act more like managers, and some
laboratorians are in charge of more POCT work in addition to
their own responsibilities without any additional
compensation. This
job description and salary discrepancy is generating a buzz
among POCT professionals across the nation.
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November 2004
More Studies
Support
Tight Glycemic
Control in Hospitals
By Kay Downer,
Clinical Laboratory News
For years physicians have known the importance
of controlling blood glucose levels in diabetic patients, but only recently
have they begun to realize its importance in treating critically ill
patients—both those with and without diabetes. In
the past few years, several studies have shown that a range of patient
outcomes can be significantly improved by tight glycemic control, a
process of maintaining blood glucose levels within a narrow target
range via frequent insulin administration.
The
rest of this article can be found in the November 2004 issue of Clinical
Laboratory News. Visit www.aacc.org/cln/default.stm
for more information.
Push for Electronic
Medical Records
Gains Momentum
By Penny Allen,
Clinical Laboratory News
In an executive order last April, President
George W. Bush called for widespread deployment of health information
technology within the next 10 years. Intended to improve health care safety,
quality, efficiency, and coordination between providers in the U.S.,
implementing this technology is a noble but lofty goal considering that the
Healthcare Information and Management Systems Society (HIMSS) reported that
this year only 19% of health care provider organizations have fully
operational electronic medical records (EMRs).
The rest of this article can be found in the
November 2004 issue of Clinical Laboratory News. Visit
www.aacc.org/cln/default.stm
for more information.
October 2004
Making the Connection
By Todd Smith,
Advance for Administrators of the Lab
Amid
the information age where technologies are exploding and prices
are shrinking, there is little excuse for point-of-care testing
that is not interfaced.
Connectivity
is an important and complicated issue in point-of-care testing (POCT).
The basic idea is to replace all manual data entry, but there
still is a lot of manual testing. With non-connected testing, the
operator must manually enter the result and other pertinent data
to get it into the information system.
The aim of
connectivity is to provide all this in an electronic,
instantaneous fashion. But one of the most significant issues
surrounding connectivity is the question of compatibility.The
benefits of interfacing POCT are obvious. All lab testing—whether
it is point of care, central lab, satellite lab, etc.—must be made
part of the medical record. Nearly 40 percent of testing is
performed at the patient's bedside, say experts. With technology
becoming more affordable, more devices bearing wireless capability
and all the networks present in the hospitals, there are numerous
options for connecting devices.
"To do point
of care without interfacing makes no sense at all," says Kenneth
E. Blick, PhD, professor, department of Pathology, University of
Oklahoma Health Sciences Center and Medical Center, Oklahoma City.
"There are no excuses for letting devices proliferate throughout
the hospital and having non-lab people select the devices and use
them in a way that is not very businesslike."
This is only a
small part of this article. The complete story can be found in
the October 2004 issue of Advance for the Administrators of the
Lab, Vol. 13 • Issue 10 • Page 63.
Click here for more >>
September 2004
POCT and the New CMS
Guidelines
By Sue Auxter-Parham, Clinical
Laboratory News
Late last year, the Centers for Medicare and
Medicaid Services (CMS) released “Appendix C, Survey Procedures and
Interpretive Guidelines for Laboratories and Laboratory Services”.
This
300-plus-page resource not only provides a general guide for implementing
CLIA ’88, but also gives clinical labs a new way to approach quality control
(QC).
Check
out the September 2004 issue of Clinical Laboratory News for more on this
story >>
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