Positive Patient Outcomes

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.

CAP Today April 2007 Feature Story
Glucose Test Frequency Spawns New Analyzer Needs
By 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 >

CAP Today, April 2006, Feature Story
When POC Connects the Data, Everyone Wins
By Sue Parham

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:

• http://www.fda.gov/medwatch/safety/2005/safety05.htm#maltose

• http://www.fda.gov/medwatch/safety/2005/safety05.htm

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. Click here for more

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. Click here for more >

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 >>

August 2004
Applying Evidence-Based Medicine to Point-of-Care Testing to Improve Medical Care
By Renee DiIulio, CLP, August 2004

Point-of-care testing (POCT) has been embraced by a medical community that equates new technology with better patient care. Providers of medical care are under pressure to provide care more quickly than in the past, and many see POCT as a solution to remove patient bottlenecks. 

However, James H. Nichols, PhD, DABCC, FACB, said there is a proliferation of misinformation about POCT. Nichols, associate professor of pathology at Tufts University School of Medicine in Boston and director of clinical chemistry at Baystate Health System in Springfield, Mass, gave the keynote address, “Finding Value at the Bedside: Evidence-Based Practice for POCT,” at the 20th International Symposium on Critical Care and Point-of-Care Testing in Wurzburg, Germany. “Faster is often understood to mean better outcomes without the research to back this conclusion,” he said.

Evidence-Based Medicine (EBM) represents a new age in health care. Nichols traced medicine’s development through the ages, from its dawn with humors, astrology, and bloodletting, through its dark period characterized by belief-based treatments, into an enlightenment with the discovery of the pathologic basis of disease, and followed by subsequent growth with advances in prevention, diagnosis, and treatment. Click here for more >>

August 2004
Optimizing Point-of-Care Testing
By Barbara M. Goldsmith, PhD, FACB

POCT Applications as a Useful Tool for Rapid Laboratory Results

Point-of-care testing is growing rapidly at an estimated rate of 12 percent to 16 percent per year and is predicted to double by 2005, becoming a $950 million market. In 1997, the Food and Drug Administration convened an expert panel to describe future trends in medical device technology over the next 10 years. The panel identified six major trend categories. Home and self-care and minimally invasive procedures were among the six categories, each having applications in POCT.

POCT is referred to as laboratory testing performed outside of the clinical laboratory. It can be performed at the patient's bedside or in a centralized area within a unit, such as an intensive care unit. POCT applications include:

• Testing for emergency diagnosis (e.g. acute cardiac syndromes)

• Treatment and monitoring of existing disease (e.g. diabetes)

• Testing in the physician's office

• Self-testing

The diversity of testing locations also is broad, including: acute care settings

• Ambulances

• Clinics

• Schools

• Drug treatment centers

• Patients' homes

Click here for more >>