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December
3, 2003 Meeting Minutes
The
final meeting in 2003 of the Tri-State POC Network serving Illinois,
Indiana and Michigan took place at the Radisson Hotel in Merrillville,
Indiana on Wednesday, December 3, 2003 from 8:00 AM to 3:00 PM.
The meeting was attended by 40 registered healthcare
professionals as well as representatives from the program sponsors and
vendors: Biosite, Dade, RDI (Ryan Diagnostics), MAS, and Roche
Diagnostics.
The meeting commenced
with the introduction of the core group and opening remarks by Darlene
Sobucki, founder of the Tri-State POC Network.
Members of the
core group include:
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Wendy Denk,
Ingalls Hospital, Harvey, IL
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Gil Salas, Univ
of Illinois – Chicago, Chicago, IL
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Darlene Sobucki,
Advocate Trinity – Chicago and
Advocate South Suburban, Hazel Crest, IL
“D-dimer
and the Need for Speed”
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The first
presenter for the day, sponsored by Dade, was Terry Thompson, BS,
MT (ASCP). His presentation, “D-dimer and the Need for Speed”,
included discussions on Venous Thromboembolic Disease (DVT and
PE), why PE is missed so frequently and how we can utilize a
simple, fast, economical diagnostic test for reliable exclusion of
DVT/PE. He further discussed what is D-dimer (the specific breakdown
product of a fibrin clot), conditions with elevated D-dimer (DVT,
PE, DIC, etc), physiological effects on D-dimer levels (age, size,
position of thrombus, impaired fibrinolytic response and
anticoagulant therapy), the utility of D-dimer, and the D-dimer/Cardiac
Marker match. There
are five major types of D-dimer assays: Manual latex (lacks
sensitivity for DVT/PE, use for DIC), Elisa (sensitive but takes
several hours, is the Gold Standard), Whole Blood Agglutination
(fast and reliable when used with clinical model, Simple Red),
Rapid “Elisa” or Immunoassay type (sensitive with high NPV,
Stratus and Vidas) and Turbimetric (sensitive with high NPV,
Roche). The remainder of the presentation identified the features
and benefits of the Dade Stratus CS and the use in the measurement
of D-dimer. What he
did stress, D-dimer is a RULE OUT test and the Power of Negative
Thinking.
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“Economic
Impact of Point of Care for the Hospital, Lab, Doctor and Patient"
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The
second topic, “Economic Impact of Point of Care for the Hospital,
Lab, Doctor and Patient", was presented by Denise Kark from
Biosite. Denise started
with the Top Ten Reasons that you are the POCC, number 10 being “I
thought it meant Princess/Prince of Chemistry” and number 1
“Because I have the Necessary Attributes”.
She also stressed that POC testing is a Team Sport, not an
individual activity, and that you, as the POCC, can have the high
potential to have a highly positive impact on the quality of patient
care, reimbursement, operational improvement and cross departmental
cost reduction. Although
her presentation focused on cardiac testing, the same principles
discussed could be applied to other POCT, the need to benchmark,
define financial measurements, perform impact assessments, and
define the change in practices. She further encouraged the POCC to
create a POC committee, investigate POC reimbursement, attend a
staff meeting and educate and inform.
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Roundtables
Following
lunch, we gathered for Round Table discussions: PPM, Competency testing,
How we accomplish our Goals, Communicating Compliance with Nursing/Non-POC
CAP Issues.
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Highlights
from the PPM group: CAP has a new section POC.09200 that states
physicians do not have to do competency if their specialty includes
that discipline, however, JCAHO has requested a list of CLIA #, a
copy of the license and a list of authorized personnel that perform
POCT from CAP labs.
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Competency
testing: How to accomplish and how to track competency testing are
the two main issues. For the how to do category, use written tests,
checklists, CAP samples, and computer based learning. And for the
how to track, keep a copy of the competency in the POCC office,
utilize an Excel worksheet, utilize the lockout features of the POCT
device. A recommendation to the manufacturers, compile competency
exams, case studies, etc to help the POCC set up a competency
program.
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How
We Accomplish Our Goals: Use skills days, lock out, education,
understand everyone’s needs and be flexible.
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Communicating
Compliance With Nursing: Explain WHY procedures need to be followed,
help nursing to UNDERSTAND the WHYS of QC/documentation and the
value of the result, Beware of shortcuts, and realize the need for
mutual respect between nursing and the lab.
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“Getting
It All Together for Your Inspection”
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Our
final presentation for the day was Rodney Stewart from
CAP,“Getting It All Together for Your Inspection”. As always, the attendees were anxious to hear about the Dec
2003 changes to the checklists, as well as what will the inspectors
look for and where to start. As to where to start: identify all POCT
sites and the testing performed, review the POCT checklists, perform
a mock inspection, and implement corrective action for the
deficiencies identified in the mock inspection.
The inspectors will look at Proficiency testing, Quality
Control (especially documentation of out of range results), general
items like reagent labeling, reference ranges with the patient
results, maintenance and function tests performed, a mechanism to
determine the testing personnel who generated a specific result,
training and competency records for all testing personnel, and a
procedure manual in each POC site.
And finally, the changes for 2003: the checklists have been
re-organized into 4 sections (general topics, qualitative testing,
quantitative testing and physician performed testing) and the
Alternative Test Systems WILL BE DELETED FROM THE NEXT VERSION OF
THE POC CHECKLIST!! The
discussion of AMR (performed every 6 months, at changes in major
system components, and when a complete change in reagents for a
procedure is introduced), CRR (your dilution protocol) and
Calibration Verification (don’t use the same lot number calibrator
for re-cal verification) was explained one more time (will we ever
understand?).
And a
reminder: Due to the rise in costs, the Tri-State POC Network will
continue to impose a $15 registration fee, payable in cash at the door.
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The
next meeting will be April 6, 2004 at the Holiday Inn in Lansing,
Michigan. It is our
hope that some of you will join us as we take our Network on the road.
If not, we’ll see you in August!
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