Hot
Topics I NT-proBNP
I Quality Management for POCT
The 2009 fall meeting and Vendor
Fair was held at the Doubletree Hotel in Alsip, Illinois on
Wednesday, October 14 from 8:30 AM to 2:00 PM. The meeting
was attended by 47 registered healthcare professionals and
sponsored by MAS and Roche. The Vendor Roster included
representatives from Abbott Diabetes Care, Biosite, Epocal,
Fisher Healthcare, Helena, Hemocue, Instrumentation
Laboratories, Inverness Medical, Lifescan, Nova Biomedical,
MAS, Quidel, Radiometer, Roche, and Siemens.
The meeting commenced with opening
remarks by Joanne McEldowney, RN. Members of the core group
include: Wendy Denk, Ingalls Hospital, Harvey, IL; Joanne
McEldowney, RN, Univ of Illinois – Chicago, Chicago, IL; Gil
Salas, Univ of Illinois – Chicago, Chicago, IL and Sandra
Curran, Univ of Illinois.
POCT
Hot Topics
The first session, POCT Hot
Topics, was a Roundtable discussion led by Gil Salas and
Sandra Curren. Members shared recent experiences from
inspections for both CAP and TJC as well as concerns about
POC testing in general. Items covered: PPM credentialing;
Reference Ranges; Urine Pregnancy and should a Sp gravity be
performed first; operator competency requirements should be
put into policy; Patient identification in the ED; revenue
for BGMs; POC testing at health fairs; and the need to
prevent POCT vendors going directly to patient care testing
sites and not to the POC Coordinator.
“The Diagnostic and
Prognostic Utility of NT-proBNP”
After a short break, Jean Quaglia,
RN, BSN Clinical Specialist, presented “The Diagnostic and
Prognostic Utility of NT-proBNP” sponsored by Roche
Diagnostic. The echocardiogram is considered to be the Gold
standard, however, they are expensive, time consuming and
require an expert to read/interpret. An alternative method
to aid in the diagnosis of CHF is the use of Biomarkers such
as BNP and NT-proBNP. The biomarkers enhance the diagnostic
ability when the diagnosis is not straightforward and they
may help identify patients who are under treated or at risk
for acute exacerbation as well as help to avoid unnecessary
diagnostic procedures and to detect heart failure in the
earlier stages. The NT-proBNP along with the Clinical
picture is a diagnostic tool to make the diagnosis of heart
failure. The NT-proBNP may also be a prognostic tool as a
prediction of mortality when there are no symptoms.
The Tri-State POC Network thank
the vendors in attendance for their representation and
support of the October Vendor Fair.
“Quality
Management for Point of Care Testing”
Following the Vendor Fair and
lunch, the final presentation, “Quality Management for Point
of Care Testing” was led by Rodney J. Stewart, Lead
Inspection Specialist from CAP.
There are six requirements for the
Quality Management Program for the Point of Care Laboratory:
-
Indicators or quality
measurements defined
-
Evidence of review of
the indicators and for quality measures
-
Thresholds for each
indicator and for quality measures
-
Corrective action when the
indicator or quality measure falls below the threshold
-
Changes to operations
as a result of the QM activities as specified in the
program
-
POC QM activities
reported as specified in the plan
Examples of POC indicators
include:
-
Documenting patient
results accurately
-
Critical Value
documentation
-
Corrected reports
-
Proper patient
identification – checking patient armbands. Etc
-
Utilizing unique
patient identifiers in the instruments (e.g. not using
identifiers such as 9999999)
-
Documenting Allen’s
test when drawing blood gases from the radial artery.
All processes must be monitored
(pre-analytic, analytic and post-analytic). Examples of
pre-analytic indicators include verifying patient
identification policy is being followed, using unique
patient ID numbers in the analyzers such as glucose meters,
iStat, etc., and documenting the Allen’s test. Examples
of post-analytic include: calling and documenting of
critical values, repeating of tests that meet the repeat
criteria, results reported properly as required by the
procedure and correct reports – percentage related to total
reports. Examples of analytic indicators:
proficiency testing, quality control, analytic measurement
range validation, calibration verification, and method to
method comparisons.
Of the CAP Patient Safety Goals (1.Improve
accuracy of Patient Identification, 2.Improve the
verification and communication of life-threatening or
life-altering information, 3.Improve the
identification, communication and correction of errors, and
4.Improve coordination of Laboratory Safety role
within healthcare organizations), the fourth goal,
Improve coordination of Laboratory Safety role within
healthcare organizations is probably the most cited
patient safety goal. ANNUAL evaluation is required
for laboratory processes related to patient safety.
As for ID requirements, the CAP
requires 2 identifiers for both In and Out-patients. For
the Primary container, 2 identifiers are recommended but are
required for compatibility and reproductive samples. For the
ID of secondary containers (slides, aliquots), 2 identifiers
are recommended but are not required.
Rodney reviewed some of the new
and revised checklist changes released in June 2009. He
also discussed the paperless reapplication process and
highlighted the August 2009 implementation of the Personnel
Evaluation Roster. This roster is for the personnel involved
in the testing of the non-waived tests and yes, a copy of
the personnel’s education (diploma) must be on file.
Respectfully Submitted,
Wendy Denk, MT(ASCP)
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