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Improving the quality of point-of-care laboratory testing performed by non-laboratory staff . G. Augustine, K. McKenna, S. Kahn Near Patient Testing - Clinical Laboratory Loyola University Medical Center. Opportunity Statement.
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point-of-care laboratory testing
performed by non-laboratory staff
G. Augustine, K. McKenna, S. Kahn
Near Patient Testing - Clinical Laboratory
Loyola University Medical Center
Point-of-care (POC) lab tests are diagnostic tests performed at locations outside of the main laboratory. These sites include hospital units, outpatient clinics and satellite facilities. These tests are generally performed by staff not formally trained in clinical laboratory science such as nurses, perfusionists, patient care techs and respiratory techs.
While most laboratory testing continues to be performed in the main clinical laboratory, more than 25,000 tests per month are performed at approximately 80 point-of-care locations throughout the Loyola University Health System.
The growth in point-of-care has provided the opportunity to ensure that laboratory testing conducted at diverse locations by non-laboratory staff is performed using good laboratory practices and in compliance with relevant regulatory standards to produce accurate test results that optimize patient safety and minimize process errors.
Most likely causes of testing process errors at the point-of-care included:
Significant quality improvement opportunities at point-of-care were identified and the following solutions were implemented:
Requiring that all tests performed at POC be approved by the POC steering committee to ensure that only accurate, easy to use and supportable tests are implemented with methods that can be standardized across all areas.
2. Quality assurance tools were developed to improve the accuracy and reliability of patient testing results (illustrated in Figure 1).
3. POC testing and data handling were improved (illustrated in Figures 2A and 2B).
A point-of-care testing quality assurance audit was implemented in October 2001 and continues as a quality tool to monitor the performance of all areas that perform POC testing.
The following graph illustrates that through continued surveillance, corrective action and assistance from the laboratory, the percentage of units passing per quarter has increased significantly.
The point-of-care glucometer patient identification monitoring tool was implemented in June 2003 and continues as a quality tool to track patient identification errors involving glucose results.
The following graph illustrates that through continued surveillance, corrective action and assistance from the laboratory, patient identification errors involving glucose results have been declining despite an increasing volume of glucoses performed monthly.
To maintain this improvement, the laboratory will continue the quarterly POC quality assurance audit and glucometer patient identification error tracking tool to ensure compliance with good laboratory practices.
The laboratory will be mailing a point-of-care customer satisfaction survey to all sites to gather information on how the laboratory can improve its support of POC testing.
The laboratory will continue to pursue state of the art analyzers to streamline POC testing.
The laboratory will continue to optimize electronic data management in POC testing.
To decrease patient identification errors, the laboratory will continue to send notification of errors to unit or satellite managers and to educate staff on proper identification procedures and use of case numbers.