Meeting Minutes

April 2, 2008

The 2008 spring meeting was held at the Doubletree Hotel in Alsip, Illinois on Wednesday, April 2 from 9:00 AM to 3:00 PM.  The meeting was attended by 51 registered healthcare professionals and representatives from MAS, Metrex, Radiometer, Roche, and Telcor.

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.    

The first topic, “Systemic Anticoagulation Management: A Response to the Joint Commission”, was presented by Mark Wurster, M.D., Ohio Sate University and sponsored by Roche.  Dr. Wurster outlined the steps that need to be taken for complete implementation of the new National Patient Safety Goal 3E by January 2009.  TJC (The Joint Commission) have set guidelines to aid hospitals and clinics in achieving this goal by establishing timelines.  The first timeline is to form a committee by July 1 comprised of pharmacists, dietary nutritionists, nurses, medical technologists and at least one physician to determine the risk factors related to anticoagulation management.  He stated that an INR goal must be established for use in monitoring and therapy adjustment for patients receiving warfarin as well as establishing a baseline and on-going lab tests for heparin and LMWH.  There are currently 650 medications that interfere with warfarin and stresses that patient education is critical.  Dr. Wurster sees POCT as a benefit to the in-patient sector and a definite in the out patient setting.  He recommends the use of a POC device for the last test performed in the hospital before the patient leaves to the out patient setting.  Why?  POC devices have a tighter CV than the larger, higher volume laboratory instruments so the variance between POC devices in the out patient areas (clinics, coumadin clinincs, physician offices, etc) allows for more consistent results and therefore easier monitoring.  And for information sake, the new series Coagucheck device does not demonstrate interference with heparin.

Sandy Curren conducted a roundtable discussion”Pitfalls and Peril” – Running a POCT Program.  As the POCT program at UIC was recently surveyed, Sandy and Gil Salas shared some of their experiences.  One issue they mentioned was ensuring there was documentation for the initial orientation for PPM.

Following lunch, Becky Clarke, Executive V.P., Telcor, discussed “POCT Connectivity: Connecting Multiple Instruments”. She outlined why POCT devices should be “connected” (electronic medical records, reduce errors and omissions from manual charting and billing, program management to name a few) and defined point of care testing and devices.  Some considerations for connectivity: determine if the device is interfacable, does it allow for scanning of operator/patient, can it differentiate between patient and QC, does it allow for comment entry, what type of connectivity software is needed, is the interface uni or bi-directional, is it network wired or wireless or connected via modems.  Becky’s power point presentation demonstrated POC Middleware as a proven technology and how it provides value to POCT.  MW (Middleware) solutions don’t have to change when the LIS changes, they offer quick deployment and allows for freedom to select “best of breed”.

The final presentation “Active Surveillance for MRSA: What are the options, what is our experience so far?” was given by Paul Schreckenberger, PhD., Director, Clinical Microbiology, Loyola University Medical Center.  MRSA (Methicillin Resistant Staphylococcus Aureus), was reported by the Chicago Tribune in 2002 and since, there has been mass media coverage to increase public awareness as well as mandate legislative surveillance.  The State of Illinois Public Act 95-0312 mandates hospitals to reduce the risk of MRSA in all intensive care units and other at risk patients (such as dialysis or previous MRSA infections) identified by the hospital through active surveillance testing. Prisons are also targeted by the same act. The statistics indicate a growing problem.  In 1974, 2% of Staph infections were MRSA, in 1995 the number increased to 22%, and many hospitals today are reporting 60-70%.  The main mode of transmission in hospitals is via hands contaminated with colonized or infected patients, body sites of the hospital personnel themselves, and devices, items or environmental surfaces contaminated with infected body fluids. MRSA can remain persistent on dry surfaces (such as the hand rail of a bed) for 7 days to 7 months.  MRSA cannot be eradicated without active surveillance and is costly but through surveillance, lives are saved and costs go down. The Gold-standard for MRSA detection is sensitive but slow. Real time PCR is the most effective method for detection of MRSA from patient specimens.  The Cepheid GeneXpert is the next generation PCR technology and can be performed in the POC setting (moderate complexity).  

Joanne presented the results of the survey conducted during the day:

  • CAP Discussion: 20

  • JCAHO: 12

  • Continue with two meetings annually and one vendor fair

The next meeting with a vendor fair will be October 1 or 8, 2008 at the Doubletree Hotel in Alsip.

Respectfully Submitted,

Wendy Denk, MT(ASCP)

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