Meeting Minutes

April 4, 2007

The spring meeting for 2007 was held at the Doubletree Hotel in Alsip, Illinois on Wednesday, April 4 from 8:30 AM to 3:00 PM.  The meeting was attended by 40 registered healthcare professionals and representatives from the sponsors: Hemocue, MAS, Radiometer, Response and Trinity Biosite.

Presentations included:

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.  Sandra Curran from the Univ of Illinois group assisted in registration.

The session started with a presentation by Dan Tobin, IDN Manager for Radiometer. His topic, “Avoiding Preanalytical Errors in blood gas testing", identified the challenges that face today’s working environment.  It has been identified that out of 4,000,000 lab tests per year, 1% are erroneous which means 40,000 are erroneous lab results and 6% of these lead to inappropriate care.  That 6% equates to 2400 cases of lab related care problems per year or greater than 6 cases per day.  And where do “lab errors” occur in blood gas testing? 68.2% are due to pre-analytical errors and are due to: patient identification, dilution affects, positioning the needle, air bubbles, clotting, hemolysis, prolonged storage/transport, and mixing/re-mixing.  The number one cause of error are air bubbles not expelled as soon as possible after the sample has been drawn and before mixing the sample with heparin and sample has cooled.  The second leading error is clotting which can occur with improper mixing or the inappropriate amount of heparin for the syringe used.  Radiometer now offers a pre-analytic module to automatically identify sample as well as mix the sample prior to testing to eliminate at least two of the pre-analytical errors.

The second presentation, “Rapid HIV Testing and the New CDC Recommendations” by Janice Pinson from Trinity Biotech, was based on the presentation of Bernard Branson, M.D. from the CDC.  The four priorities identified for Advancing HIV Prevention are: make voluntary HIV testing a routine part of medical care, implement new models for diagnosing HIV infections outside medical settings, prevent further infections by working with persons diagnosed with HIV and their partners, and further decrease prenatal HIV transmission.  There are four FDA approved Rapid HIV tests: OraQuick Advance, Uni-Gold Recombigen, Reveal G2 and Multispot.  Two additional rapid tests recently approved by the FDA are Sure Check and Stat Pak.  Confirmatory testing by Western Blot is essential, venipuncture for whole blood or an oral fluid specimen is required for Western Blot.  A mother infant rapid intervention at delivery success story: there has been a 95% reduction in HIV transmission at birth since administering AZT at birth.  Rapid tests are not good for infants, more testing is needed to determine if rapid testing is effective so the Western Blot confirmation is required to determine if the exposure is mother’s AB or infant’s AB.  If an Occupational Exposure, take the AZT ASAP!

Following lunch, Kathleen Walrath, RN, MSN Clinical Practice Specialist from the UIC Medical Center, presented “Competency Assessment”.  She described the five steps to a competent employee: develop a good job description, identify critical skills/competencies required for the job, hire an excellent employee, provide orientation/education and practice ongoing training/education.  There are three levels or types of competencies: general (new hire orientation, annual tests), job specific (department specific, instruments, new procedures) and population specific (specific to direct patient care, age specific).  Competency Assessment is a Continuum, initiated at hire and continues throughout employment.  Competency Validation alerts: education is not competency validation, annual education days are not the best way to demonstrate ongoing competency, equipment in-services/presentations are not competency validation on the piece of equioment and performance review is not competency validation.  Examples of Competence/Competency Assessment methods: direct observation of daily work, written tests, peer review of daily work performance, medical record/chart audits, completion of CE hours, simulations, and patient satisfaction surveys.  CAP (POC.06900) and JCAHO (WT.1.30 EP7) both outline what is required to be in compliance.  Competency records need to be documented and tracked and readily available.

Our final speaker, Marcia Zucker, Ph.D., Director of Clinical Support for Response Biomedical Corporation, presented: “Point of Care Cardiac Markers: What? Why? Options?”.   The “What” portion of her presentation defined Cardiac Markers and the tests used in the laboratory as well as the non-laboratory tests such as family history, stress tests, coronary intervention.  The “Why” portion described the use of cardiac markers based on symptoms such as chest pain, nausea/vomiting, swelling of feet/ankles/legs and the possible diagnosis based on the symptoms.  The “Options” portion identified the type of testing systems available and the technology used: RAMP Reader, Biosite Triage, i-STAT, Roche Cardiac Reader, Stratus CS.  POC system selection is based on the Menu provided, pre-defined panels vs site selected paneling, lock out for non-validated assays and yes, you can use different markers in the lab and POC.  Be aware that correlation to the lab does not mean match but the tests are evaluated for clinical agreement and accuracy.   POC cardiac markers are recommended if lab results are not available in less than or equal to 30 minutes, POC markers can be equal to the lab in accuracy and POC markers are cost effective by reducing both LOS and more invasive diagnostic procedures.

The next meeting will be October 3, 2007 at the Doubletree Hotel in Alsip.

Respectfully Submitted,
Wendy Denk, MT(ASCP)

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