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:

  • Wendy Denk, Ingalls Hospital, Harvey, IL

  • Gil Salas, Univ of Illinois – Chicago, Chicago, IL

  • Darlene Sobucki, Advocate Trinity – Chicago and
    Advocate South Suburban, Hazel Crest, IL

“D-dimer and the Need for Speed”

  • 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"

  • 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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Following lunch, we gathered for Round Table discussions: PPM, Competency testing, How we accomplish our Goals, Communicating Compliance with Nursing/Non-POC CAP Issues.

  • 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. 

  • 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.

  • How We Accomplish Our Goals: Use skills days, lock out, education, understand everyone’s needs and be flexible.

  • 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”

  • 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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