Leave the Lab Behind
October 14, 2009 Meeting Minutes

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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