Diana
DeHoyos
How
long have you been involved in the POCT field and in what
capacities?
I
was initiated
as a POCC in February of 1999 and am involved with
discrete disciplines of manual waived testing & ppm’s,
including the coordination of training and monitoring qc
compliance and writing policies. In addition I also design and
maintain our POCT website, co-coordinate our local POCC
group (including co-ed of our newsletter) and design and develop learning material content for
our Test Site Manager and Residents.
Please
tell us which kinds of POCT you have in your institution and the
approximate volume of that testing (either per month or per year)?
Our
POCT
menu includes:
-
Manual Testing: Guaiac, UA, strep A screen, UPT, pH,
clinitest.
-
Automated: glucose, hemoglobin, hematocrit,
ACT,
PT, PTT’s, hemoglobin A1C
-
PPMP’s: koh, wetprep, fern,
UA sediment, nasal smears
Given
UTMB’s decentralized layout, testing sites are grouped according
3 categories as reflected below (number in parenthesis reflects
the number of sites), each reflecting annual test volume per CLIA
category.
•
Hospital including Campus Based Clinics (101)
-
Waived:
800,000
-
Moderate:
75,000
-
PPMP:15,000
-
Waived:
550,000
-
PPMP:
45,000
A
breakdown of Annual waived POC test volume (in thousands) for
Inhouse sites follows:
-
Glucose
190
-
Guaiac
400
-
PH
14
-
UA
80
-
UPT
5.8
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What
are some of the biggest changes you have seen in POCT during the
time you have been involved in this field?
Please answer this from a global perspective as well as
from the changes experienced within your own institution.
Globally,
I believe it's the
growing acceptance of POC testing as a reliable measure for
patient assessment and treatment outcome; the growing
need and parallel effort spent to fully automate and standardize
compatibility & connectivity processes in order to close the
loop on billing and patient medical record issues; and the standardization of quality control monitoring.
The biggest change is yet to come however when the FDA
publishes the finalized revised criteria for waived testing; yet
to see how it will impact supply and demand or users and
manufacturer’s and ultimately patient outcome.
At
our institution, the biggest changes have been going from a one-sided perspective to seeking
team effort (mainly nursing’s perspective) in the resolution of
outstanding and problem issues.
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Are
you involved with a POCT Committee within your institution and if
so, what types of issues are commonly discussed during those
meetings?
Yes,
and I am an active member of this committee. Our continuous process
improvement (CPI) team represents various departments
within hospital (including nursing, laboratory, Quality Management
and Supplies dept as needed) and meets on a monthly basis one year prior to
due inspections so that we can discuss any outstanding issues. Among the most prominent issues
discussed include:
-
Competency
and Training Processes (includes re-certification frequency)
for Nursing staff (on waived testing) and Faculty &
Resident
-
Competency
& Training (on ppmp’s and some waived testing) –
Accomplished through
-
definition of such processes
and coordinating process
with Nursing’s General Orientation to tackle nursing
New-Hires,
-
development of the Test Site Manager (TSM) program, the TSM
being a nursing
employee within a given unit (or clinic) who is empowered by
the laboratory –TSM attends lecture on regulations,
compliance, etc given by
POCC’s—and at the same time serves as liason between
nursing and the
laboratory plus a leader or mentor to clinic/unit employees.
-
elimination
of the Train-the-Trainer program at sites where process
was unsuccessful
-
Identification
of POC testing performed in in-house units
-
Standardization
of POC use (kit/ monitors brands) across institution where
applicable: accomplished by the development of a formulary (institution
POCT menu) and a vendor control policy followed by
establishment of a POC Implementation process having
laboratory as the approving party.
-
Compliance
with regulations by those units maintaining a manual quality
control program.
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Can
you discuss a POCT initiative that you personally have witnessed
that has turned into a positive outcome for either the institution
or POCT in general? This
could be a PI plan, an evaluation of a product, or any type of
process that has changed the way in which your institution
addresses POCT.
Sure.
I can summarize those initiatives as follows:
-
Built website infrastructure—web page design, layout
(navigation of), program mission, and other content reflected on
web pages.
-
Evaluation of various online testing software programs followed by
the implementation of one (webquiz writer, Eon Communications).
This allowed the standardization of nursing competency and
physician PPMP proficiency testing through the development of
online testing modules—meant to serve for educational purposes
as well. Gathered
clinical specimens for digital imaging for use in proficiency
testing modules. (note: I held fulltime position in Bacteriology
and parasitology for 5 years).
-
Programmed online QC module (using ASP scripting language) that
collects monthly sample comparison data from various sites and
automatically dumps data to access database. The program gives
users feedback- Comparison Passed/ Failed – based on
the information submitted.
Prior to the development of the module sites used to fax
data to POCC.
-
Increased compliance of sites where POC tests that involve
maintenance of a manual quality control log are performed.
Accomplished through routine site visits and staff
education/counseling.
-
Co-designed and gathered learning material for Test Site Manager
Training Module.
-
Co-established the QA/QI program for Point of care, a process
that aids in the tracking of POCT compliance across institution
using 4 performance monitors.
Sites get monthly feedback by accessing compliance report
through POC website. A
cumulative Aggregate Score reflects compliance for a given month;
the Test Site Manager reviews monthly reports and takes corrective
action as needed and/or works with POCC.
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