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REFERENCES |
Who's Who in Point-of-Care Testing...
LuAnn Hildebrand
How
long have you been involved in the POCT field? Back
in 1988, York Hospital Laboratory identified a need for over-site at our
non-main-lab locations. Those facilities included a small laboratory in
a family practice center on-campus, a collection site/laboratory that
supported a brand new medical facility a couple miles from the hospital,
and a small lab in a rehab hospital across town.
At that point, I was officially the Technical Supervisor of
Satellite Laboratories. In late 1991, our Laboratory Operations Manager, Jan Witzke,
returned from a CLMA conference with news that “CLIA is coming!”
The message from CLMA was “POC is here, whether you like it or
not. Either embrace it or
lose control of it.” A
POC Steering Committee was formed, policies were developed, and the need
for a coordinator was identified. I
was chosen as the POC Coordinator for York Hospital. My early tasks involved identifying the testing that was
being performed in our patient care areas, FINDING the patient care
areas (lab people don’t leave the lab!!), meeting nurses and nurse
managers, being EDUCATED by the nurses, and addressing the issues that
existed. We blended the requirements from PA State, CLIA, JCAHO and
CAP to form one policy that “sort of” fit all, then worked with the
front line testing staff to incorporate those requirements into their
current work routines. As the years passed, we added a piece-of-this-person and a smidgen-of-that-position until we created a “Point of Care Team.” The team has consisted of a variety of talented laboratory professionals with expertise in many areas who have made our program both unique and successful.
As
of March 2000, my involvement with POC changed.
I am currently the Laboratory Customer Services Manager.
My role has expanded to address new challenges, but it still
includes responsibility for POC testing.
Are you involved with a POCT Committee
within your institution and if so, what types of issues are commonly
discussed during those meetings? When Jan Witzke returned from the CLMA conference in 1991, she convinced the Vice President of Medical Affairs that the CLIA issues were significant, and recommended that they pull together a group of those involved with bedside testing. At that time, the major test was fingerstick glucose testing. This test was high profile - performed by everyone everywhere at various levels of competency. The initial POC Steering Committee was chaired by the Vice President of Medical Affairs, and membership was comprised of individuals representing nursing, critical care areas, diabetes educators, and laboratory members. Initial meetings were frequent, at least monthly for the first year, in order to address all of the new issues presented by CLIA. This group determined that the laboratory would be responsible for ALL TESTING within our hospital under a single CLIA license. The committee developed a policy defining responsibility. Very significant was the decision to create a separate cost center, under the control of the laboratory, that would consolidate POC testing supplies and revenue. This was one process that helped us to overcome territorial issues between the lab and patient care areas.
As
the years passed and the type of POC issues changed, so did the face of
the POC Steering Committee. Members
were added to address new issues, and placed on an ad hoc list as issues
were resolved. We never wanted to entirely release ANYONE with interest in
helping! Meetings
decreased to quarterly as the intensity and frequency of the issues
decreased. Today’s
POC Steering Committee is responsible for over-site of POC Testing in
our WellSpan-York Health System. That
territory currently includes one hospital, several off-campus entities,
plus 23 physician offices. Our
sister hospital, WellSpan-Gettysburg, has a separate process managed by
their POC Coordinator, Wendy VanDyke.
The membership of the current committee parallels the
organization of our service lines. We have a medical and an administration representative from
each of our major service lines plus representatives from patient
support departments. Our
committee is currently chaired by one of our pathologists, Dr. Danilo
Escaro. The
current committee now “meets” via e-mail to address new issues as
they develop. For example, if an area would like to perform a new test, the
appropriate Steering Committee representative must “present” a
document that provides both medical justification for improved patient
care as well as financial justification for the new test.
The committee reviews the proposal via e-mail, and members vote
to accept or reject. If the
vote is “YES” for a new test, the laboratory evaluates the test and,
if the assay quality is acceptable, works with the POC team and the
petitioning area to implement the new test.
If the decision is not unanimous or the issues are not clear cut,
the committee schedules a “live meeting” to debate any issues. At
this point, the committee members are familiar with the requirements,
and with each other. This method has been effective for obtaining input for every
issue from every service line. My
role is to coordinate the activities as appropriate. 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
program includes all of the “standard” tests performed by most
hospitals/health systems of our size.
If you can name it, we probably perform the test.
We currently “capture and charge” about 185,000 tests per
year, and realize that there are many others that are still slipping
through the cracks, or are covered under some other process.
Our
menu includes bedside glucose testing (both by meter and visual); waived
tests including Hemoccult, Gastroccult, and urine dipsticks; some of the
“kit” tests including pregnancy and rapid strep,; small instruments
and analyzers that test for hemoglobin, ACT, cholesterol, and
prothrombin times; iStats; a QBC and PPMP tests.
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. The
process of responding to this question makes me feel like an
“old-timer” who has seen the development of the wheel turn into
space travel! When CLIA hit the streets, there were requirements, but
there were no procedures. We
spent the early years making up the rules and procedures as we went
along. EVERYTHING has
changed, both globally and within WellSpan. I
polled my fellow POC Team members for a response to this question, and
their comments included the following:
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. By
far, the most important development in POC is electronic data
management, especially for our high-volume bedside glucose testing. Here’s
a little of our history for the benefit of the newcomers to POC who have
never had to walk these steps... Once
upon a time, long ago in the year of 1992, we had manual audit trails.
As you old-timers know, in order to assure a quality result, we
had to make sure many things were linked to the result, and everything
was documented, including:
With
all of these issues, we had NO shortage of Performance Improvement
indicators!! We have LOTS
of fun stories from those days related to non-compliance, but one of the
best is the tale of a poorly maintained glucose meter... One of our POC testing areas was particularly non-compliant, resentful, and non-cooperative. NOTHING we did made any impact on anything THEY would do. One day, after several threats of removing testing from their area, we snitched their glucose meter. Without hesitation, they walked down the hall to our in-hospital pharmacy, and purchased a new meter and supplies!! The story caught the attention of their leaders, the illegal meter was removed, and today they are a wonderful and compliant area! The
“old days” sure were interesting..... We
currently have electronic data management systems in place for our
glucose meters (62 in 30 areas) and our iSTAT analyzers (13 in 10
locations). For
years, our efforts were directed toward addressing and monitoring
compliance for our high volume tests as the expense of our attention to
the details of all other POC testing.
Now, we have improved compliance to all requirements.
We have seen a significant decrease in transcription and
identification errors (we use barcode readers for both the patient and
the operators). Staff
competency and quality control compliance are at 100% due to the
operator lock-out features. We
are no longer missing results that were performed by the nurses, but
never documented. We also
virtually eliminated staff pilferage of supplies since the meter
captures ALL tests performed and the supplies we use are specific for
the hospital meter. Bottom
line: Automation allows us
to focus our efforts in new directions.
The Team approach is what has made the WellSpan POC program both a
success and a pleasure! NOTHING
that we have done or can do will replace the personal touch of the
people who make it all happen, and no interview of WellSpan-York POC
would be complete without a huge “Thank You” to the past and present
members of our POC Team:
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LuAnn
Hildebrand MT(ASCP) LuAnnis
a pioneer for the WellSpan Health System point of care program, which
started in 1992. During her
8 years as the point of care coordinator (POCC), she also functioned as
the physician office technical consultant for the health system,
providing advice on
office laboratory procedures and regulations. LuAnn
started her laboratory career as a bench tech at York Hospital in 1980.
She held the position of technical supervisor of satellite
laboratory testing as of 1988, where she successfully planned, equipped,
staffed and implemented laboratory services in a new medical center.
Other duties included coordination of phlebotomy activities and
general supervisory responsibilities.
LuAnn
is currently the Laboratory Customer Services Manager for Wellspan
Health System in York, Pennsylvania.
She has held this position for the past two years during which
time she continues to manage the Point of Care Testing program for York
Hospital and Wellspan-York facilities.
LuAnn serves as the facilitator of the laboratory customer
service steering committee, manages laboratory service contracts, and
coordinates and helps instruct the laboratory module of the Family
Practice residency program. LuAnn
holds a Bachelor of Science degree in Medical Technology and is board
certified by ASCP. She is a
member of the Keystone Point of Care Coordinator’s group for Central
Pennsylvania, a member of CLMA, and has been a CAP inspector.
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Last updated: 09/16/2009
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