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REFERENCES |
Who's Who in Point-of-Care Testing...
Proving
a Scientific After
spending my “youth” in a rural community, I understood the saying
“You can catch more flies with honey than vinegar”.
Little did I know I would see this theory prove valid in a
Healthcare setting, specifically in Point of Care.
However, for the saying to be valid in POC terms, it would need
to read “A POCC can get more cooperation from staff with candy (honey)
than reprimands (vinegar)”. After EMORY HEALTHCARE adopted a “Process Improvement” model, I applied the template to a specific POC problem. The model consisted of the following parts:
1.
Describing the Opportunity: Compliance
in maintenance and cleaning of the glucose meters was dropping.
Compliance in documentation of corrective actions was also
dropping. Our
policy required the glucose meters to be cleaned (or checked for
cleanliness once per day and documented by the use of “EVENT CODES”.
Staff input these codes into the meter during the Quality Control
process. The
goal of the Process Improvement Project was to increase compliance with
the maintenance and corrective actions on the meter by sponsoring a
contest. We also were using
the opportunity as a retraining for staff to assist in troubleshooting
of the instrument. 2.
Decide on a Monitoring Mechanism: Process
was monitored using periodic (usually monthly) uploads.
Each period, units were divided according to total number of test
performed (to allow “more” winners) with maintenance, as well as
corrective actions being monitored. 3.
MONITOR – MONITOR – MONITOR Data was monitored for 3 months to set a baseline for a contest (Our version of “honey”). The “contest” was announced and data collected during the next 6 months. 4.
Assimilate Data Each
month, information from the meters was collected and “graded” and
information such as presence of open dates on vials of strips and
control solutions, cleanliness of tote used to carry meter, etc.
This information was used in case of a tie.
Each nursing unit received a grade on “Documented Cleaning of
the Instrument” and “Corrective Actions Documented”.
Scores from all units were placed on a grid and distributed to
each unit. Cutoff
level for acceptable performance was 75%.
This was calculated by: #
of days meter cleaned documented by EVENT CODE ----------------------------------------------------X
100 #
of days meter was used Corrective
actions were calculated using a similar calculation.
Areas that did not achieve >75% on the maintenance of the meter were indicated by that score being shaded on the grid (Shading on the grid was our version of vinegar). 5.
Give Feedback to Staff Feedback
to staff was accomplished by distribution of the grid to Nursing
Administration and Units and the contest between the units to see which
unit could have the best score. We
set up a Golden Reward Program to provide positive reinforcement
(another type of “honey”) and attempted to stay away from any type
of negative reinforcement (a type of “vinegar”). Our
Reward Program was a Golden Tote Award.
****New glucose totes were painted gold and decorated with
various items – stickers, ribbons, colored paperclips, bells, glitter,
etc. They were so tacky
looking they were cute! The
totes were filled with candy and delivered to the winning units with
lots of fanfare (pom poms included).
Representatives from Nursing Administration, Lab Administration,
Diabetes Education Clinic as well as Point of Care Representatives
delivered the totes and congratulated the staff on a job well done! ****Many thanks to the manufacturer of the glucose meters for donation of the totes to this project. We couldn’t have succeeded without them! Our Golden Tote Rewards!
6.
Evaluation of the Process: Compliance
improved during the time of this contest.
Fluctuations appeared after the contest, but overall, compliance
was improved. We looked at
number of units that were NOT in compliance. Facility
A: (Total 28 Nursing Units evaluated) Average
number of Units “not in compliance”: 2
years prior to contest (A1 – A9) 6.6 1
year prior to contest (B1
– B15)
7.4 Year
of contest (C1 – C11)
3.7 Year
after contest (D1 – D9)
4.7 Facility
B: (Total 41 Nursing Units evaluated) Average
number of Units “not in compliance”: 2
years prior to contest (A1 – A9)
12.6 1
year prior to contest (B1
– B15)
11.4 Year
of contest (C1 – C11)
5.2 Year
after contest (D1 – D9)
3.1
Point of Care Lessons Learned during this
process:
In
conclusion Thinking
back on this project, I remember the smiles from the staff members when
they opened their tote and saw the candy.
I remember the laughs about how tacky those totes really looked.
And, I remember the same people that laughed about the “tacky totes”
asking what they needed to do to win it again.
My advice to anyone who will listen is to use every opportunity you have to further your cause. Casual conversation in the hallway with a staff member will many times help solve that recurring problem. Create ways to get the staff involved even if it is a tacky tote reward. We are all doing more with less, and consequently, have to create ways to get staff involved despite how busy they are. Remember, you can catch more flies with honey than vinegar! Karen
Jenkins, MT(ASCP) is the Point of Care Coordinator for Emory
Healthcare in Atlanta, Georgia. She
has been at Emory for the past 3 years and has been in Point of Care for
a total of 6 years. The
Point of Care program encompasses 3 hospitals with 145 glucose meters,
35 ACT instruments, Rapid Coagulation Testing as well as numerous manual
POC tests. Karen
provides these areas with technical expertise for POC testing systems as
well as assistance with accreditation processes.
She acts as a liaison between Lab, Nursing, Education and
Diabetes Education Staff and works hard to maintain open lines of
communication. During
her tenure as a Point of Care Coordinator, Karen has assisted in
numerous inspections, developed and evolved a team training approach for
Point of Care Testing, evaluated new tests, upgraded testing, worked
with staff to streamline quality control practices, facilitated removal
of paper logs in several areas, and has assisted in the establishment of
a coumadin clinic to better serve patients. She has developed as needed
inservices to train and re-train users of POC equipment and also created
a POCT overview lectures of pathology residents at Emory University.
She has also been spotlighted in several hospital nursing
newsletters using this opportunity to disseminate information.
She has attended many workshops in order to stay informed about
POC issues and diligently continues to stay informed of happenings in
the POC field. She
has participated as a panel speaker on regulations at Manufacturers
Meetings, participated on focus panels to help design future testing
equipment, organized and hosted numerous POCT User Club meetings within
the community, and was selected to participate in the CIC user's group
meeting. She is a founding
member of the Georgia Point of Care Network and maintains the Networks
website. Karen
was raised in South Lousiana, graduated from University of Southwestern
Louisiana and worked there until moving to the Atlanta area in 1988.
After working in manufacturing for several months, Karen returned
to the hospital setting and settled in Point of Care Testing.
|
Karen
Jenkins, Karen
Jenkins, MT(ASCP) is the Point of Care Coordinator for Emory
Healthcare in Atlanta, Georgia. She
has been at Emory for the past 3 years and has been in Point of Care for
a total of 6 years. |
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Last updated: 09/16/2009
Questions or corrections: My Point of Care.net
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