QUALITY INSTITUTE CONFERENCE – 2003
Charles W. Baker, MT (AMT)
AMT National Board and Director of Laboratory, Clarendon Memorial Hospital-Manning, SC
American Medical Technologist (AMT) received an invitation to become a partner with the Centers for Disease Control and Prevention (CDC), along with many other lab and other health care organizations (39 partners total), to explore “Making the Laboratory a Key Partner in Patient Safety.” Approximately 240 laboratory professionals (pathologists, MTs, MLTs, MDs, PhDs and BSD Scientists), were in attendance, with every laboratory discipline represented.
As a national board member, I was appointed to attend this 3-day conference as the AMT representative, but as a laboratory manager/director in a small rural hospital in South Carolina I was especially intrigued. In the preparation for our most recent JCAHO survey, March ’03, the “pre-analytical” and “post-analytical” lab testing is what all laboratorians have less control over. Serving on the Process Improvement Committee in my hospital, our emergency department director and I were able to make major steps in improving Patient Identification throughout our facility and present this valuable procedural change to our Hospital JCAHO survey team as a Health Care Failure Modes Analysis (HCFMA). Of course, if you are in a JCAHO facility, you will most likely become extremely familiar with the first six National Patient Safely Goals:
1. Improve the accuracy of patient identification
2. Improve the effectiveness of communication among caregivers
3. Improve the safety of using high-alert medications
4. Eliminate wrong-site, wrong-patient, and wrong-procedure surgery
5. Improve the safety of using infusion pumps
6. Improve the effectiveness of clinical alarm systems
All participants were provided a 23-page white paper to review for “homework” to help prepare the participants for beginning three days of dialog on patient safety. As laboratory professionals, we knew the core lab’s precision and accuracy in testing was, with few exceptions, very good as we are used to monitoring SD, CV and SDI and participation in proficiency testing and accreditation surveys. Most of us don’t have the warm feeling about the specimen(s) “before” it was received in the lab or the results “after” they leave the lab. Don’t get me wrong, we are not perfect yet but we’ve come a long way in my 30+ years in the lab. The question for Quality Institute attendees: How do we continue to improve what we do in the lab, as we achieve superior quality in the pre- and post- testing areas?
Here are a few items included in the pre-analytical (or is there a “pre”, pre-analytical) category:
1. Is the test the physician ordered “really” part of the assessment, diagnosis or treatment for the patient? (Should the laboratory professional intervene?)
2. Is the test the physician ordered “really” the test the physician needs? (Should the laboratory professional intervene and advise the physician that the test ordered might be obsolete and a more advanced diagnostic procedure or lab test available?)
3. Was the specimen obtained from the correctly identified patient?
4. Regarding specimen collection: Was the correct blood specimen collected at the correct time under the correct patient conditions, i.e. fasting etc.?
5. Did the specimen arrive in the lab for testing properly labeled and identified? If necessary was the specimen centrifuged timely and for the correct time and speed necessary?
6. Was the specimen verified for identification at testing and was there any obvious problem with the specimen integrity such as lipemia, hemolysis or icterus condition?
Here are a few items included in the post-analytical (or is there a “post”, post-analytical) category:
1. Were the results reported in a timely manor?
2. Was the normal (reference range) report appropriate for the patient’s sex, age etc.?
3. Did the results, at reporting, really get into the physicians hands for evaluation in a timely manner?
4. Did the physician evaluate, diagnose and review with the patient information and plans for treatment and/or follow up?
5. Did the patient return for treatment and/or follow up as per the physician’s orders?
After Day 1 of a discussion and review of comments by various nationally known, recognized laboratory leaders, On Day 2, the group was divided into workgroups to address and “straw vote” on topics and questions relating to the laboratory’s future involvement with and for the Quality Institute. Day 3 was a recap of the “straw vote” with discussion. The workgroup topics centered on the following three topics:
1. Collect analysis and distribution of National Reports of labs’ quality performance.
2. What are the Quality Indicators to be used for the National Report?
3. Will there actually become a Quality Institute to address and oversee quality issues relating to pre- and post- analytical testing.
As the meeting came to a close, Joe Boone, Ph.D., Associate Director for Science, Division of Laboratory Systems, CDC thanked all participants for completing the beginning of a two-year culmination of organizing this meeting.
Hospitals, laboratories, physicians’ offices and clinics have SOP to guard against errors in health care, but we also ask: Has EVERY employee read, understood and followed, without exception, those guidelines? It has been my experience that when errors occurred, it was because several small “less critical” procedures were not followed (a calamity of errors) that ultimately resulted in a larger error.
IN SUMMARY
What does all of this have to do with laboratory professionals? As a medical technologist with 30-plus years of experience, I am asked by some physicians for my opinion and or suggestion of test to consider in evaluating certain patients. As we continue to (finally) open the laboratory to the outside world with “Direct Access Testing”, HIPAA rules, and a more informed and inquisitive patient, the laboratory professional has a chance to claim his/her rightful position to the “left” side of the throne. (physician as king and nurse on the right).
If you would like additional information on the Quality Institute, stay tuned to the AMT Website: www.amt1.com or visit the Quality Institute Conference 2003 website: www.phppo.cdc.gov/mlp/qiconference/
In closing, the bottom line in all we do as “Laboratory Professionals” is Quality Work. If you are in a situation to make a difference, look at your pre, pre and post, post analytical steps and make the changes necessary to get 100% QUALITY.
|
