Making a smooth pivot to point-of-care IQCP

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McGovern

Unlike at some other institutions, many of the VA Connecticut point-of-care operators are in the OR setting. So the i-Stat, for example, is operated by anesthesiologists, perfusionists, certified nurse anesthetists, and one anesthesia technologist. This range creates complications. “That’s four categories of people, some of whom only provide coverage on fairly rare occasions,” Dr. Campbell says.

“We also have people who only come in for night coverage. So we’re maintaining competency on the i-Stat on this group of about 25 people at various levels of training. They have different schedules and all of them are busy. It’s an ongoing challenge and it takes a lot of time and diplomacy on the part of the POC coordinator.”

An important part of developing an IQCP is looking at every sample type and making sure specimen collection is adequate and correct, McGovern says. But Dr. Campbell finds the addition of pre- and postanalytical phases to risk assessment to be a redundant requirement. “The problem is that stuff is already on CAP checklists and Joint Commission checklists. So it’s just a bunch more lines to put on your IQCP risk assessment. It’s not a horrible thing to have to sit down and go through again, but it’s nothing new.”

The VA Connecticut IQCP process resulted in keeping its QC program the same as before IQCP implementation, although with more documentation. Dr. Campbell regards the adoption of IQCP as equivalent to fixing a non-problem and not a good use of health care resources. “I don’t think there were documented issues with EQC that required a rather laborious and elaborate replacement. So anything to streamline IQCP would be good.”

In the meantime, his advice to POC coordinators who are developing IQCPs: “Don’t just take what the manufacturer gives you. Add your own clinical and technical judgment to it. And make sure you do a thorough job with your risk assessment.”

Admittedly, Kerstin Halverson, BA, MS, contemplated IQCP with something less than enthusiasm a couple of years ago. At Children’s Hospitals of Minnesota, a two-hospital system where she is point-of-care coordinator, she was the lone staff member charged with developing IQCPs for three sets of moderately complex devices: 35 i-Stats with about 300 operators across all areas, eight Medtronic ACT Plus systems, and three Avoximeters.

Halverson

For her, the main challenge in developing the risk assessments was talking to the operators, mainly nurses and respiratory therapists. “I made lots of appointments, talked to key players, observed operators, and said, ‘Okay, this is what I think you are doing versus what I have in my procedures. Are you following the process? Is this what happens on a case?’” She explained to operators that her purpose was to help them out so they don’t need to perform QC every eight hours.

Addressing the environment was not much of a problem with the ACT Plus and Avoximeter, Halverson notes, because operators don’t have to worry about reagents being refrigerated. “The i-Stat, however, does have a shorter outdate on its cartridges once they’re removed from the refrigerator. So we have staff sign them out and date them right then and there, or we try to encourage that, but we’re not always sitting there when they come take them.” It’s a struggle to make sure the sign-out happens correctly, she says. “Follow-up spot-checking on cartridges stored at room temperature shows us they are dating them, though.”
Halverson suspects some laboratories may be going overboard in generating multiple IQCPs tailored to different point-of-care locations. “It depends on how you quantify the differences. If you have the same staff who are moving through different departments and operating the same devices in the same fashion, then the devices will be handled the same.” She has opted to do fewer IQCPs for this reason.

Her advice to laboratory managers assigned the task of developing IQCPs is not to go it alone.

“Obviously, you have to do your own IQCP. You can’t just expect to get one from somebody else. But do not be afraid to reach out to other coordinators to see if they can help. All the vendors out there have also provided the help I’ve needed. They have information to get you through the risk assessment that will help to answer the questions you will have covering the preanalytic, analytic, and postanalytic testing phases for each device. They don’t tell you how to collect your specimens, but you should already have your procedures in place for that. So everything’s there already. It’s just a matter of pulling it together into one document.”

Fortunately for harried laboratory directors, an amazing array of tools has been forged for developing IQCPs. “Theory is a little bit separate from practice, and when it comes to putting pen to paper, IQCPs may not appear so simple,” says Valerie Ng, PhD, MD, chair of laboratory medicine and pathology at Highland Hospital in the Alameda Health System, Oakland, Calif. “But there are so many resources available, it’s phenomenal. I would just encourage everyone to do what I did and consult the templates, the websites, and the webinars that are out there.”

Dr. Ng, for one, sees IQCPs as a positive step for the laboratory. “To me, this is the light at the end of the tunnel. It gives us the flexibility to focus on the things that are high risk and draw back from the things that are less critical. Where else can you get that kind of opportunity?”n

Anne Paxton is a writer and attorney in Seattle.