Is this Quality or Just Habit?
Director of Nursing hotly defended her staff. They had in fact performed quality
control on the point of care glucose meters per policy. They had dated and initialed the appropriate line on the sheet. What was the lab
complaining about? What did the state inspector mean by citing them?
me back up and explain. A few years ago I was associated with an organization where
nurses performed glucose and urine pregnancy point of care testing. The nurses
were trained to perform quality control and to document QC as well as
maintenance on a log sheet. However it was a constant battle to ensure compliance. One
day the state came in and found a couple instances were QC was performed, but
were out of range. There was no corrective action documented, yet patient
testing was performed.
Director of Nursing could not grasp the concept of running QC to indicate
acceptable performance of the test system. In her mind, QC and maintenance were
just tasks to be checked off a list. Over the years, I have come to realize
that many concepts we medical laboratorians consider fundamental are alien to those in other
professions, including nurses.
have also noticed that as laboratorians we also do some tasks by rote without
thinking whether they are logical or not. Some recent examples I have seen with
clients: performing 3 levels of QC daily for low volume tests that the lab
performs maybe twice weekly. Another client performed correlation on all 82 of
their (identical) glucose meters instead of using a representative sample as
recommended by CLSI. A small laboratory performs quality control on their
chemistry analyzer each of three shifts. Yet another , strapped for space) uses valuable refrigerator space storing their urine samples for a week. Why? Their policy says, "patient specimens are stored for 7 days."
much of what we do is based on ensuring quality and how much is simply checking
off a task on a list? With the increased sophistication of laboratory
instruments is it still logical to perform the sort of validation studies traditionally
required by CLIA? How often should methods be revalidated?
Another area that needs consideration is reporting results. Increasingly physicians are pleading for decision limits or cut-points instead of a "normal range." Maybe our reference intervals should provide more information than normal/abnormal, or low-normal-high.
laboratorians we are very concerned with quality, but I suggest we periodically
look at our long list of “tasks” and reconsider which ones contribute to quality
and enhance patient care, versus those which are just something on a list and no
longer serve a useful purpose.
there a task or process in your lab that has passed its prime or that you perform
without knowing exactly why you do it?