High scores in labs create better patient care

by Cindy Abole, Public Relations

Dialysis technician Leroy Davis prepares the Hemachron, a machine which monitors the Activated Clotting Time (ACT) of a patient's blood, confirming heparanization treatment. On average, the clinic performs more than 1,750 ACT treatments per month.

Performing a test measuring a person’s Activated Clotting Time (ACT) may seem like a routine procedure. But for weakened individuals undergoing dialysis, the results can be crucial, especially as it relates to a patient’s recovery and healing process.

ACT and other tests for blood gases, blood sugar/glucose, rapid strep, fungal cultures and hemoglobin AIC for diabetics are examples of specialized lab tests performed by nurses, technicians and other medical personnel within various patient care areas as part of MUSC’s point-of-care testing program. Their continual education and training on laboratory procedures are vital to the diagnosis and treatment of patients.

Recently, MUSC’s special function laboratories were surveyed and re-accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO). The laboratories received a score of 99 out of 100 points. Results of this accreditation inspection compliment the fine work relationship established between the clinical patient care staff and laboratory service’s Point-Of-Care Testing (POCT) coordinators, Joyce Foster, Nina Epps and Becky Reynolds.

“The interdisciplinary efforts involved in the POCT program provided the quality mechanism needed for optimal patient care,” said Foster, M.H.S., coordinator of the point-of-care testing team. “We were able to establish work continuity in a user-friendly, non-laboratory environment.”

MUSC Laboratory Services became actively involved in laboratory testing throughout the MUSC Medical Center in response to the Clinical Laboratory Amendments of 1988 (CLIA ‘88). CLIA’88 represents the federal government’s establishment of quality laboratory standards. Federal oversight of these standards applies to any location performing tests on human specimens for the diagnosis, prevention or treatment of disease.

JCAHO is an independent and non-profit accrediting body which surveys hospital practices based on established standards. However, the JCAHO laboratory survey program is required to meet or exceed CLIA ‘88 standards before being recognized by the federal government as a “deemed status” organization. A survey by JCAHO ensures compliance with all federal laboratory standards.

To comply with JCAHO and CLIA’88 requirements, MUSC established the Point-of-Care Testing Council in 1994. The council approves all point-of-care testing and is charged with ensuring that all POCT provides relevant, cost-effective and quality laboratory information. MUSC laboratory services’ POCT coordinators provide the regulatory and laboratory expertise to assist in maintaining quality laboratory practice.

The special function laboratories accredited by JACHO include: MUSC’s pediatric primary care; nuclear medicine; 7B CH-pediatric hematology and oncology; pediatric catherization lab; heart center; adult catherization lab; life support; hematology, family medicine (Calhoun Street); dialysis; and neonatal intensive care unit (ECMO).

Sonia Muckenfuss, a nurse educator in pediatric hematology-oncology area said that patient procedures are becoming more decentralized. “More things are being done at a patient’s bedside,” said Muckenfuss, commenting on the many lab tests performed and analyzed by nurses and trained technicians. “In the long run, it’s just more cost-effective.” “It’s good justification,” said Nancy Black, R.N., program coordinator of the acute hemodialysis unit.

“It’s important that all of us who are involved take time to follow regulations and meet quality control for more accurate results.” Black, along with a team of 11 nurses and four hemodialysis technicians worked under less established test guidelines prior to the establishment of MUSC’s POCT program. Foster and her team gradually introduced federally-approved test procedures, certification programs, equipment calibration, monthly reviews, inspections, etc. Recently, Black discovered just how effective their POCT training program compares nationally with others at a spring 1998 clinical nephrology conference.

Black and Nancy Davidson, nurse manager, attended a point-of-care testing seminar of the International Continuous Renal Replacement Therapy Conference in San Diego, Calif., and learned MUSC’s program ranked ahead of other hospitals and health care facilities.

“Our goal is not to try converting clinicians into laboratory technicians,” Foster said. “Busy as they are, staffer’s hardly have any spare time to perform basic patient-care functions. When it comes to conducting tests and procedures, there’s only one correct way to perform the work. There’s no room for any deviation.”

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