Fern Testing
Does anyone have physicians performing fern testing in a hospital setting? Does the hospital have a PPM waiver or are you testing under moderate or high complexity? Do you have the providers performing any QC or proficiency testing? I have some doctors that have hospital rights that would like to perform fern testing within the hospital. They have the PPM for their own private practice and I know that they can not perform testing at our facility under the private practice CLIA but I am not sure what the best route to take would be. I am wondering how other facilities have handled this situation. Any information that you would be willing to share would be greatly appreciated.
Thank You,
Kelly VanWagner MLS(ASCP)CM SHCM
Point of Care Administrator
Covenant HealthCare Laboratory
Saginaw, MI
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We perform fern testing as moderate complex, however I must admit it has been difficult to get the physicians to perform annual competency and comply with QA materials.
We stopped Fern testing several years ago. We didn’t even know that the docs had brought in their own microscope until a CAP Pathologist found it during an inspection. We now perform AmniSure
ROM and are currently looking at switching to ROM Plus.
Jeremy Williford, PBT (ASCP)
Point of Care Support Specialist, Clinical Laboratory Services
South Georgia Medical Center
2501 N Patterson St. | Valdosta, GA 31602
229.433.4804 (office) | 229.259.4836 (fax)
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From: Kelly VanWagner via POCT Listserv (Groupsite) [mailto:users+1176677@poct.groupsite.com]
Sent: Thursday, January 19, 2017 7:10 AM
To: Williford, Samuel 'Jeremy' <jeremy.williford@SGMC.ORG>
Subject: [POCT Listserv] Fern Testing
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We also perform Fern Testing as Mod-complex and it is performed by the residents and PA/NPs. We supply them with competencies, proficiencies, and report monitoring.
We have physicians perform fern testing as a Moderately Complex test. Annual quiz and skill validations are hard to accomplish but our OB-GYN leadership insists
on keeping this option available to providers. I enlist the Medical Education department to help me. They have more authority in keeping the doctors compliant.
Rosie Brungardt
Rosie Brungardt MT (ASCP)
Point of Care Coordinator
Wesley Medical Center
550 N Hillside
Wichita,Ks 67214
Phone 316-962-2896
Fax 316-962-2827
Rosemary.Brungardt@wesleymc.com
WE do not do Fern Testing anymore.
They do not do maintenance on the microscope so we decided 15 years ago to stop that test.
Now we do Amnisure.
We dropped Fern Testing this year. We now use the Amnisure and use this as a nursing test. We looked at the ROM-Plus also, but chose the Amnisure due to better literature sources. Both have a problem with insurance reimbursement, though.
Hi Kelly,
OB Physicians perform Fern testing at our hospital and also at their private practice. They have a PPM CLIA in their office and they are under the hospital laboratory CLIA when delivering babies. The POCC, who must be a Technical Consultant, performs annual competencies with all physicians performing testing(which must meet all six requirements) and API surveys. There is no QC for Fern Testing. My advice would be to ask your laboratory director and medical director if they would be willing to have these physicians perform testing under the lab CLIA. If not, then another PPM CLIA would have to be assigned to that unit. Hope this helps!
Susan L. Alford
Laboratory Point of Care Coordinator
Nanticoke Health Services
801 Middleford Road
Seaford, DE 19973
Phone: 302-629-6611 Ext. 2560
Fax: 302-628-6352
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Hello my fellow POCC’s,
We defined and instituted our “critically ill” policy for Nova glucometer use in 2015. We have been monitoring the performance improvement ever since then. We are seeing compliance within our ICU area but are struggling in ER. We have created yet another committee to get to the root of the problem. The nurses have asked me a question that I cannot answer so I am hoping someone will know the answer or lead me to another source. They want to know if there is any CMS, FDA, CAP, or TJC rule that states exactly when they have to begin using non-capillary specimens? In other words, ER nurses claim that the Dr. has not technically diagnosed the patient so without that physician diagnosis and order of Non Capillary Glucose then they should be able to draw all patients via capillary. I personally disagree here because the issue is with poor peripheral blood flow and quality of the glucometer result. They still asked me if they could see something in writing. Any suggestions or resources would be appreciated.
Susan L. Alford
Laboratory Point of Care Coordinator
Nanticoke Health Services
801 Middleford Road
Seaford, DE 19973
Phone: 302-629-6611 Ext. 2560
Fax: 302-628-6352
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Susan,
What is your critically ill definition?
Susan,
We decided that if the patient has a capillary refill of > 2 seconds, they have poor perfusion and a capillary sample may not be used. No matter what the diagnosis or where they are located in the facility.
I like that idea - it's the first objective indicator I've seen so far in the whole "what is critically ill" issue.
Is the issue ONLY about perfusion, though?
Here's a little video about the capillary refill test:
https://www.youtube.com/watch?v=U-oSBEx6ZSM
Those of you doing the Amnisure in the hospital, what are your thoughts on the letter from the manufacturer regarding the Amnisure is to be used as an aide for diagnosis? We eliminated the fern test also, but due to this letter they are wanting to reinstate it.
Here is the letter.
Hi Max,
Our critically ill definition is:
1- The need for Vasopressors
2- A Mean Arterial Pressure <60mmHG on two separate occasions at least 30 minutes apart
3- Hypothermia (less than or equal to 36C)
4- Hyper-osmolar hyperglycemia (with or without ketosis)
5- DKA with a glucose value of greater than 250 mg/dl
Susan L. Alford
Laboratory Point of Care Coordinator
Nanticoke Health Services
801 Middleford Road
Seaford, DE 19973
Phone: 302-629-6611 Ext. 2560
Fax: 302-628-6352
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Most ER patients get a rainbow colored tubes sent to the lab.
Even though a fingerstick is already done, Basic or
Comprehensive Panel, almost always , is ordered on the blood sent to the lab.
There will almost always a double check for the glucose result.
We have Nova glucose meter. I did comparison of glucose on all the patients in ER,
and critical units before we had a policy written for critically ill patients in our facility.
We have very good comparison results.
Now we have a policy and the critical units are following the policy very closely.
The managers of the units are very aware of the policy.
It is included in their annual policies to be reviewed and attestated.