Waived testing direct observations for competency

We don't worry about direct obs for many of our waived tests since it is not required by CLIA or Joint Commission or CAP. So for those two tests I do a quiz only for annual comps. They do hands on training at hire only, and for those I usually use old CAP samples.

There is a very helpful tool provided by the Joint Commission site called the Standards BoosterPak for Waived Testing.   In there you will find the JC standards.  On page 8 Under element of Performance for WT.03.01.01 it lists, competency for waived testing is assessed using at least two of the following methods per person per test:

• performance of a test on a blind specimen


• periodic observations of routine work by the supervisor or qualified designee


• monitoring of each user's quality control performance


• use of a written test specific to the test assessed 

We have found it easier to track in HealthStream which allow a written test with passing score identified in policy along to include pictoral result interpretation, a skills checklist for QC performance validation by unit educators and Ishihara test for color blindness. In the BoosterPak it also identifies competency is assessed at time of orientation and annually thereafter.  Love the booster paks!

Hi

The recipe for occult card specimens has been on the other POC listserve. I used to thin out cooked oatmeal with the water from blendered (do they still make blenders? old fashioned!) broccoli for + occults. I had to store it in a food refrigerator. Others have used meaty dog food. Our nursing educators used blood mixed into pudding but again, need to store in a lab refrigerator. Mary Wrenn posted a positive control (positive control called CAMCO Positive Control Solution by Cambridge Diagnostic Products, 6880 NW 17th Ave, Fort Lauderdale, FL 33309, Catalog number 700-C-1)...oh and chocolate agar.

We use TJC for WT and we don't require direct observation either. We are reading the TJC Standard though to mean we need to have two means of comp assessment annually as well as new hire. We require one of the two means to be the quiz then the second means is flexible/decided by the test site trainer. 

I have used chocolate pudding with iodine mixed in and refried beans with iodine mixed in for fake +  stool sample. Cream of chicken soup with iodine and lemon juice for + gastric.

I implemented a annual competency in my clinics this year. The clinics are only waived and we are not accredited (YET). They complete a quiz for each POCT they have been trained on and do an in-person demonstration for each POCT in their clinic. 

Thanks Colleen! I had forgotten about the booster packs! It's been a while since we 'copied and pasted' from the booster pack onto our website competency page (I wonder if we cited that booster pack...HAHA).

Thanks for the "recipes."  We are JCAHO accredited and so one of the methods I use is a quiz on NetLearning.  So this question I've posed is for a second method.  I can't rely on periodic observation because they don't do these tests often enough on patients for each and every nurse to be observed.  I've just  been having them interpret one I've already developed but since they do these so infrequently I'm not sure they really  are doing them correctly and the only way to know for sure and for them to really fulfill a second method requirement is to actually test a blind sample.  Oh, and thanks for the reference to the booster pack.  I'll definitely check it out.

We use old CAP samples. However, we have also just had them drop the developer on blank cards, because our operators don't apply the sample, they just develop the cards. We discuss the application of the sample and observe them developing the cards. They still see the difference between a positive and negative with the internal control, it's more the process of dropping onto the "sample" first and then the QC portion after so the blue color doesn't run into the sample.

Does anyone currently use a fake sample for urine dipsticks? If so, what do you use?

Hi Zach, 

We usually keep 'training' samples that are expired QC materials that have been confiscated from units during audits, or if we happen to have a small supply left past manufacturer's expiration date. 

We use a quiz and then at comp fair use a mix of verbal questions about the test process and mocked up cards/cartridges and interpretation of the results.

For urine dipsticks we use the QC product that we have in the lab for our Clinitek - we just have them drop it on the sticks. We only have a handful of operators for this though so we don't go through much.

I have a quiz and do direct observation for waived competency initially and annually.  Not all nurses do QC although it is required to have it rotated among all staff.  Having everyone do it at annual competency is how we are meeting that requirement.  I find I can't get away from direct observation for competency because it gives me a chance to update the nurses on policy/procedure updates and to correct bad technique, especially with urinalysis and rapid strep.  I am hoping at some point to have quizzes online to facilitate competency tracking.  I still have a manual process with 400+ testing personnel in 53 offices.

I also use CAP proficiency samples for competency assessment (fecal occult blood), and as a blind specimen.  I pick them up on my audit rounds.