UA Analyzer

i did a project about 10 years ago showing the improvement with urine proficiency testing results when performed on the Clinitek Status versus manually read results. We learned most non-laboratory staff do not time and record the results as they should, especially those who rarely perform the testing. Nurse management supported the switch to instruments when they saw the results.  

When I first came to this hospital, they were using manual dip for UA dipstick.  I knew at the time that they can get Cliniteks for reasonable price. When we did the annual competency, I noticed that the users did not use a timer when doing urine dipstick. I mentioned ( during the Skills Fair) that there is an instrument they can use that they did not have to time the reading: the instrument will do that for them.   After the Skills Fair I approached the managers and presented the importance of Timing the Reading of each color block. As mentioned earlier ,  someone can have an abnormal UA because the tester took so long to read the Glucose, blood or protein.  Also no chance of reading the wrong color block. Siemens at the time had a promotional where you buy 10 boxes of dipsticks and get an instrument for free. If you buy one then it was $400.  Now it is more money.  All my locations in the hospitals and the clinics have Clinitek readers for their UA.

Now we have Clinitek Connects and they are interfaced for uhCG. Still trying to figure out how to do UA dipstick  without double charging if there is confirmation  for UA dipstick

Hello, we also instituted Cliniteks on our inpatient units.  Some use it a lot and some not so much, but they are all the same.  We took away the ability for them to hand enter results.  Our sister hospital got dinged by TJC because they did not have a way to confirm manually entered results, so interfaced is the way to go.  Also, consistency of results and charting were pluses.  Also, we got QC lockout, operator lockout, barcode scanning for operator, patient ID and Lot information.  So many pluses.

Be aware that we got push back from our HOT unit because the specific gravity on the clinitek did not match manually read ones due to the pH correction.  Operators also hate that they have only 8 seconds to dip and place the test strips (if they miss it, they have to start over), but it gets better with experience.

We currently have Cliniteks placed in our inpatient and outpatient H/O units and the ED. The ED has 2-one strictly for UA and one strictly for pregnancy testing. All are interfaced with a the Connect to Telcor. The outpatient H/O performs both dips and pregnancies-they flip the tray over. ED is too busy to tie up an instrument in a pregnancy test.

Because of the issue with SpGrav and chemo, we moved to a digital refractometer for our H/O units. They generally only test for SP, blood and pH. We have "Powerforms" in place for the nurses to manually enter the patients' results in a consistent manner.

Any confirmations needed are sent to the lab. From what I can tell there are not charges with the exception of microscopic exams.

I think that even lab staff would be hard pressed to time a manual UA. I did it when first in the field but the workflow is different now. Covering multiple benches does not cater to the precise timing needed for multiple pads. I know that the timer was being ignored with manual pregnancy testing-one major reason we moved to the Clinitek for it. We did sacrifice a bit of sensitivity (20 IU to 25 IU), but I can breathe easier!

Yes, these are all great points that we have already conveyed to them.  We even offered to do a trial in their location and they refused.  I think it is more them just being resistant to change because, understandably, it is a lot of work to do so.  We will get them there, we just don't really have the instruments that will be utilized yet to test with and I was hoping that I could see some data.  In the validation setting where you have a POCC who is reading at the correct intervals hopefully should be able to get pretty close to what the machine sees.

Thanks for the extra tips about the sgrav.

We currently switched to the Clinitek Status Plus after the Roche Urysis recall. The only downfall I have seen with this analyzer is the 8-second rule.  You have 8 seconds to dip your urine and place on the table AFTER hitting the start button. We have had some false negative and positive results due to this.  After training and education, we have not seen these false results. Also, if you are using a dropper style control, it can be difficult to get those drops on the pads and onto the test table within that 8 seconds.

I would agree with that "drawback", but isn't any automated strip reader going to have the same issue (a limited window within which the sample is applied and the test strip is pulled in for analysis)?

I do wish there were more competition for the STATUS but unfortunately there is not.

Debra,

We also acknowledge the issue with SG in our chemo patients.  What digital refractometer do you use and is it waived?

We use the Atago PAL 10S. Unfortunately it is not waived even though it is easier to perform than the Clinitek-just a few drops on the well, wait about 20 seconds, and push a button. From the time I was investigating refractometers, none were waived. I think that CMS needs to catch up with the technology. This is not the "telescope" we used in school (and when I first entered this field). We have only been using it for around a year. Because it is moderately complex, I have had to handle the training/competencies.

Trying to push for Cliniteks in our point of care, but getting money these days for anything is a complete struggle.  It's hard to justify the expense when there is no real dollar savings, only a bit of time and assurance that the results go to Epic consistently and accurately.  Doesn't mean a lot to them in this day and age.  I need all the help I can get and I am hoping for your help. 

We are about 800+ beds plus many clinics and I need to show that we are most likely behind in upgrading to a dip reader.  Our volume recorded is about 30,000+ tests per year.

Could you tell me how many of you are performing manual dipsticks and how many are utilizing a urine dip reader.  If possible, can you tell me the size of your facility or how many tests per year you do?

Cliniteks are pretty cheap, as lab or even POC devices go - about $1200.  It's really a no brainer in POC - I would really approach the topic from a standpoint of quality.  It is difficult for even a skilled laboratorian to accurately/consistently interpret results on a manual read.  There's a very great likelihood that direct care staff is not honoring the required timing of the readings.  Proficiency Testing isn't a must for waived testing, but if you do do it, have you had any PT failures?  If you don't do it, maybe you could prove your case with some blind samples, tested in your main lab, vs. the POC manual read interpretations, done by your POC staff.  I would think you would be bound to have discrepancies.  I would go from that angle.  Or from the perspective that it is a time-waster and a plain hassle if nursing staff is truly doing it correctly.  An automated reader saves nursing $$ because it can be walk-away and also automates your reporting.

1. Operator lock out is a wonderful thing!

2.  QC lock outs

3. No manual result entry/no transcription errors/no log sheets!

4. The Cliniteks can also run UhCG tests - just flip the strip tray over

5.  The 8 second countdown is scary for some but it really is plenty of time to dip, drag,blot and place the strip in the tray.

6. Immediate result print out

7. They are robust instruments and we rarely have any problems

I can't say enough good things about them. We have 30 Clinitek Status Plus analyzers in our system and performed over 35,000 patient tests last year.

Debbie Stark

University of Missouri Health Care

We have a combination of Clinitek and visual urine dips in our sites (15 hospitals, about 60 clinics). We have so many issues with QC logs for visual urines, and observation of actual practice tells us that timing the test is crucial and often not done properly. For QC log failures, they are required to do an action plan, sometimes doing a patient lookback. Our recommendation is ALWAYS for them to purchase a Clinitek to prevent QC log failures. 

I suggest contacting Peggy Mann at UTMB; she has a poster of a study she did with her medical director related to errors in reporting with manual urine dips vs Clinitek. Perhaps that can help.

Even though the devices aren't very expensive, it is a consideration for many sites. We are trying to standardize one of our big clinic groups to Clinitek only. It's going to take a while due to the financial aspect of it, but the organization is committed to standardization as well as patient safety and quality care. Although it doesn't save much operator time, it does ensure consistent, accurate results compared to visual methods.