Creating an interdisciplinary POC hospital committee

Happy Lab Week!

I am in a position where we have 3 separate hospital systems as part of our program. Each of the systems has their own POC Advisory Committee. They are at varying stages of sophistication, and we're working to make them more standardized. The biggest things we discuss at the meetings are requests for POC testing and quality issues (action plans for QC, instrument disinfection, etc.). We have a test request form, and also a Compliance Agreement that the unit/clinic director will sign, that lists out all the things that are the responsibility of the department (like purchasing all supplies, performing QC and PT, competency requirements, etc.). This lets them know what they're in for. Sometimes that's the last we hear, as they decide the requirements are too onerous. We're working on a process map for requests, that would include hospital administration, purchasing, IT security, etc. 

The membership is usually POCT personnel, medical directors for the various programs, unit/clinic directors/managers (especially when they have a test request or a very serious action plan), hospital administration (they usually don't come to meetings but get all the minutes), purchasing, infection control, and ad hoc members as needed.

I feel strongly that this is essential to a good POCT program. It ensures that everyone knows what the expectations are for all parties, makes sure that requests are considered from a viewpoint of cost as well as clinical utility and standardization, and promotes a collaborative atmosphere between lab, POCT, and the hospital. Having administration and purchasing there streamlines the process and ensures that all requirements are met.

Libby....welcome to the club of POCT!

In the olden days, I used to have a POCT committee. This was in the 1990's when POCT was shiny, new and REALLY scary to lab directors and pathologists.

It was tough to get people from all hospital areas to take the time to come and listen to the lab explain things....then have them make a decision. I found that nursing sided with what other nursing units wanted, etc. Towards the end of the committee....they just told me to make the call.......if I could get anyone to show up! I resorted to using voting buttons on Outlook finally. Nursing and lab were the main members with ad hoc people such as IT involved when it was needed.

So, fast forward to current day......what I did is to write a procedure with a form for anyone who wanted new testing. The form comes to me. I then evaluate it and present it to the pathologist and bosses with my recommendation. It contains the "Who, What, Where, When, Why and How?"  as well as "How Much?"

Much easier....no meetings and the onus is on the requestor. The other thing that this form does is to highlight main lab issues. "We need POCT lactate." With the research you find that the main lab is slipping on the TAT for lactate.

Many times, the docs will go to the pathologists with the request, and the form will be "verbalized".

Since you are new to POCT, finding unauthorized testing happening is just a fact of your new job. You will have to walk the units and look everything. I used to say that I was "Hunting for the boogie man...behind the bushes, in closets and upon occasion even in operator lockers." One time I found a person who was cutting urine dipsticks in half to save money.....

Good luck.....Deanna Bogner 210-297-9657

Happy Lab Week!

I am a new POCC and my position is brand new as well! I am in a community hospital with 140 beds, a very active ER and 6 clinics performing POC testing.

We have a POC Steering Committee.  The committee is an inter disciplined team consisting of representative staff from Training and Education, Risk Management, Regulation, Quality and Safety, Distribution, Bio Med engineering, as well as clinic leaders, lab leadership, nursing leadership and myself.

The team meets quarterly unless there is a need.

We review standardization of POC testing, procedures, and documentation across our system. We also review requests for new testing, change in testing and any instrumentation requests.

The group works together to identify and implement performance improvement opportunities as well.

It is a great group to bounce ideas off of and to get input on any regulatory changes that may need to be implemented.

I also found it helpful to sit on committees within my hospital where POC testing may come up. For example I sit on our Product Standards Committee. This committee reviews any new requested items that want to be brought into the hospital. It is amazing how many POC tests have been caught through this committee!

I have made good friends with our Purchasing and distribution folks as well. They know if someone who shouldn't be requesting a test kit requests one. They then send them on to me. Same with our BioMed engineers. If it sounds like an instrument for testing, they contact me first!

I have been learning as I go in this position! Hope this was helpful!

Michelle

Happy Lab Week!

I've been through many transitions over the years. A POC committee that dwindled down to very few attendees, an increasingly large Health System, and now a transition to become a member of HCA Healthcare.

Last year, before the purchase, it became apparent that we needed to put together a new POC steering committee in order to determine what testing was being done within our system. We have a single team, comprised of Pathology, POC, Lab leadership, Nursing, physician office leadership, accreditation, IT, and other Adhoc members as needed. We meet monthly as a general rule.

A  policy was created for the system, including competencies, exams, application for new testing, and as part of the HCA transition, a complete listing of tests, CLIA certificates,  and locations.

It has certainly helped that we have a process in place for new requests that is not an automatic approval. Having Lab pathology and accreditation to support the process is a huge plus.

I am also the lab rep on the purchasing committee and they know to contact me with new equipment requests. 

Best of Luck to you! Jean

...All of the above! is our current path, except we did not continue to put time into an interdisciplinary 'committee'.

Looking back 20+ years, I agree that to start a new program (eg 'the lab' is taking charge of what may have been scattered POCT performed by nursing staff, governed by no one) it was essential to get stake holders at one table for a series of 'building/organizing'. There is no doubt that building processes (probably not so much the 'plans' or 'procedures') benefitted by using an interdisciplinary committee. As we in POC because more savy about managing the program, we considered the 'committee' there in case someone disagreed with the outcome of a decision made (eg POC not agreeing to add a new test, a test not on formulary). We found the committee was never needed so a natural disband occurred. 

Going forward to meet 'the crisis' presented one by one (eg critically ill? what's that mean to us here?) we formed focused stake holder groups but in a lot of cases, POC met 1:1 with the stake holder and then compiled 'the concerns/input' into our decision on how to deal with issue.

If the lab director and POCC/staff starts out after setting goals for their program, that may help direct who best to pull in if you do want to have a committee.  Each health system is considerably different in how they have to handle purchasing, testing staff (are they union? is nursing leadership strong or not so much?) and how many POC staff folks are contributing time in the program. Then perhaps consider within your system how best to meet each goal while tapping into resources (as you did here!) related to the goal.

We are here for you - good luck.

We have the same history here as Peggy. We had a steering committee for years with  wide variety of folks from all throughout the organization. It was difficult to get a large majority to attend and it ended up being the same few people over and over. They tried to meet quarterly but sometimes there just wasn't much to talk about as we don't as a rule have many new test requests, or the topic didn't apply to most areas, etc. The committee was dissolved and I've yet to pick it back up. At this point I prefer to work with small groups and pull in who I know will be a stakeholder or have a large presence in the project.

Another perspective from my absolute hatred of meetings  and another possible process.  Create a work order type system that is probably in place with your IT, housekeeping, etc. departments.  I worked with our website team to create an internal website just for Point of Care with two buttons one to request simple troubleshooting and one for requesting new or additional point of care testing.  After clicking, the department manager fills out a detailed form justifying the reason for the addition.  Some are simple requests to add a meter, other may be new testing that needs more information and discussion with the Medical Director.  You get to decide which and can move it up the chain through email discussions and all parties involved can participate.  I'd be happy to share any information!  I've had this in place about six months and I like how I can keep several "projects" in process and moving them along quicker.

Lori, I would be interested to hear more about your process.  sundee.carver@confluencehealth.org