Vaginal pH and Fern Testing Alternatives

We had the same issue with providers not being compliant, so we took it away from them and went to amni-sure. I know that you said you wanted a non amni-sure way, but this is how we resolved the issue and personally I like the test, and we have control of the testing the nurses just bring the specimen. The biggest reason we were able to do this is we got cited for non performance from the providers.

dave m

Thank You.

Do the providers still perform pH testing or were you able to eliminate both with the Aminsure? Are nurses collecting the specimens or just placing orders and sending specimens to the lab?

Currently we have a few providers that are very vocal about their dislike and distrust in amnisure. We tried to move to the amnisure process about 3 years ago and the OB medical director at the time, was very much against it.

I have a few docs that would love to have amnisure as an option but they still want ferning and pH too.

I am hoping to get some insight from other organization to either get them to be willing to move to a different process all together or at least understand the need for compliance.

Thank You Again,

Kelly

I am so sorry but I can not access the email from Tessa @ Covenant Health.

I also feel I should clarify. The providers I have currently do not seem to be confident in anything other than Ferning and pH. It is not Amnisure specifically.

I am hoping that someone has somehow found success with a lab based process or other clever alternative.

Thank You Again,

Kelly

My hospital runs both the Amnisure and Fern testing. Most doctors don't like the Aminsure because of its price, and prefer the Fern method. My competencies are held once a year in which I come to the OB meeting, sit amongst them, and have an open discussion. I pick a doctor in which will walk me through the procedure, and then I open it up for a discussion if anyone does it differently or if I had noticed areas in which they left out key steps. The doctors will take a pictorial test and a question test. I also throw in an additional pictorial test to use as a secondary proficiency test for those who don't get to complete the one during the year. They also sign a form to agree to our policy and rules. Basically its  a two sided conversation ...they not so eagerly walk me through everything and I inform them on any news with inspections that I have heard of or any new organizational news.

My forms document the 6 required competency requirements and how they were completed whether verbal, demonstrated, observed, simulated, test, etc.

I also make sure to emphasize that since its a physician perform test the provider must order and result the test....this can not be handed off to a nurse.

Not a fun experience, and they hate every minute of it, but they get a little nicer each year.

Alayna

Thanks Alayna.

How do you handle the direct observation and instrument function requirement? Do you have them perform an unknown on a scope and observe?

Currently I have a short combination quiz that includes photos and limitations. My form verifies that they have read and understand the procedure and that they were successfully observed performing a unknown sample. I also review patient results monthly and make sure that any questionable or inconsistent results were followed up on appropriately. This is how I have been handling competency for awhile now and it has been fairly successful but they are protesting louder and louder about the direct observation aspect. As you can imagine the physicians would prefer that they didn't have to be observed at all.

Any insights on direct observation would be appreciated.

Thanks Again,

Kelly

Kelly, to answer your question the amni-sure took away both the fern test and ph. For us  (lab) it was a win win mainly because the Dr. and midwives were so non-compliant with the proficiency testing no matter what we did. There favorite saying was we have been doing this for such and such time and we know what we are doing. It also does not help that at the time our director was not a very strong willed person, and once the amni-sure came about the providers jumped on board. To have control the nurses collect the swab and the LAb does the testing, that way the billing process is being done, as stated they are not cheap. also the OB department was not billing or documenting what was being done consistently, because the Dr.'s were doing it.

dave

I spoke to CAP and a verbal demonstration of the FERN testing is acceptable. I can have them mock demonstrate the procedure too.....if needed. I note either way they perform it on the sheet and either way is fine. The whole point is so that the POCC can note differences in technique and spread the knowledge, this is done by group discussion in my case.

 I also make sure they have to label the slide correctly if they leave the patients room.....and I tell them where they can be obtain slide labels if needed. I emphasize this is important!!

I have them walk me through how to properly identify their patients, and how to properly order and result the test into the EMR. I provide step by step printed directions for the doctors that don't do this often and inform them no results will be accepted if not ordered and resulted by the doctor themselves.

 above is the criteria I have stated on my form for direct observation...I note the evaluation method V=verbailizes D=Demonstrates O=observes S=simulates T=test etc... date and initial

For instrument function I clarify the cleaning process and walk them through downtime forms, and make sure they are aware of the type of scope needed to perform testing. I also log all scope maintenance records, but I don't keep a log of daily cleaning because we barely perform this test. The cleaning log might be one area in which I could improve.

I initial and date all of these areas

Our hospital is both Joint and CAP and so far both has been ok with our competency setup.

Alayna

Thank You.

We found our paper at Fisher but there are other suppliers. We ordered the JANT Pharmacal AccutestT Nitrazine pH phenaphthazine paper. The description specifically mentions testing for amniotic fluid. (Catalog # NC0629451)

Jessica Lang, POC Supervisor

We are moving Fern testing to the lab.  Any suggestions for specimen handling and transportation to the lab?  Thanks in advance. 

What products are you users using for pH testing?

We moved away from using nitrazine paper, as it was traveling to and from offices.

We are currently using a FisherBrand 0-14 pH strip.