Waived competency - Hemocue
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In one of my emergency rooms, I have both nurses and RT that are trained on the Hemocue. They have a long standing battle over who is responsible for daily QC and come to find out, it's only been RT doing it.
My question is - we have always had users demonstrate QC and a patient test for their competency. If the RNs are not ever doing QC, they will have no idea how to perform it for a competency. Is it required or everyone's opinion that if you use an instrument, you need to be responsible for the test system as a whole, including QC?
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Which HemoCue? This may be an unpopular opinion, but we do not do liquid QC on the HemoCue 201+ at all anymore because it is not required by the manufacturer. The meter performs a self-check with every patient, that data is captured in Telcor, so that is the only QC we do. For new hire training, we do have them run a simulated patient test using QC material, but that is not really the same as running QC.
I thought the Hemocue was a moderate complex test. If so, the QC would be a requirement of competency.
I am looking at getting one in the near future. Can QC lockout be set on the Hemocue through an interface like RALS or Telcor?
thanks,
Point of Care Coordinator
CHI Health Laboratories
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From: Danyel Olson via POCT Listserv (Groupsite) <users+1234833@poct.groupsite.com>
Sent: Thursday, June 6, 2019 2:15:56 PM
To: Epstein,Nancy K
Subject: [POCT Listserv] Waived competency - Hemocue
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We have Hemocue 201DM. I just asked my heme technical specialist why we do QC each day (we have hemocues in the lab as well) and he said "because we always have!".
I'm going to have to explore that. I honestly would like to remove all of meters as the volumes are super low but once they have something, they don't like to give it up even if they don't use it!
If your waived testing program is accredited through The Joint Commission, I would warn that standard WT.04.01.01, EP #5 states: For instrument-based waived testing, quality control checks require two levels of control, if commercially available. This would supersede anything the manufacturer states.
Sorry, WT.04.01.01 EP #4 states "For instrument-based waived testing, quality control checks are performed on each instrument used for patient testing per manufacturers' instructions."
Silka is correct with EP #4, however EP #5 will supersede #4 because the manufacturer also states: "If quality control checks are required for regulatory reasons they should be performed using liquid controls recommended by HemoCue "
The Joint Commission will survey all recommendations as a requirement.
On the HemoCue 201+ under Quality Control it states "The HemoCue Hb 201+ analyzer has an internal electronic "SELFTEST". Every time the analyzer is turned on, it will automatically verify the performance of the optronic unit of the analyzer. The test is performed every second hour if the analyzer remains switched on. Upon passing the SELFTEST, the display will show the HemoCue symbol and three flashing dashes, indicating that the analyzer is ready to perform a measurement. An error code will be displayed if the SELFTEST fails. If use of liquid control material is required by local or other regulations, contact HemoCue, Inc. for control information."
In our state, as a waived test we are only required to follow manufacturer recommendations. I read this to be saying that the device self-QC's and locks out if there is a failure - which is the definition of EQC.
Wait...did my husband get in into this conversation and change the topic mid way into an argument? so typical!
The Hemocue DM201 Danyel mentioned is a glucose analyzer whereas the Hemocue Hb 201 or 301? is a hemoglobin analyzer. I think.
Danyel, you are not alone in the 'low volume but can't give it up' quandary. Especially with glucose, it's difficult when there are no other glucose meters/analyzers nearby and the testing site occasionally gets unexpected severely ill patients showing up.
Nancy which of the Hemocues are you asking about complexity?
So Greg, to go along with TJC EP#5, how frequent does the manufacturer state the liquid QC should be/required to be performed based on MIFU on the Hemocue Hb 201 (or 301)?
We set up every day of patient testing with liquid QC for years (TJC WT Chapter) but then quantitative was reduced to 'MIFU', correct? We reduced ours to new shipments/new lot#s and monthly (Hemocue 201+)
We use the 201DM for Hgb - I believe it's also the glucose meter but we do not use it for that. We are CAP accredited.
The deciding factor: Who use the Hemocue to test patients?
If only the nurses use it, they have to do the QC.
If the RT use it also, then they share in doing QC.
The standards specify that users must do the QC.
QC performance must be rotated
among users.
CAP does not specify who must do QC on waived tests so theoretically lab can do it.
Sent via Groupsite Mobile.
CAP does not specify who must do QC on waived tests so theoretically lab can do it.
Sent via Groupsite Mobile.
CAP does not specify who must do QC on waived tests so theoretically lab can do it.
Sent via Groupsite Mobile.
Sorry Carol....I was sited for doing QC for Hemocue because I was not the one testing
patients.... whoever tests patients must do the QC... OR techs/ doctors didn't want to do the extra testing they were only interested in patient results (Hgb)
Betty
It is better to have the users own the procedure including doing QC.
As a POCC, I always find a way to delegate some of the tasks that are mundane.
Probably because I am the only POCC for 2 hospitals and clinics.
I cannot do all the little things that someone else can do.
It won’t hurt for the nurses to do the QC.
It also make them appreciate all the behind the scenes we do in the lab before they get a test result.
One of them is QC and instrument maintenance.
AS long as it is within the scope of regulations of the accrediting agency.
Learn to delegate.