Waived Testing
Good morning,
Am new here. Appreciate your indulgence.
I’m a Med Tech with 20+ years experience and am currently working at a rural hospital in Georgia.
We are CAP, but the dozen doctors offices associated with the hospital are neither CAP or JC affiliated.
Couple of years ago I took over the task of “visiting” these clinics to review their laboratory processes. For the most part they perform only waived tests (GLU, HGB, UR, LEAD).
The expectation has been these facilities should perform External QC (if Available) and document temperatures/maintenance. Until I came along these tasks have been done haphazardly and half heartedly. We now expect Best Lab Practices - Written policies, Medical Director (or designee) reviewing QC/TEMP/MAINT Logs, documented training, and ongoing training.
Am wondering if anyone else here has a program such as this in place for Waived testing or do you think we’re totally off our rocker?
Thank you
Paula
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I have clinics that only performed waived testing. When I first started they were spotty with their compliance. We standardized all the testing and I updated all the logs (and made more) and implemented annual testing competencies.
I have gotten them (2-3 years later) to now reach out to me when they think they are not doing something right. I feel this is a huge step.
Starting in 2020 we are going to be "rounding" in all clinics (my system has over 200 but POCT is only performed in around 70) and I will see how they are doing. I anticipate non-compliance since this has not been done in years so I have prepped everyone that the first couple of years will be getting back to the base that I expect.
I expect a high level from my clinics and know they can do it so I do not think that you are way out of line with what you are doing at all.
You always have to understand that performing POCT in a clinic setting is very different than in a lab but there are still non-negotiables that they should be doing no matter what. I am mindful that they do ALOT in the clinics and POCT is not their only job so I make it as easy as I can for them to do the right thing (what I want them to do).
* Temperature/Humidity sheet with all POCT supplies list and the Technical support numbers for all the manufacturers.
* QC and Expiration date sheets so they have a quick reference guide to refer to when they have questions.
I hope this helps.
Anastasia
No, certainly I don’t think you are off your rocker to define expectations to those performing and locally overseeing (at the testing site) waived testing.
From my point of view it would be easier to generate compliance to QC and competency assessment related to their testing site CLIA if the sites were under an accreditation survey/inspection but I know that is not under your control.
My suggestion is to interpret CLIA into plain terms and tell them “these are rules, lab testing is a federal government thing related to your reimbursements” if you can’t get traction, don’t see improvements.
The local management for the clinics may not have clued in “no inspections but there are rules”. If an incorrect result/bad outcome is reported to CMS, that will unscrew the lid off the no inspections.
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Thank you for the feedback, ladies. It’s one thing to be a bench tech in the hospital all these years, but it’s entirely different when dealing with clinics. I appreciate and respect what the nurses and CMAs do at the offices, and I want to support, not hinder. But the bottom line is patient care.
Appreciate you being my sounding board
You are spot on! We recently overhauled our program with similar findings. Don’t forget “Manufacturer’s Information”! Reference and link to policy.
Sharon
Reflecting on what Paula said (Sunday, Sept 22 post), I'm throwing out a suggestion to consider *IF* anyone has the time (remember I am the messenger!) to 'do more support' for the CMAs.
I'm coming up on my 4th Saturday to volunteer to present waived testing/CLIA/what in the heck is QC and why do we do it? topics to the local or state/regional Medical Assistant's Society.
I was approached a couple of years ago by one of our clinic CMAs who had rotated in as the state president. The meeting was scheduled for one of our large ambulatory building conference rooms so for me, it was just a matter of volunteering several hours on a Saturday to get the opportunity to not only talk to our MAs who were members of the society, but to also blast the message to MD office MAs who don't have the kind of support that your and my oversight provides because they aren't part of a hospital network/system. Benefitting patients not in our own systems is just as sweet as benefitting those within our system - we know that otherwise we'd not be sharing on this listserve!
I look at it as a win-win for me as well. I get to know our MAs outside of 'work' which increases my visibility and credibility to the new ones we hires. Also, I find out what MAs 'didn't know' (they are very clear on telling me what was 'new' to them) and I get to talk about my favorite subject (not including quilting or my family!).
The last time I presented a 'case study' which combined their roles as lab specimen collectors and their performance of POCT (of course I used urine for dip and culture - easy target!). All of our MAs do both roles in our clinics.
Just an idea. I'll tell you that as an audience, I have never found a more appreciative one than the MAs.