Eye pH in ED

Here in NY, because of the lack of compliance from the ER in doing the QC when an eye ph was being done we decided to use the urine dipstick ph, we cut the stick to the ph send it to the ER in a clean baggy, We do the controls daily and all the ER needs to do is document. Since providers are the ones doing the testing, they get proficiency once and then are good for the time that they are here.

dave

I may be reading more into this than I should, but if a urine test strip is being used to check eye fluid, wouldn't that be considered an off label use and bump it into a high complexity test?  Perhaps there's something in the instructions for use that state other sample types can be used?

We use Hydrion pH strips (pH 0-13) and pH buffers 4.0 and 8.0 as QCs.  We are using paper log for daily QC documentation.  As for competency, it is direct observation (testing a QC sample) and taking a quiz.

Who is performing the testing?  Are they RNs or physicians?  Do they have competency assessments for other tests in addition to the eye pH?  How often do you require QC?

RNs.  They also perform AccuChek glucose and Hemoccult.  QC daily or when patient testing is performed. 

Thanks Don!

Agree Linda - You would have to read the package insert, but the Siemens Multistix are only to be used for urinalysis and would be considered off-label use in the example above.  Also, I would question the cleanliness of using lab scissors to cut a dipstick that was then going to touch someone's eye.  

We do eye pH in our EDs with MicroEssential pH papers (range 1-12) and with QC buffer from Fischer-Scientific (pH 4.00 and pH 7.00). The EDs order the pH paper and the QC buffer is supplied by lab. I might be mistaken, but I thought a while back eye pH was not considered a Lab Test since it lacked an actual sample. I am recalling that is was deemed a procedure/assessment. 
We have designated operators in our EDs that are trained for storage and QC (at open and every 3 months) with a control log associated. The Providers perform the assessment. There is a web based training and competency program that can be registered for if needed. 

I contacted CAP and was told that eye pH was not considered a test because there is no actual sample that is collected; however, my manager pulled a CAP today article from May 2009 where eye pH testing was discussed and recommended to be under point of care testing.
I like the idea of a limited number of people performing the QC on the pH paper and making sure it is stored properly.  Do you have the complete training and competency assessment or is that for the select ED operators who perform QC & verify accurate storage conditions?
Thanks!

2009? My goodness. :) I'm glad you clarified with CAP.

I'll send you privately....

Hi all. It was recently discovered that our ED physicians are performing eye pH testing with no protocol or procedure. Does anyone here have a policy that they would be willing to share? Thanks so much!

ruth.harmala@mghs.org

Ruth...Don't you just love the "recently discovered" items. Good luck! I've responded to you privately. :)