Proficiency and iStat

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I was recently told by a TJC surveyor that I did not have to perform proficiency surveys on our iStats. In the lab we use Seimens Dimension Vistas and the lab analyzers are considered the primary  analyzer per the surveryor and the iStat is considered secondary. This is based off QSA.01.03.01 EP3: "The laboratory performs proficiency testing for each test method used as the primary method under each Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) certificate for each regulated analyte. Note: Proficiency testing for secondary analyzers is not required."

Has anyone else been told this? We have always completed proficiency on the iStat without being told this so I just want to investigate more before we make any changes. 

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This is true only if your POCT is under the lab's CLIA. The lab device is considered primary, and you should not be doing PT for the secondary device. However, it is required to compare the POCT device with the lab, so that is an alternate PT. We no longer do PT for any POCT device in the hospital, unless that lab doesn't do the test (like ACT).

Kathleen is absolutely correct.  Only the primary method of testing is required to enroll in PT.  

This may be true for JHACO but I don't believe it is true for CAP.  

To be honest, I would be uncomfortable not doing PT on my POC tests even if it isn't required.  Why: I know for a fact that I can get perfect results on the iSTAT with the iSTAT QC and a floor user can't get it to pass.   Why is this?  Because of the difference in technique.  I've seen this time and time again.  Proficiency testing is explicitly stated that it must be performed by the users of the system.  Is the lab staff doing the iSTAT to lab analyzer correlations?  If true, this would miss a important component of PT testing.  Doing PT testing is another quality metric to confirm the results going to the patients charts are accurate.

Interesting discussion.  OUr POCT is under the main lab license, CAP.  The only test we perform on iSTAT for POC is ACT.  However, if we used it for other POC tests, say creatinine,  also performed in the lab, the iSTAT would have a different entry on the Activity Menu.  Checking the Master list for POCT, it is listed as proficiency testing required.  If you have 2 of the same chemistry analyzers, would one of them be the secondary?  Can't quite figure the iSTAT as secondary.  

Interesting! I'm currently running PT on the iSTATs as this is what was in place prior to me taking this role. I see how PT would be redundant for my Chem 8+ and Creat. We run cTnl troponin as a screening tool on the iSTAT and the main lab runs HS troponin. Since they aren't the same troponin, would PT still be needed for the cTnl? I'm leaning towards yes but wanted to see if anyone else out there has any experience with this.
Thanks!

CLIA does not ignore the second test method. Evaluation of the secondary method is still required.  Laboratories may use PT as part of this evaluation.
 See below
 ยง493.1281 Standard: Comparison of test results (a) If a laboratory performs the same test using different methodologies or instruments, or performs the same test at multiple testing sites, the laboratory must have a system that twice a year evaluates and defines the relationship between test results using the different methodologies, instruments, or testing sites. 

I believe the requirement is based on your activity menu for CAP.  If the main lab runs creatinine on serum and whole blood is used for iSTAT testing, then those are two different activities and the iSTAT would require PT.  For items like blood gases that may be run in the main lab and on the iSTAT, they are both whole blood and the iSTAT would be a secondary method.  In Cath Lab, I was reporting total hemoglobin from the co-oximeter survey and I was told to stop as the lab was reporting total hemoglobin on another survey and the "primary  method" was covered.  Thankfully it was two different surveys and not duplicate testing!  Now TJC  may have different requirements, but CAP aligns with CLIA's expectations.

We were just inspected by CAP and they accepted our twice a year accuracy testing with the instruments in the lab (lab and POC testing falls under the same CLIA and CAP # which is required).  I have heard that TJC allows this.  As a previous CLIA inspector, I am 100% sure that CLIA and COLA also allow this.   

If you qualify for verifying the accuracy of the testing in lieu of participating in proficiency, you would need to develop a plan (write a procedure/policy) on how the comparisons would be performed and how you determine if the comparison testing is accurate.  

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Cathy Skyles
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