Moderately Complex Testing- Initial Training

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Good morning everyone- Our moderately complex testing falls under Washington State Department of Laboratory Quality Assurance. This has been our accrediting body for this testing for 15+ years. Most recently during an inspection a discussion took place around initial training documentation. We are being told by DOH that for initial training documents that the medical director or technical consultant must sign off on individual staffs training documents (or we can choose to have some sort of cover letter on each staffs individual training packet). Has anyone else ran into this and if so which standard outlines that this is an individual sign off by the medical director or technical consultant? We have reviewed the state WACS, the CFRs. talked to other accrediting bodies and their interpretations are different. 
We do have an overarching quality assurance policy that outlines the training program, the cadence, who is approved to sign off on training documents, carry out training, etc. but we are being told this isn't good enough because the sign off on the individual training document must be the medical director or technical consultant. We have dug and dug into this to try to find something tht aligns with what DOH is stating (even met with them) but we still arent able to connect the dots on their interpretation. If anyone can share their understanding, cite the regulation specifically, etc. that would be super helpful! At the end of the day, we want to do what is best for patient care, in alignment with standards, etc. but this one has us stumped! Thanks!

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CAP has regulation on this look at POC.06920

I am having trouble attaching the form we use, but I can email it to you.  

cindy.sorensen@stlukes-stl.com  

The following 2 regulations specify it is the laboratory director's responsibility to authorize/approve testing personnel.
 
§493.1407 Standard; Laboratory director responsibilities (e)(11) Ensure that prior to testing patients’ specimens, all personnel have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results; 
 §493.1407 Standard; Laboratory director responsibilities (e)(14) Specify, in writing, the responsibilities and duties of each consultant and each person, engaged in the performance of the preanalytic, analytic, and postanalytic phases of testing, that identifies which examinations and procedures each individual is authorized to perform, whether supervision is required for specimen processing, test performance or results reporting, and whether consultant or director review is required prior to reporting patient test results. 

We are also licensed by the WA DOH so I too am curious what they are asking for.  In the past we've provided them a delegation of responsibilities form signed by the Medical Director.  This delegation form lists responsibilities and which job title(s) can perform it.  We have a separate document that is updated as needed with our current staff and their respective job titles.  This has been sufficient in the past.  

You can have multiple Technical Consultants; are they asking for something more complicated than a list of who fulfills the qualifications of being a Technical Consultant? 

We have a QA policy that outlines the training program, the deeming down of responsibilities for our education program to include training, competency etc. They are stating that for each initial training document they want to see the medical director's signature or the TC signature for EACH staff trained. Based on the standards above we agree that our program needs to address each of these items in the standard and have sign off/approval by the medical director for the overarching program and duties deemed down. We however, do not see anything that states that the medical director or the TC must sign off on each individual staff document for initial training. No question the medical director needs to approve the processes in place and is ultimately responsible for all standards etc. but individual sign off by him/her or the TC for Indvidual training documents has never been a callout by DOH and they have been our regulatory body for 20+ years.  Is there something specific that outlines the medical director or TC must sign off on Indvidual training documents vs approving the program and how it is conducted overall with all components of standards outline in a QA policy which the medical director approves?

Here is where I found that information:
CLIA_CompBrochure_508 What do I need to do to assess personnel competency.pdf
The relevant statement is as follows:
Who is responsible for performing the competency assessment?
The Technical Consultant for moderate complexity testing (42 CFR §493.1413(b)(8)) is responsible for performing and documenting competency assessments. The competency assessments may also be performed by other personnel who meet the regulatory qualification requirements for TC for moderate complexity testing.

Hi Stephanie- with regard to competency we aren't questioning the TC sign off on competency documents, only initial training documents. Thanks!

Gotcha - I don't see anything specific to initial training either in this document or the regulation cited.  My assumption (and it very well may be incorrect) is that initial training should be done by someone at least as qualified to do the competency assessments.  I'll keep digging and will be curious to see if you or anyone else finds initial training info spelled out more clearly.

Thank you Stephanie :) 

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