POCT Decentralized Competency Assessment for Waived Testing

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Hello everyone, 

We currently have monthly Skills Day for Point of Care Testing.  We have individual booths set up for glucose, hemaprompt/pH/Refractometer, Urinalysis, urine hCG, (as well as i-STAT) that are manned by nursing and laboratorians.  The two elements for waived competency required by TJC that we use are a quiz and observation of QC.  The quiz is taken on Healthstream and the certificate is brought to Skills Day.  The QC observation is done at the booths at Skills Day.  We have one form that contains all of the direct observations with signatures of those that have observed them.  Staff are required to attend the pertinent stations required for their unit and are only updated in the glucose system if all elements are completed.  We have very good compliance with this forum.  

Recently, Nursing Education has expressed an interest in decentralizing this process and completing unit-based competency assessments.    We are trying to determine the best way to capture the two elements in the absence of a Skills Day.  We have approximately 3,000 operators performing the waived testing.  We have the quiz in Healthstream which we would continue to have available.  QC for glucose testing can be captured in our middleware system (UniPOC).  We are not certain how to best capture the second element for the manual non-interfaced kit tests and are looking for suggestions.  The majority of our floors perform both glucose and Hemaprompt testing.  Other floors like the ED perform a multitude of waived tests.  Any recommendations you can provide would be helpful.  


11 Replies

We have direct observation competency checklists built in Healthstream.  Each person has to have a "qualified observer" complete their checklist.  We bundle the whole thing together in a 3 part assignment: short reminder module and quiz completed by the employee, then the checklist completed by someone qualified on their unit.

Just a quick comment, but isn't using a refractometer moderately complex, or did something change?  I only know because I made an assumption several years back that it was a simple waived test only to have JC ding me at three clinics for not meeting moderately complex criteria.  We promptly dropped it :)

Danielle-- I am wondering how you designate and keep track of qualified observers in healthstream? This sounds like a great course of action. We currently use healthstream for assessments but require physical checklists from staff on the unit / at the ambulatory location. 

Danielle,  thank you for your reply! 

James, you are correct.  We include refractometer with one of our waived booths but it is actually moderate.  We put it there for ease because it's done by few people.  

HI
You don't have to do direct observations for waived testing.  I leave urine QC on a unit for 30 days (Quantimetrix Urine QC is good for 30 days at room temperature), leave logs for staff to record results then collect them at the end of 30 days.  For one unit I made a bunch of "unknowns" with the urine QC and plastic test tubes and left on a unit to complete within the 30 days.
At our institution point of care testing is limited to Urine Pregnancy, Glucometer, and CoaguChek INR testing. Only test interfaced is the glucometer!
Good Luck.

Our nursing educators work with the healthstream super users to designate the qualified observers for each checklist on their units based on the definitions I give them.  Also, the first question in each checklist is an attestation that they are qualified to perform this competency assessment, with a definition of the requirements (we require at least a year of experience with the waived test to check others off).

Agree with Amanda that for TJC, one is allowed to use 'routinely performed QC' for comp assessment and it can be an element that is not observed (it's preferred to do so but not a rquiremnt).
As far as not getting too elaborate trying to do 'on-site/decentralized checkoffs for waived testing', the benefit of having the checkoffs be 'local'/on-site is related to the issue if there are more than one CLIA#s covereing the waived testing. If you aren't aware of TJC interpretation, for WT comp assessment, the comp assessment must be conducted where the testing is being performed/at the CLIA# of the 'laboratory' on the Certificate. (We are TJC WT chapter for survey but I've been told by CAP inspectors that CAP does not use this interpretation of CLIA.)

What helps us comply with that is having organized a 'POC champion/test site lead' program so each testing site has a lead to review QC logs, help with troubleshooting, monitor expiration dates etc. They also are the 'local' trainer and manage the comp. assessments. We use alot of manual kit testing and have for WT only 2 analyzers connected plus do not have an electronic documentation for competencies (yes, all paper).
Since the folks are local to the testing sites, we are able to do much more in the way of 'observation' for checkoffs but still, using 'routine QC' is an option we allow.

Hi

For waived testing,
 

In our hospital, the Educator works with the RNs to perform the unknown samples. At the same time, the RNs / staff must complete the health stream course & quiz.
If some department has no educator, the Department director / POCC will follow up and complete the annual competency (computer-based quiz in health stream and perform unknown sample or QCs.)

When we have a newly hired, we try to complete the initial competency within the first month after hiring.

For Non waived testing,

- complete the quiz in the health stream
- initial trainee, six-month and annual trainee by POCC or department director.

All competencies (Unknow testing & quiz) are recorded in the form and kept as annual competencies.

Peggy - I greatly appreciate your thorough response. I am in also in a situation where our department is over near two dozen different CLIA #s, so your description is very pertinent. 

Hello, I am hoping that maybe  someone who has Healthstream would be willing to share with me a file.  We have healthstream and I would like to utilize it and we currently have a class built in Healthstream for Hemaprompt with a quiz that they must pass and then a competency that they must send to an evaluator.
However, we are switching to CAP instead of Joint Commission and my supervisors feel that all this must be done in person.  I not only am the point of care coordinator but I also work in the laboratory when they are short staffed.  I feel that it would best benefit us if we used all available tools.  Can someone help me that has healthstream.  I was wondering Danielle Ennis if you would be willing to share your process with me and a link to your files.  Thanks in advance.  

We're CAP.  The checklist is done in person with a "qualified observer".  It shouldn't be all on you as long as you have qualified observers roaming about.
ED POC Fecal Occult Blood Testing Competency Checklist.docx
Asante Point Of Care - Provider Testing for Fecal Occult Blood - Seracult.pptx

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