Specimen type for CAP Alternative Assessment

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Hello,
I'd appreciate if anyone can help me get some clarity on this....... Our POC has AVOX, iSTAT CG8, and Crea cartridges.  The lab is the "gold standard"/ primary method, so POC can't report the same analytes to CAP.  The current method established here is performing an alternative assessment by method comparison, using patient samples. 
I contacted CAP and their response was "If the laboratory (under one CLIA license) uses multiple methods for an analyte, proficiency specimens must be analyzed by the primary method at the time of the PT event or be rotated among primary methods with each PT shipment. Comparison of instruments/methods is required for non-waived analytes. Refer to checklist requirement COM.04250. Yes, the 6 month method comparison be used as "Alternative Proficiency Assessment"."
 
The question was brought up about the samples used for alternative assessment and how they need to have a defined value.  
  • If you're not using patient samples for alternative assessment, what are you using? 
  • Would CAP quality cross checks work for alternative assessment? The lab is submitting all CAP PT results for the analytes
  • Are you performing both a 6-month method comparison AND an alternative assessment? 
  • Are you just ordering an alternative PT survey such as one from API instead of CAP?

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You can't run the same analyte from two methods on the same survey. So for i-STAT I have the AQIS survey and run the "whole blood" analytes which is different from in lab. For the AVOX if you are running the same analytes as the in-lab yes you would need to run a comparison. You could use the CAP quality cross check or patient samples. You can also get a second PT sample from CAP, tell them you are not reporting it, run after the submission deadline and then compare when results come back.
We are doing an alternative assessment and a 6-month method to method comparison, not sure if we need to or not.

We use the SOQ cross check on the AVOX as alternate assessment with the end user operators. This also counts for the biannual pt correlations for AVOX to AVOX.  POC does the 6 month correlations to our GEM, and then Main Lab Sysmex and ABL's.
We use the AQSQ cross check on IStat as alternate assessment with the end user operators. This also counts for the biannual pt correlations for ISTAT to ISTAT.  POC does the 6 month correlations to our GEM, and then to Main Lab Cobas and ABL's 
We have a form we use to meet both regulations.  

For creatinine, we just perform patient correlations because the samples are easy to get and it also counts for both.  We have end users run the creats on ISTAT and then we take the tubes up to Main Lab to compare against the Main Lab Cobas method.

Email me if you want to see our forms - miranda.cotter@mercy.net

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