CAP vs TJC

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Here's a fun topic idea:
Citations you've gotten that maybe the other organization isn't citing.
Especially in POC, there seem to be some really big differences in what CAP and TJC are focused on.

TJC citations (does CAP focus on these?):
1. Accu Chek meter disinfection (first wet time requirements, then number of vertical and horizontal wipes as directed by the mfr in their several hundred-page glucometer manual)
2. Individually labelled ACT cuvettes with new expiration (not on the whole box)
3. Humidity tracking in storage locations when prescribed by mfr (think glucometer strips!)
4. Direct patient observation in addition to annual prev/blind/prof performance (actual sample collection from a patient through resulting)

I'm sure I'll think of more.

12 Replies

All 4 were brought to our attention by the Inspectors over the years.
#1 – we were able to show our education fliers regarding dwell time – not cited but we did a lot to reeducation.
#2 – we always label it when taken out of refrigeration not an issue but was discussed extensively on the WHY?
#3 – We have to install TEMPTRACK on all storage location that were discovered so that we do not get cited – did it during inspection.
#4 - extensive discussion on what it means to do “Direct Observation” with the inspector to prove what our process is on meeting this competency documentation requirements.

Sincerely,
Alma
“Far and away the best prize that life offers is the CHANCE to work hard at work worth doing” – Theodore Roosevelt

Alma Calzado-Knudson, MBA, CLS, MT (ASCPi & AMT)
Manager, Lab Quality and Point of Care Testing
Student Education Coordinator
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[cid:image002.png@01DC1688.B31A7090]1531 Esplanade Chico CA 95926
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• alma.calzadoknudson@enloe.org
“Together you and I will Each Accomplish More as we WORK towards achieving a common goal – Patient Safety and Satisfaction”

All four were also looked at by our CAP inspectors- they went on the floors for #1 and observed - also requested the operator manual and our current policy for comparison. #2. Inspector went to the Cath Lab to look at re-labelled cuvettes and QC. #3 inspector asked for locations, temp. charts and went to see what was being used for temp tracking. #4 Inspector requested actual patient observation examples.

Hi Ken,

This year I have gone through BOTH TJC and CAP inspections a few months apart.

Both wanted to hear about the cleaning and disinfection of the Accuchek glucometers. They wanted to hear the horizontal/vertical cleaning steps exactly as described in the operator manual.

All cartridges should be individually dated (this goes for Hemochron, iSTAT, ect.) Both sets of inspectors wanted to see this in my OR and Cath Lab areas.

I was asking for room temperature and humidity tracking for several POC testing supplies. Luckily, we have paper documentation on all units that perform POC testing. CAP wanted to see areas that are closed on weekends with min/max temperature documentation as well. 

As per direct patient observation, I have created an assessor delegation for that is signed by my medical director to ensure that the personnel signing off competencies is aware of and understands their required duties. We use blind samples (QC) with known values for competency assessment.

Well, inital responses are encouraging and unexpected. I was starting to feel like the TJC inspected labs were getting it way worse the last couple of years. CAP and TJC must be more on the same page than I had expected...

The only difference we have noticed with TJC and CAP is the i-STATs;
TJC considers cartridges as the analyzers were all the reactions happen and the i-STAT as a reader, so running electronic simulators between i-STATs are considered equivalent, where else CAP always considers Cartridges and the i-STAT analyzer as a "test system" and requires liquid QCs to compares i-STATs. This is just my observation and thought.

1. We were cited by TJC for not recording the temperature acceptability of reagents that we ship to other sites in the region. CAP has never asked for that.
2. TJC also asked nursing in every one of our facilities during the last round of inspections to demonstrate proper cleaning of glucometers....CAP has never               asked for that either. 
3. On the flip side, CAP looked at the expiration dates of our glucometer batteries...TJC has never done that.

@Ashley... BOTH?! That's intense.
@Kayla... oh man those are great. I love hearing some of these. 

@Kayla - what glucometers do you use? We use Accu-Chek Inform II. Our batteries only have a manufacture date, not an expiration date.

@Christina - we use Nova Biomedical Glucometers. The batteries only have an expiration date.

oh my goodness. I had no idea there were expiration dates on my Nova batteries!
Thank you! 

@Ken my CAP inspection was last week and TJC came in February. We also get inspected by Department of Health at our satellite emergency department along with MQA (Internal Quest Diagnostics inspectors) and Vizient which is a mock TJC inspection. Super busy over here with inspections and some how I am involved in all of them haha

One of mine for JC was not rotating QC among more than one operator. I have a charge nurse at one clinic who ran QC each lot/shipment and the inspector said it has to be "rotated among operator staff". It does not specify how many, but has to be more than one. They 'prefer' it to be rotated as much as possible, but at least two should meet the rule. 

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Ken Charpie
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