Quality Assurance Monitoring for POCT

We assess every year based on repeat issues we are seeing, compliance rates from previous reports and inspection findings. The one standard is critical value policy, including provider notification compliance. This year we also have glucose meter disinfection and reagent labeling. In the past, we had patient ID compliance (correct encounter used, follow up on Emergency ID use, etc.), manual result entry, storage temperature monitoring, and others I can't think of right now. We stop when compliance has been good for a while or if we find a way to ensure 100% compliance (ex. electronic monitoring of storage temps)

We monitor invalid patient/sample ID scanned by users, proficiency testing failure rate, log completeness, and reagent and control expiration labeling. 

Critical result documentation, Invalid patient IDs, Clean meter documentation (Accuchek), Error code rate (istat), QC failures not repeated.  I send out a monthly QA report to the unit manager, if a unit falls below 97% compliance.  

We also assess each year what we will monitor based on repeat issues or offenders. Currently, we monitor Invalid Patient ID's for Accu-chek and i-STAT scanned by users. We also monitor i-STAT Quality Check codes/errors by operator and unit location, as well as critical value documentation and manual result entry. 

Here's what we do:

Acceptable thresholds for the indicators are listed on the QI report.  The monitored quality indicators that are reported to the Laboratory Quality Team:

o   Corrected Reports with the SAFE # and details
o   Maintenance performance and acceptability, including temperature and humidity monitoring, for applicable areas
o   QC performance and acceptability, for applicable areas
o   Scanning labels instead of armbands, for applicable areas
o   Patient ID Errors to include reagent scans, non patient ids, made up numbers, badge barcodes, etc, as patient identifiers.
o   Results not accepted on Nova glucometers
o   Properly documented critical results, as applicable
o   Preventable instrument errors
o   Misuse of coworker access

Additional Quality Indicators may be reported on the monthly QI report.  These are not reported to the Lab Quality Team at this time.  These can be monitored by POC Lab and reported to the area.  These will be Instrument or Test Specific Monitors.   This may include:

o   Delayed Patient ID Results -Other ID errors such as used an E#, appt #, etc

o   Reagents and/or QC dated
o   Expired reagents used
o   Duplicate testing ran or manual testing WebMRE duplicate entries
o   Clerical errors made on paper logs, such as forgetting to write a date/time, using illegible handwriting, using correction fluid, etc.  

o   WebMRE QC failures
o   Results not entered
o   Results not validated
o   Comments used incorrectly
o   Wrong specimen type selected

Hi Miranda,

How do you monitoring misuse of coworker access? We have locked out users "borrowed" other's ID to perform testing, but we found out by accident. We can't find a proper way to pinpoint those events in the system.

Thanks,
Xu Li

Yes, that is the same for us. We usually find out randomly. Most of the time, we are contacting an operator about a mistake they made and they tell us that wasn't them that ran it. When they tell us this, we go over the importance of not sharing badge access and that it is a violation.  A fair amount of the time, they will share with us who borrowed/used their badge access. We contact that person and their leader for corrective action. If they are expired, we get them recertified. If they are not trained, we get them the info to make that happen.