2 MedStar Health‘A not-for-profit healthcare system serving Maryland and the Washington DC region’Maryland Hospitals:MedStar Franklin Square Med. CenterMedStar Good Samaritan HospitalMedStar Harbor HospitalMedStar Montgomery Med CenterMedStar St. Mary’s HospitalMedStar Union Memorial HospitalWashington DC Hospitals:MedStar Georgetown University HospitalMedStar Washington Hospital CenterMedStar National Rehabilitation Hospital
3 Laboratory Teams Chemistry Hematology Coagulation Microbiology Blood BankPoint of Care TestingCytologyAnatomic PathologyShared TestingSafetyQuality AssuranceComplianceLaboratory Advisory Council
4 Challenges for the POC Team Variability Hospital to HospitalScope of POC Services / Test MenusDisparate equipmentVarying clinician needsSome have fulltime POC staff and some cover POC in addition to other responsibilitiesAside from a common Glucometer vendor, the team seemed to have little else to focus on as a groupTeam did not function as a teamMeetings held via conference call were poorly attendedMembers didn’t see the benefits of the teamMembers resisted bringing their issues to the group
5 Team Refocus 2011 Began meeting face-to-face Developed a Team Charter Discovered that some members had 20+ years of POC experience while the newest POC coordinator (Gabby) had been on the job for only 4 months.All shared the same LIS and had similar needs for interfaces and group purchasing advantagesDespite their differences all were challenged with:Meeting regulatory requirementsControlling “rogue’ testingEnforcing general policies in POC testing areas
7 Gabby Gets the Call December 2011 Pharmacists from Coumadin Clinic Expressed concerns about iSTAT INR results >4.0# of incidents and poor correlation to the main labJanuary Pharmacists still concerned2011 – Jan 2012 Correlation reviewed91.8% correlatedAll QC, liquid and electronic reviewedall acceptableInstrument Performance Reviewed1 instrument had a higher % of results >4.0Notified Abbott Point of CareReplaced the instrument, conducted own investigationNotified Medical Director & POC Chair about the issue
9 Bobbie Gets the CallNotifications made 4 sites using I-stat were informedOne other facility reported similar issuesData and details were collected to look for common factorsSites work together Correlation data was collectedAll North site Coumadin clinics express concernData was not correlating and could not be used for dosingAbbott begins assisting in data collectionData causes Abbott to escalate concernsMarch Abbott issues a product recallMedStar ceases testing all PT/INR on I-Stat
10 POC Team Works Together Team meets to discuss plan Patient Safety primary goalIncluded Technical Experts and Coagulation teamLook back of prior reported patientsValidation of Abbott recommended software upgradeComparison to MedStar dosing schedulesImpact analysis of any biases before patient testing resumesIs POC safe for our patients and coumadin dosing?Data is gathered and reviewedAll sites actively participated in reviews & decisions2 weeks of 100% correlations yielded hundreds of data points100’s of patient records were reviewed with pharmacyCoagulation experts were consultedTechnical standards were evaluated and compared
11 Data Compared for Safety Before Software Upgrade --- GSH only dataAcceptability rate (POC result)nMedstar New Criteria1191%1844%2020%138%60%overall w/in therapeutic range5723%< 25% acceptability for all patientsAfter Software Upgrade --- All MedStar Sites combinedAcceptability rate (POC result)nMedstar New Criteria91100%7599%5995%1258%633%overall w/in therapeutic range15291%< 95% acceptability for all patients
12 Decisions are made Team evaluates data to determine SAFE limits Standards from CLSI, Vendor and Medstar appliedCLSI +/- 0.4 difference up to 3.0 INRAbbott +/- 20% differencePharmacy dosing patterns are in 0.5 INR increments
13 MedStar Reinstates Testing Conservative but safe limits are definedPharmacy, Lab and Medical Staff agree+/- 0.4 INR difference for INR ≤ 2.5Within 15% agreement for INR >2.5 to 3.5Reporting limit of 3.5More proactive monitoring practices adopted by all POC INR sites. Some sites opted to cease POC INR
14 Lessons Learned Team work led to improved patient safety Coagulation experts were instrumental in truly understanding how data was used.Actual comparison biases were essential to maintaining a safe correlation standard.A strict correlation factor or R value will not show the potential dangers in dosing anti-coagulation medications.
15 Ensuring Patient Safety Going ForwardMedStar Point of Care Workgroup members have committed themselves to understanding the clinical use of Point of Care testing within our institutions and to ensure that clinicians using these methods fully understand their limitations, accuracy expectations, and correlation to main lab methods before allowing their use.The MedStar POC team finally realized they have one very important goal in common ---Ensuring Patient Safety
16 PresentersBobbie Eichensehr, QA and POC Supervisor MedStar Point of Care Team Leader MedStar Union Memorial HospitalMarcelino Gabriel POC Supervisor MedStar Point of Care Team Member MedStar Good Samaritan Hospital
Your consent to our cookies if you continue to use this website.