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Provider Performed Microscopy Testing: The Wet, the Wild and the Wiggly Robert L. Sautter, Ph D. PinnacleHealth System.

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Presentation on theme: "Provider Performed Microscopy Testing: The Wet, the Wild and the Wiggly Robert L. Sautter, Ph D. PinnacleHealth System."— Presentation transcript:

1 Provider Performed Microscopy Testing: The Wet, the Wild and the Wiggly Robert L. Sautter, Ph D. PinnacleHealth System

2 History of PPM testing CLIA Classifications –Waived –Moderate Complexity –PPMP –High Complexity

3 Classification of Tests CDC described the System 7 categories were used to classify 1,200 original laboratory tests. A point system was used in each category, categories were associated with the analyst. 3 were associated with the test and one was calibration, QC and proficiency testing.

4 Categories used for Classification Knowledge Training and Experience Reagents or Material Preparation Characteristics of the testing steps QC, Calibration, Proficiency Testing Trouble Shooting and Maintenance Interpretation and Judgement of the Analyst.

5 POCT at Pinnacle Health System 1996 Merger of 3 hospitals, additional 1 hospital added in Exception to Section 5.22(f)(to direct more than two laboratories) Inpatient POCT Outpatient POCT Training/Competency Testing of Resident and Staff Physicians over the last 5 years at ~ 30 out-patient sites and in-patient employed physicians. (200 Practitioners)

6 Regulating Agencies College of American Pathologist Joint Commission on Hospital Accreditation State Department of Health.

7 Criteria to Qualify for a PPM License The examination must be performed by a Physician, Mid Level Practitioner, or a Dentist The procedure must be classified as Moderately Complex The microscope must be of the bright field or phase contrast type. The specimen is labile or delay will compromise the accuracy of the test. Control materials are not available for the entire testing process. Limited specimen handling or processing

8 Common PPM Tests* (Moderately Complex Tests) Wet Mounts- vaginal, cervical and skin All Potassium (KOH) preparations Pinworm Exams Fern Test Post-coital direct, qualitative exam of vaginal or cervical mucous Nasal smears for eosinophils Microscopic urinalysis Fecal leukocyte examination Semen analysis, or sperm motility *This is different from the PPT tests for CAP

9 Regulated Physician Testing CAP - PPT (Physician Performed Testing- includes a different menu compared to PPMP) Both Waived and PPMP tests are included. –Amniotic fluid pH –Gastric biopsy for urease –Occult blood, fecal and gastric –Synovial fluid for crystals –Urine dipstick

10 Personnel Requirements Confined to Physicians, Midlevel practitioners, and Dentists. Other requirements for this test differ by agency

11 Physician Training CAPSTATEJCAHO Document No distinctionDuring Docs trainingbetween Docs training and other Mid-Level analystsPractitioner, evidence of training

12 Physician Competency CAPSTATEJCAHO Evidence ofCompetency No training assessmentrequired, norequirement or distinctionfor Docs credentialingbetweenMidlevel- yesanalysts

13 Procedures CAPSTATEJCAHO TechComplete Written Procedure manual,procedures that includespatient ID,including specimenprep, collection,specimen handlinglabeling,handling preservation, transport and processing

14 Quality Improvement Program CAPSTATEJCAHO QC of reagentsSame, asScopes used including stainsboth agenciesshould be in Instrument good working maintenanceorder and review and correctivecleaned and action taken serviced regularly

15 Verifying Accuracy of Results CAPSTATEJCAHO Same as othersHow are The lab uses a tests with no PTsystem for evaluated at least verifying every 6 months accuracy and for unregulated reliability tests? PT, of test results biannual review for tests not program, split samplesrequiring PT testing with ref lab, orby law split samples in laboratory

16 Reporting of Results CAPSTATEJCAHO Is the system forDo test recordsAll results for reporting PPTinclude the: PPM should be adequate?patient namefiled promptly Patient identifier,or unique identifier,in the patients test ordered,date and time ofclinical record Performed,docsspecimen collection,along with the date name or identifier,receipt, reason for and name of analyst. date/timerejection, date of test, of sample collection,identity of analyst result,reference interval, interpretive notes and any additional comments sample quality

17 Pinnacle Health System Procedure PPM procedures in place 12/1997 Training of Docs began 1/1998 Paper competencies began On-line competencies began –Tests included, Wet mount all types, KOH, pin worm preparation, gram stains (one clinic only), urine microscopic, PPT testing (one clinic only- Docs at other clinics have other analysts performing tests.)

18 Twice a year PPM Performed for first time users, live sample presentation with Dawn, Jenny and myself. Primarily for residents. Every 6 months to assess competency of analyst and for procedure verification.

19 Resident Training First Year residents in Family Practice and Internal Medicine (key- make it practical and interesting!) Scheduled time with all of them at once. Power Point, slides, wet samples. Formalized to include other parameters –including-CLIA regulations, office practice, technical presentation on PPM, costs of tests, collection of samples, in-depth tour of entire laboratory, predictive value of lab tests.

20 Physician Competencies Over 200 performed twice a year Pictures you are seeing are those used. Always have an educational sample Key-teach them Dont just satisfy the regs.

21 Calcofluor White Stain Report what you see! Questions-

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