Core Lab April 2007 Staff Meeting Presentation
JCAHO Question What quality improvement measures are collected and assessed in the Core Lab? • Turnaround time • Completion of A. M. Phlebotomy Rounds • Time to reach a Physician with a Critical Action Value.
JCAHO Question What do you do to keep patients safe? • Require two patient identifiers. • Require physician to read back patient information. • Practice proper hand hygiene.
JCAHO Question Where do you report quality or safety concerns? • Your Lead or Supervisor • Pathology Administration • http: //www. insidehopkinsmedicine. org/JHHScompliance/faqs. cfm • 1 -877 -WE-COMPLY • www. complaint@jcaho. org • 1 -800 -994 -6610
Read Back • Customer Service – CAVs • Clinical Laboratory Scientists – CAVs • Critical Tests: -- O. R. ABG’s -- SUPER STATS -- ANYTHING YOU CHOOSE TO CALL TO A PROVIDER • Write it down, read back, and receive confirmation.
Unannounced JCAHO Surveys • Laboratory Surveyor: - Take to Supervisor - Escort to Pathology Administration • Hospital Surveyor - Accompanied with Hospital staff - Provide answers or documentation to the specific questions
African-American Male, Age 50 Component 3/10/07 3/11/07 3/12/07 3/13/07 3/14/07 SODIUM 134 136 139 134 33 POTASSIUM 3. 8 * 3. 5 * 4. 4 * 3. 1 * 3. 2 * CHLORIDE 103 105 104 102 SUN 13 9 33 * 12 * 7 170 * 105 * 122 * 102 * 96 * CREATININE 0. 8 1. 1 0. 9 0. 8 CALCIUM 7. 9 8. 8 7. 1 * 7. 4 TOTAL PROTEIN 6. 1 5. 8 6. 4 5. 6 5. 4 ALBUMIN 2. 5 2. 2 3. 3 * 2. 4 * 2. 2 BILIRUBIN 0. 3 1. 4 * 0. 3 * 0. 4 * ALT 14 15 81 12 * 16 AST 54 56 40 71 * 69 ALK / PHOS 575* 484 * 65 * 456 * 439 CO 2 18 * 23 26 23 23 ANION GAP 17 12 13 10 11 SUN / CREAT 16 11 30* 13 * 9 AST / ALT 3. 9 3. 7 0. 5 * 5. 9 * 4. 3 GLUCOSE
African-American Male, Age 50 3/10/07 3/11/07 3/12/07 3/13/07 3/14/07 WBC 3860 4420 2130 * A 5270 3940 * RBC 3. 25 2. 64 2. 56 A 2. 54 2. 49 Hg. B 9. 1 7. 5 8. 8 A 7. 2 PCV 29. 6 24. 1 28. 1 a 23. 1 22. 8 MCV 91. 1 91. 3 109. 8 * A 90. 9 * 91. 6 MCH 28. 0 28. 4 34. 4 A 28. 3 28. 9 MCH C 30. 7 31. 1 31. 3 A 31. 2 31. 6 RBC DISTR 15. 4 19. 2 15. 4 15. 2 PLATELET 56 66 117 A 81 94 NRBC NO. 0 0 50 A 0 20 Component
Scenario 3/12 -- Delta MCV called to the floor and resulted. Delta Chemistries repeated and resulted. Patient typed and crossed A Pos (no previous history). 3/14 -- Patient transfused 2 units A Pos. Transfusion reaction 3 hours into the transfusion. Patient typed O Pos.
Patient Outcome • • • HIV-positive patient Minimal reaction Cleared 2 units of A Pos in 2 days Slightly elevated bilirubin Minimal organ damage Most likely no long-term impact
Lessons Learned • Always transcribe patient’s name and history number from the wristband. • Never transcribe name and history number from the run sheet. • Label in the presence of the patient. • Phlebotomy survey. • Phlebotomy/Observations and In-Services.
Sample Investigation Policy Suspect specimen issue. Forward to Lead or Supervisor. Look at ALL Lab info for date & time. Decision to cancel. Notify all Labs. ~~~~~~~~~ When in doubt, bump up to faculty.
Outreach Potassium Study - March • Inspect all samples • Document all issues • Outcomes: 1 Improperly spun sample 1 Slightly elevated unexplained • Excellent detailed monitoring • Maintain “Heads Up Approach” to all Specimens
Lockers • You cannot “will” a locker to another employee! • Locker assignments: BLUE >30 hours BEIGE <30 hours
Electronic Devices • Cell Phones - Better • i. Pods - Not permitted Safety Issue: Cords Volume Distraction
Weekend Callouts v v Early Notification FML Patterns Weather Issues Remember Your Peers
MPA Update • Processing: Monday, 4/23 • Trained Operators • Validation
MPA Update • • Automation: Monday, May 21 Flow Ratios Instrument Outages Monitor TATs
From the Beginning …. . until …. . July 2011
Jennifer Taylor Phelps Hematology Supervisor Flow Cytometry Oncology Hematology Molecular Hematology • University of Pittsburgh graduate • Hematology/Chemistr y Experience • QC Technologist • 11 Years JHH
ASCP Workshops Tues. 5/1 thru Fri. 5/4 v 70 Attendees over One Week v Towson Sheraton v Roundtable Discussions to Follow
Lab Week April 22 -28, 2007 Lunches, Breakfast Special CEs: 4/25 (Dr. Hruban) – 10 AM, 6: 00 PM, & 7: 30 PM 4/27 (Dr. Jackson) – 10: 00 AM, Hurd Hall Fun, Games, Contests Pictures of Staff Fri. 4/27, Jeans Day for Ronald Mc. Donald House ($1. 00 min. donation) Manic Monday – April 23, 6: 00 AM Fells Point (breakfast afterwards at Jimmy’s) 2 nd Annual Medical Laboratory Expo to promote Medical Lab Profession Hippodrome, Sun. 4/29, 1: 00 -5: 00 PM (see Chris H)
Lab Week Committee Members Renee Lazarony Leandra Soto Margo Echols Rhonda Cole Tora Ruffin Debbie Boblitz Polly Shukla Mark Swartz Christine Hostetter Kathy Kowalewski Lydia Nelson & Crew Willie Ferrer & Crew
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