Aligning Clinical Practice and Process Improvement
POL_INSIGHT_2013_B
1. A Continuing
Education
Publication for the
Physician Office
Laboratory
In this Issue:In this Issue:In this Issue:In this Issue:In this Issue:
QualityQualityQualityQualityQuality
AssuranceAssuranceAssuranceAssuranceAssurance
Simplified:Simplified:Simplified:Simplified:Simplified:
PPPPPararararart IIt IIt IIt IIt II
Lab Coats &Lab Coats &Lab Coats &Lab Coats &Lab Coats &
AntimicrobialAntimicrobialAntimicrobialAntimicrobialAntimicrobial
FFFFFabricsabricsabricsabricsabrics
CME on Your
Budget
ISSUE 68
POL Insight2013-B
3. Event 2013-B P.O.L. Insight Page 3
CME Due Dates and P.A.C.E.®
Course Codes
Event 2013-A .................... February 28, 2014....................... 254-001-13
Event 2013-B ........................May 31, 2014 .......................... 254-002-12
Event 2012-C ...................September 30, 2013 ..................... 254-003-12
CME Learning Objectives
Following completion of the self-instructional
material, the participant will be able to:
1. Understand the CLIA requirement for devel-
oping a Quality Assurance program; and
use proving examples to assess a current
QA program.
2. Identify the role of soft surfaces in the
transmission of organisms in the clinic
setting; list 4 antimicrobial agents available
today in soft surfaces; and describe ele-
ments in an infection prevention “environ-
mental bundle”.
3. Identify budget-friendly alternative means
of obtaining CME.
Table Of Contents
Quality Assurance Simplified,
Part II .......................................... 4
Is your Lab Coat Working as Hard as
You are? ....................................... 7
Train the Trainer Phlebotomy
Seminars.................................... 10
Continuing your Education on Your
Budget & Timeframe .................... 11
Obtaining CME Proof of
Participation................................ 14
CME Questions ............................ 15
Guide to PT Central...................... 19
Lab Tests Online (www.labtestsonline.org), a comprehen-
sive internet resource for healthcare professionals &
consumers is seeking physician volunteers to serve on the
Editorial Board.
Responsibilities include review of website content from a
practicing physician perspective. Time committment is 1-2
hours per month.
To volunteer, please contact George Linzer at GLinzer
@aacc.org or Katie Schaeffer at KScheaffer@aacc.org.
To earn Continuing Education credit, login
to your laboratory PT Central hompage.
Click the CME link on the left side of the
screen. Follow the directions to access the
assessment. Refer to Page 14 of this
publication or the AAFP-PT Handbook for
more details.
1. B
2. C
3. A
4. D
5. A
6. B
7. D
8. C
9. A
10. D
2013-B CME Answers
11. C
12. A
13. C
14. B
15. D
16. B
17. B
18. A
19. D
20. A
21. A
22. D
23. A
24. B
25. A
26. D
27. A
28. B
29. A
30. C
4. Event 2013-BP.O.L. InsightPage 4
Quality Assurance
Simplified: Part II
By Jason A. Kendall, MBA, CLS. President & CEO,
Physician Office Laboratory Solutions.
www.polsolutions.com
This is the second installment of Quality Assurance
Simplified, a two-part series that reviews the
Clinical Laboratory Improvement Act of 1988 (CLIA
’88) in regards to the ongoing process of Quality
Assurance (QA). As previously stated in Part One;
the QA process is not a one-time process but rather
an ongoing mechanism that monitors the total
testing process. The total testing process is defined
as the pre-analytical, analytical, and post-
analytical. Policies and procedures should be put in
place for relevant areas of the total testing process
and this second installment will help the reader to
understand the necessary items to include in the
policies and procedures for the laboratory. Just like
in the first installment this article will help to
explain the systemic structure that the QA program
encompasses; however it should be noted that the
purpose of the entire QA program is to provide
continuous improvement in patient care and not
necessarily for just patient testing.
The relationship of patient information to
patient test results is the first assessment this
article will discuss. Patient test results should be
evaluated if found to not be consistent with patient
demographics such as age, sex, diagnosis, and
there should be a correlation with other testing
results on the same patient. An example of an
evaluation could be something known in the
laboratory setting as delta checks. These are
markers that will flag the testing personnel in the
event a patient’s values change significantly from
the last time the patient was tested. The alert is
useful to the laboratory to determine if there might
have been a mislabeled sample, the instrument is
malfunctioning, the patient’s condition worsened,
etc. The point of the flag is to determine whether
the laboratory should take further action on patient
testing. There would also be different reference
ranges based on sex or age for several analytes
listed on the final report. Monitoring the reference
range based on sex or age is an internal quality
marker. Statistical data based on analyte value
would either correspond with the established
reference range or be included in the decision to
either update ranges or investigate the laboratory
process further.
Personnel assessment is the next area to discuss
as part of the QA process. It is used by the
laboratory to be sure the technical personnel’s
duties are being fulfilled. The positions listed in
CLIA that require a personnel assessment are:
clinical consultant (CC), technical consultant (TC),
technical supervisor (TS), general supervisor (GS)
and testing personnel (TP). The responsibility for
this depends on whether the testing is moderate or
highly complex; however the ultimate responsibility
falls on the laboratory director to be sure the
technical personnel are competent and maintain
their competency. Personnel assessment is
achieved by documenting direct observations of
routine patient test performance, including patient
preparation, if applicable, specimen handling,
processing and testing; monitoring the recording
and reporting of test results; review of
intermediate test results or worksheets, quality
control records, proficiency testing results, and
preventive maintenance records; direct
observations of performance of instrument
maintenance and function checks; assessment of
test performance through testing previously
analyzed specimens, internal blind testing samples
or external proficiency testing samples; and
assessment of problem solving skills. Employees
that fail to demonstrate satisfactory performance
should be reeducated and retrained as part of the
corrective action process. Of course, reassessment
would be required to be sure the employee was
sufficiently competent in their duties and this
corrective action documentation would need to be
available in the employee file for future follow up.
The next assessment area is communications.
This area is often misunderstood because
communications is a very broad scope but to
simplify; this assessment is in regards to
communication breakdown between the laboratory
and the person, or persons, ordering the test. The
laboratory needs to have a system in place that
documents the breakdown(s) and also that will
provide corrective actions for the breakdown(s). As
with any other assessment there also needs to be
5. Event 2013-B P.O.L. Insight Page 5
follow up after the fact to be sure the corrective
action put in place worked. Examples of
breakdowns can be linked to physicians, nurses,
phlebotomists, etc. or the processes that were
designed by the person ordering the test. These are
items that are outside the control of the laboratory.
Usually these breakdowns will occur in the pre-
analytical or post-analytical phase of testing. It
needs to be noted that simply documenting the
breakdown is not enough. The laboratory needs to
implement a corrective action that will help to
eliminate the problem from happening again in the
future and then provide follow up to be sure the
corrective action actually worked. However the
laboratory should also implement simple steps such
as monitoring daily fax status failures or
undeliverable reports/results even if the delivery
system is completely manual. Monitoring the
system will help when it comes time to find the
cause of the problem(s).
Our next assessment to discuss is complaint
investigations. The assessment is not difficult to
implement as the basic premise is to review all
complaints and investigate appropriately. The
follow up documentation is the corrective action
put in place by the laboratory in the event the
complaint addressed requires laboratory
intervention. Some complaints that are brought to
the laboratory administration are simply
misunderstandings; however the complaint that is
justified needs immediate addressing and follow up
monitoring to be sure the correction has stabilized
the problem. Basic laboratories use a simplified
complaint and investigation log. Larger, more
complex, laboratories utilize committees and
subcommittees to investigate issues. A useful
method of complaint/improvement suggestions are
to route annual or biannual questionnaires to
patients and clients. This can provide the
laboratory with items to review, and if appropriate,
act upon. Usually these committees are termed
Continuous Quality Improvement (CQI) and
monitors corrections from initial implementation
though final steps of the new processes.
The quality assurance review with staff assessment
is very important in the QA program. This
assessment provides the staff with the necessary
education that will help to ensure the problems will
not happen again. This is also part of the corrective
action mechanism(s) that meets
the criteria to prevent
reoccurrences. Discussions
with the staff at designated
meetings are usually the
most appropriate;
however there are times
when immediate in-
service intervention
is needed to
eliminate a
problem. No
matter how the
information is
filtered to the
staff there needs
to be
documentation
showing that this
assessment has
been implemented.
The final assessment in our group is quality
assurance records. The CLIA requirement for this
is that the laboratory must maintain the
documentation of all the quality assurance
activities which include the problems identified and
the corrective actions taken. These records must be
readily available for a period of not less than two
years. Look backs are often necessary for these
types of documents because problems often re-
arise and root causes can be linked to previously
put in place corrective actions.
To recap the Quality Assurance Simplified Part II
we will review what has been discussed and
provide probes the laboratory can use to help
define their needs. For the relationship of patient
information to patient test results the laboratory
would want to start by asking itself if there are any
types of mechanisms in place that help to review
patient data in regards to results and
demographics. Any items that would help to alert
the testing personnel, when certain criteria are
met, will flag that further investigation should be
done. As stated previously most laboratories
employ delta checks and this is a very useful item
to monitor. For personnel assessment the
laboratory would want to develop competency
assessment documentation that would monitor the
technical personnel on all items relating to pre-
6. Event 2013-BP.O.L. InsightPage 6
analytical, analytical, and post-analytical phases of
patient testing. The duties for each position are
outlined in CLIA ’88; however it is ultimately the
responsibility of the medical director to ensure that
all duties are fulfilled completely. Most laboratories
utilize what is termed “check off sheets” along with
annual competency forms for each position. A
simple probe for this part of the QA is to ask
whether there a process in place to ensure that all
individuals involved in the total testing process are
documented as competent for the position they
hold and is this competency approved by the
medical director. For communications assessment
the laboratory would want to monitor delivery of
patient reports to the person(s) that ordered the
testing to be completed and also to monitor the
ordering process as many times the individual(s)
ordering the testing does not provide all the
necessary information to the laboratory. Probes for
this would be does the laboratory track written
orders for completeness or does the laboratory
monitor completed delivery of the patient reports.
These are simple items that can be put in place for
continuous quality improvement in the overall
process. For complaint investigation assessment
the laboratory would want to address how
complaints are logged and how those logs are
acted upon. Any complaint that is routed to the
laboratory should be reviewed and documented as
such. A probe for this assessment would be does
the laboratory document complaints and are all
staff trained to recognize significant verses minor
complaints. Generally the laboratory administration
would review all complaints; however, again, it is
the medical director’s responsibility to ensure that
all complaints are acted upon and resolutions are
made when appropriate. For quality assurance
review with staff assessment the laboratory would
want to ask itself if there is a communication and
training process with the staff in regards to
recognized quality issues. A probe would be how
does the laboratory distribute information to the
staff or how does the laboratory in-service the staff
on issues that need to be educated. For quality
assurance records assessment the laboratory would
want to ask itself how are records stored and are
they accessible when there is a need to review as
appropriate. For the most part a two year look back
is required for all QA documentation; however
depending on the issue resolved or the department
the QA was documented for the record retention
could be longer than two years.
In closing of this two part article quality assurance
is the umbrella that covers all facets of the
laboratory and provides an ongoing monitoring that
is used to identify, evaluate, and resolve problems
specific for all phases of testing, the services
provided, and the clients served. It is a
comprehensive plan that assesses each activity,
corrective actions, review the effectiveness of the
assessments and corrective actions such as revising
policy and/or procedures to prevent reoccurrence of
the problem(s). However, above all, the entire QA
program should be designed to provide continuous
improvement in patient care and not necessarily for
just patient testing.
Sources
1. Title 42 Subpart P: Quality Assurance
493:1711 Relationship of Patient Information to
Patient Test Results
2. Title 42 Subpart P: Quality Assurance 493:1713
Personnel Assessment
3. Title 42 Subpart P: Quality Assurance 493:1715
Communications
4. Title 42 Subpart P: Quality Assurance 493:1717
Complaint Investigations
5. Title 42 Subpart P: Quality Assurance 493:1719
Quality Assurance Review with Staff
6. Title 43 Subpart P: Quality Assurance 493.1721
Quality Assurance Records
7. Event 2013-B P.O.L. Insight Page 7
Is your Labcoat Working
as Hard as You?
By Peggy Luebbert, MS, MT(ASCP), CIC, CHSP,
Healthcare Interventions Inc.
While changing the dressing of an MRSA
infected wound, a nurse realizes that visitors
outside the cubicle can see her patient in a
compromised position. The nurse with her
contaminated gloves pulls the curtain shut with
a quick tug. After completing the dressing
change, she straightens the patient’s gown and
quickly throws her favorite roll of tape back
into her uniform pocket as she leaves the
cubicle — throwing her gloves into the trash.
What the nurse is not thinking about as she
leaves the cubicle, are all the fabric based
surfaces she contaminated including the
patient’s gown, the privacy curtain and inside
her uniform pocket.
There is a growing recognition that these fabric
surfaces -often called “soft surface textiles” –
play an important role in the transmission of
infections in the healthcare setting. As
healthcare workers in a clinic setting we try to
limit the transmission of pathogenic organisms
by keeping our hands clean and disinfecting
the hard surfaces that we may touch.
However, we may be sabotaging our infection
prevention program by ignoring these soft
surface fabrics in our environment. Soft
surfaces can be constantly in contact with
colonized or infected body fluids from
patients and caregivers hands as well as
contaminated hard surfaces.
Several recent studies have shown that
these surfaces can become colonized and can
be considered important in the transmission
of microorganisms. These studies also noted
that the maximal contamination occurred in
areas of greatest hand contact ( i.e., pockets
and cuffs), allowing recontamination of
already washed hands. Some of these
studies:
• A recent study published in the
September 2011 issue of the
American Journal of Infection Control
(vol. 39 No. 7 pps 555-559) confirmed
that soft surface textiles are significant
sources of bacterial contamination in
healthcare settings, with 63 percent of
physician and nurse uniforms testing
positive for pathogenic organisms,
including those that are multi-drug
resistant (11 percent). The study also
cited the lack of standardized protocols
for laundering of uniforms. Forty percent
of participants laundered their uniforms
at home and just 58 percent reported
changing the uniform every day. They
also noted that the rate of contam-
ination with resistant pathogens was
higher in attire changed every two days
compared with that changed every day
(29 percent versus 8 percent). Of the
238 samples obtained in the study, 119
(50 percent) were positive for any
pathogen most with one pathogen and
fewer with two or three different
pathogens. There were no significant
differences between the gowns worn by
physicians and nurses. Potentially
pathogenic bacteria were isolated from
at least one site of the gowns in 63%.
• Another study from London’s University
College discovered that home washing
machines may not utilize the proper
amounts of hot water necessary to
eliminate multidrug resistant organisms
8. Event 2013-BP.O.L. InsightPage 8
(MSDOs) such as MRSA and
Acinetobacter from our healthcare
uniforms.
• One study noted that MDRO
contamination is widespread on privacy
curtains. They found that 42% of
privacy curtains contained VRE and 22%
of the curtains contain MRSA. We know
that these curtains can be touched by
dozens of people daily and are only
routinely laundered minimally in most
facilities every 6 months. In other recent
studies, contamination from curtains has
also been shown to transfer from fabrics
to hands.
• In a 2012 AJIC online published study,
privacy curtains in three different
medical wards were tested for
contamination. Twelve of thirteen
curtains (92%) placed during the study
showed contamination within 1 week.
Forty one of 43 curtains (95%)
demonstrated contamination on at least
one occasion, including 21% with MRSA
and 42% with VRE. Eight curtains
yielded VRE at multiple time points: 3
with persistence of a single isolate type
and 5 with different types, suggesting
frequent contamination.
• In 2001 Perry published that 52% of the
nurses uniforms he cultured grew out
MRSA and VRE. A few years
later, Osawa noted that 79%
of the white coats he cultured
grew out MRSA.
• Neely and group summarized
in the Journal of Clinical
Microbiology in 2000 and
2001 multiple studies showing
the survival of pathogens on
fabric. They noted that MRSA
in one study lived over 20
days on cotton fabric and over
40 days on polyester. The
same holds true for VRE
which survived over 80 days
on both fabrics.
A Solution?
A variety of technologies have been developed
in the last couple decades to add antimicrobial
properties to soft surface textiles. To be
approved under EPA’s “non public health”
regulations, these manufacturers have to
prove to:
• decrease microbial growth on the
fabrics;
• reduce degradation of the fabric over
time;
• control odor.
Some of these fabrics also use conductive
materials such as copper and silver which
helps with temperature control… people
wearing these materials tend to feel cooler in
hot temperatures and warmer in cool temps.
Since EPA has not approved these products
under their “public health” regulations to date,
one will not see claims that the antimicrobial
soft service textiles decreases healthcare
associated infections.
Examples of some of the antimicrobial
technologies available for soft surface textiles
include:
• Silane-based quaternary ammonium
chloride antimicrobial. Technology
9. Event 2013-B P.O.L. Insight Page 9
uses the coupling agent silane to
attach the quaternary ammonium
chloride to fibers. It has been added
to a variety of fabrics including
scrubs and lab coats.
• Chemical combinations – Multiple
technologies using as many as 20
different chemicals in variety
arrangements have been added to
fabrics as antimicrobials.
• Copper Products - Copper has
historically been shown to be
antimicrobial in nature. Currently
found in many home as well as
medical products and fabrics.
• Silver Products- . Moisture in the air
(ambient moisture) or direct contact
with moisture (like a sneeze or
human contact) activates the release
of silver ions at a steady rate.
o Silver Zeolite is a crystal based
powder that is added as a
coating, resin or additive to fibers.
Silver is embedded within micron-
sized carriers called zeolite and
then encapsulated in the
polyurethane surface of fabrics.
o Silver nanotechnology releases
the antimicrobial silver ions in
steady rates from the fabrics.
o Metallic Silver is bonded to the
surface of nylon fibers
permanently. No silver ions are
released into the environment.
When choosing an antimicrobial fabric it is
important to be sure the antimicrobial agent
does not lose its efficacy over time or washes.
It is also important that the agent is safe for
the environment.
One of the most interesting agents to me is
the use of silver as an antimicrobial on fabrics.
Silver has been known to have antimicrobial
activity for hundreds of years. If you go back
to the time of Cleopatra, history notes that she
asked her staff to bring water back from the
river only in silver containers to keep the water
fresh longer. The old saying “born with a silver
spoon in the mouth” is thought by some to go
back to medieval ages where children fed with
silver spoons were observed to get sick less
often as opposed to the poor class who used
wooden or pewter spoons. My own
grandfather, who milked a few cows for milk
for his family, would throw a silver dollar into
the milk bucket to keep the milk “fresher
longer”! In healthcare, silver lost its
antimicrobial stature when penicillin was
discovered – we no longer needed to prevent
infections when we could just treat them! With
the introduction of organisms that are harder
to treat in the last few yeasr, we have seen
silver regain its place as an antimicrobial in
healthcare. Patient care items such as silver
coated foley catheters, silver imbedded central
line catheters, wound dressings all are using
silver based agents to minimize colonization
and infections.
Interesting, silver has been used in fabrics of
the military, NASA and even elite athletes such
as Olympians for many years.
Infection Prevention “Environmental
Bundle”
These antimicrobial fabrics can be part of an
important part of a successful infection
prevention program. A successful program
should include:
Good Hand hygiene practices
Under Standard Precautions, good hand
hygiene should be performed after contact
with any body fluids or contaminated surfaces.
To limit contamination of the environment, this
should occur before any further contact with
clean surfaces including soft surface textiles
such as personal uniforms, patient linen and
privacy curtains. Education of healthcare
workers at orientation and again on a regular
basis should remind them of the importance of
preventing cross contamination to clean
surfaces from contaminated hands.
Effective Contact Isolation practices
When dealing with significant MDROs or
uncontrolled body fluid contamination of the
environment, patients should be placed into
10. Event 2013-BP.O.L. InsightPage 10
CDC’s Contact Precautions adapted to fit your
environment. The proper practices will help to
minimize environmental contamination and to
make the healthcare worker more aware of the
additional risk of exposure and transmission.
Proper laundering of uniforms
Since, we know that organisms can live and
proliferate on fabrics we depend upon the
healthcare workers to effectively wash their
uniforms to remove the germs. Our best
practices recommend that these fabrics be
washed after each day’s wear. Uniforms should
be laundered in a manner which not only
renders them aesthetically clean, but also
hygienically clean i.e. free from pathogens.
This is achieved by a combination of heat,
rinsing, detergent and chemical oxidative
action. There is also evidence to show that
transfer of pathogens can occur between
contaminated and clean laundry during the
washing cycle. This concern may be related to
the ambient water temperatures used today as
well as the disappearing practice of ironing
clothes. Clothes dryers have added a slight
margin of safety depending upon the
temperature and the length of the drying time.
However, it is important that healthcare
workers are taught the importance of timely
and effective washing of healthcare associated
clothing to minimize the risk of transmission.
Hard surface disinfection
Environmental contamination of hard surfaces
can occur after contact with body fluids or
other contaminated surfaces. To minimize
cross contamination to soft surface textiles,
these surfaces should be disinfected properly
as soon as possible after they become unclean.
For example, a healthcare worker while
reaching across a patient’s bed that comes in
contact with a dirty bed rail with their uniform
is at risk of contaminating her hands and other
inanimate surfaces later during her work shift
or at home.
Proper use of PPE
As with contaminated hands, contaminated
gloved hands should not touch clean surfaces
such as privacy curtains or the healthcare
worker’s personal uniform. For example, staff
should be reminded to not take items in and
out of their uniform pocket with contaminated
gloved hands (i.e tape, scissors, patient lists ).
Contaminated PPEs such as gloves, gowns and
facial protection should be doffed safely as well
as to not contaminate the healthcare worker’s
personal uniform or scrubs.
If you are concerned that the soft surface
fabrics in your workplace may be “fomites” in
the spread of microorganisms, it may be time
to evaluate antimicrobial fabrics!
References
1. Wierner-Well et al. Nursing and physician attire
as possible source of nosocomial infections, Am
J Infect Control 2011, 39: 555-9.
2. Perry C, Marshall R, Jones E. Bacterial
contamination of uniforms. Journal of Hospital
Infection 2001;48:238-41.
3. Neely AN and Maley MP. Survival of enterococci
and staphylococci on hospital fabrics and
plastic. Journal of Clinical Microbiology
2000;38:724–6.
4. Neely AN. A survey of gram-negative bacteria
survival on hospital fabrics and plastics. Journal
of Burn Care & Rehabilitation 2000;21:523-7.
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11. Event 2013-B P.O.L. Insight Page 11
Continuing your Education
on Your Budget & Timeframe
By Karen Appold, freelance writer,
www.WriteNowServices.com.
Internet technologies have enabled
professionals to earn continuing education
(CE) at their convenience and at their own
pace, either from work or at home. With
increasing demands on staff and resources,
the timing couldn’t be better.
Online offerings have seen a surge in sales
among clinical laboratory organizations and
associations. One online provider reported an
872 percent increase participation in the three-
year period between 2008 and 2011.
Current Online Offerings
Several professional
organizations provide online
continuing education programs
for laboratorians.
COLA’s online selections
include:
• The Laboratory Director
CME Program. This online
course program is
approved by the Centers
for Medicare & Medicaid
Services (CMS) as a way for a
physician to qualify as the
laboratory director of a
moderate complexity lab.
• The Quality Assurance (QA) Specialist
Program. This is designed for individuals
holding the position of quality assurance
specialist, also known as:
• quality assurance manager
• quality improvement specialist
• QA coordinator or quality coordinator
• quality and compliance manager
• QA/quality control (QC) supervisor
• lead technologist or quality
technologist
• The Phlebotomy CE Courses of Study.
These programs address the requirement
for phlebotomists in certain states to obtain
CE every two years to renew their license.
COLA has two versions of the program to
allow participants to benefit from different
offerings in subsequent two-year cycles,
rather than repeating the same courses.
• COLA’s Insights newsletter, which
includes educational articles and regulatory
information is available only online to COLA
accredited labs.
ASCLS is building its library of online courses
authored by laboratory experts. Each course
is PACE®
approved to use for recertification or
relicensure requirements. Topics include
patient safety, sexually transmitted bacterial
infections, transplantation medicine and
vitamin D. Online courses are easy to navigate
and automatically bookmark progress so you
can resume them at any time. Courses can be
viewed on a computer, tablet or
smartphone.
ASCLS has also launched a
new Webinar series in
conjunction with the
Association of Public Health
Laboratories (APHL). The
Webinars are developed for
laboratory professionals
working in clinical, public
health, veterinary and
academic settings. Recent
topics include longevity and
the endocrine system and
updates on zoonotic infections
and diagnostics. The site
registration fee includes connection
to the live Webinar plus unlimited access to the
archived Webinar for six months. PACE credit
is available for each course.
Because laboratorians enjoy learning with case
studies, ASCLS offers the series, Clinical Lab
Investigations: Case Studies for the Laboratory
Professional. A variety of peer-reviewed case
studies are available to download from the
ASCLS Web site at no charge. PACE credit is
available upon successful completion of a quiz;
a nominal fee applies for online quiz access.
CLMA offers recorded sessions from its annual
conference, KnowledgeLab, (formally
ThinkLab), as well as Webinars, called
audioLabs, about six times annually.
12. Event 2013-BP.O.L. InsightPage 12
“Attendees appreciate the opportunity to
interact with speakers and other participants in
real time during live Webinars,” says Chris
Murphy Peck, senior education director, CLMA,
Chicago, IL.
The ASCP offers laboratory professionals a
comprehensive online informatics educational
solution that may be consumed on an internet
capable computer, tablet or smart phone.
Modules are available that address high needs
areas including glucose testing and the
electronic medical record, computerized
provider order entry in the electronic medical
record, telecytology and synoptic pathology
reports.
Learning Offline
“Factors such as time away from work and
‘time and place shift’ have contributed to the
popularity of online offerings,” says Michael
Eicker, director, Educational Conferences and
Enduring Activities, ASCP, Chicago, IL.
“However, onsite education such as the ASCP
Workshops for Laboratory Professionals (WLP)
and the ASCP annual meeting remain popular
with laboratorians who prefer to learn through
personal interaction.” The WLP continue to
focus on the topics essential for the
laboratory’s contributions to quality patient
care.
In addition, the ASCP publishes two peer-
reviewed journals, one for laboratorians and
one for pathologists. The articles form the
basis for CE modules. Beginning in the first
quarter of 2013, these journals will be
accessible in digital versions for iPad, Kindle
and Android-based devices.
Although attendance in offline offerings has
declined, some continue to be a valuable
alternative. “Individuals learn differently, and
many people enjoy the face-to-face
interaction, networking and ability to ask
questions that a live conference provides,”
says Cynthia Cardelino, MLT(ASCP), MT(HEW),
education technical curriculum specialist,
COLA, Columbia, MD.
Live events also provide a time and place that
is dedicated to learning—without interruptions.
Because lab professionals work with physical
samples, providing physical slides takes
education a step closer to real experiences.
In addition, conference attendees appreciate
the chance to see new technologies offered by
vendors in the exhibit hall, adds Peck.
Offline offerings also provide access to CE for
individuals and facilities that do not have
Internet access or are not comfortable with
technology. Manuals, guides, peer-reviewed
journals and fact sheets can also be a great
resource for the whole organization, serving as
references that are regularly consulted, utilized
and shared.
“Some lab professionals still prefer to read a
document versus viewing something online,”
adds Joan Polancic, MSEd, MLS(ASCP)CM
,
director of education and project planning,
American Society for Clinical Laboratory
Science (ASCLS), Tysons Corner, VA.
COLA presents two live conferences each year.
The Symposium for Clinical Laboratories
includes a lab director track that, like its online
course program, is approved by CMS as a way
for a physician to qualify as the laboratory
director for a moderate complexity lab.
ASCLS holds three live meetings annually. In
addition, it offers FOCUS articles in its
quarterly journal, Clinical Laboratory Science,
and The Learning Scope in ADVANCE for
Medical Lab Professionals. Both continue to be
popular offerings. While Polancic says there
has been a decline in the number of CDs
purchased, more laboratorians are seeking
similar topics with online products.
Best Value
Online education can certainly be economical.
In fact, some organizations have free
offerings. COLA offers a free course,
Calibration Verification, which is available to
anyone, and an additional free course, Quality
Assessment Basics, to personnel in its member
labs.
ASCLS partners with Dane Garvin, Ltd., to
offer access to a variety of laboratory Webinars
via the MedEdCafe. Topics include molecular
testing, general laboratory topics and a thyroid
disease series developed in conjunction with
13. Event 2013-B P.O.L. Insight Page 13
the American Journal of Medicine. Funding
from several laboratory companies makes free
access possible.
For a lab professional looking for CE that is
very affordable, the ASCP recommends its
Re.member solution. Re.member is an ASCP
membership benefit that includes a tracking
and organizational tool designed to help
laboratory professionals and pathology
assistants to manage their recertification
requirements entirely online. Online CE is
unlimited. Laboratory professional members
receive six free credit hours annually and
registrants receive three free CE credits.
COLA offers Webinars and three types of
“CEexpress” courses that are reasonably
priced. Bundled courses and educational
products are organized in packages targeted to
meet specific needs. These are offered at
much lower prices than their individual
components.
ASCLS offers several CE packages for its
members in conjunction with Medialab, Inc.—
called Certification Maintenance Membership.
Members can pay a flat rate for 12 hours of
online CE, which fulfill discipline areas needed
for Board of Certification recertification. Or,
members can pay a slightly higher fee for an
unlimited amount of online CE. “These
packages were created to make it simpler for
laboratorians to meet their recertification
needs,” Polancic says.
Importance of Continuing Your Education
Science is always moving forward. CE credits
are an essential and efficient way to keep
current with the newest advances, techniques
and information in the field. CE is also a
requirement by states and institutions.
“Continual learning and improvement is critical
to maintain quality,” Cardelino says. “It keeps
employees motivated in their fields and allows
for professional growth.”
Research indicates that people strive to
enhance themselves professionally, so CE is
uniquely designed to enhance professional
development. For example, the ASCP’s
Laboratory Management University, which is
currently under development, is a 25-course
curriculum leading to a certificate of
completion in laboratory management.
Eric Parks, PhD, director of Education Design
and Technology at ASCP states, “In an ASCP
nationwide survey of laboratory directors and
mangers, more than 73 percent report that
laboratory employees exhibit competency gaps
in laboratory management. Our new
curriculum is intended to address this need as
well as prepare laboratory managers of the
future.”
Creative Ways to Get Educational Funding
If your budget is stretched, employees may
want to consider asking their employer to help
fund their CE. Remind your employer that
better patient care and higher employee
morale (and thus lower employee turnover)
are two important results of CE.
Lab professionals serving as faculty for an
educational conference can benefit from the
entire meeting/conference experience while
being provided free registration as well as
assistance with other expenses.
Employees may offer to provide an in-service
upon returning from an educational meeting to
share what they have learned. This increases
the CE value by reaching more employees.
ASCLS and APHL are now offering low cost
Webinars in which registration is per site. An
unlimited number of employees can listen and
view the presentation. In addition, the
archived session is available for six months
after the live event so even more employees
can access it.
Need Documentation of CME Credits?
See Page 14 of this issue for details on
obtaining credit & documentation for this
CME activity.
14. Event 2013-BP.O.L. InsightPage 14
ContinContinContinContinContinuing Medicaluing Medicaluing Medicaluing Medicaluing Medical
EducaEducaEducaEducaEducation (CME) Inftion (CME) Inftion (CME) Inftion (CME) Inftion (CME) Informaormaormaormaormationtiontiontiontion
AAFP-PT emphasizes the importance of
voluntary laboratory improvement and
provides all participants with the educational
benefits for total quality assurance. AAFP-PT
takes pride in offering educational programs
and reference tools for our participants.
Physicians and their staff can earn continuing
education credits for their participation, review
and/or management of the AAFP-PT
proficiency testing process in their office lab.
In order to earn the continuing education
credits, participants must also complete our
educational materials that are specifically
developed for the physician’s office lab.
Physicians are eligible to receive up to twelve
hours of Prescribed (Category 1) CME by the
American Academy of Family Physicians. AAFP-
PT is also approved as a Provider of continuing
education programs in the clinical laboratory
sciences by the ASCLS P.A.C.E.®
Program. This
is a benefit offered to all participants at no
additional cost!
CME credit is earned by reviewing the
publication and completing an online quiz. The
quiz can be accessed through the CME link on
your PT Central homepage.
Please follow the instructions below to
participate in CME Online & to obtain your
documentation:
How to Obtain CME
1. Go to www.aafp.org/pt/ptcentral . Login
using the laboratory user name and
password.
2. Click the link for CME located on the left
side of the screen
3. Use the drop-down menu to choose a
CME activity. A link to the POL Insight
will appear.
4. Follow the instructions to access the
CME Assessment.
5. Enter your personal ID number/user
name and password. This is different
than the laboratory ID number.
NOTE: First-time participants must do the
following:
a) Click “Not a member or paid
subscriber?”
b) Click “Need to create an account?”
c) Enter email address
d) If not found in system, click
“continue to register”
e) Enter personal information & click
“continue”.
f) Choose a user name & password.
Note this information for future use.
4. Click “Done”
5. Click “Enter the Site”
6. All currently active quizzes will be listed.
Choose the desired test & click “Take the
Quiz!”
How to Complete & Submit CME
1. Read the questions & click in the circle
next to the correct answers. Repeat for
all questions.
2. Click “Submit” when done
3. Review your score and click “Submit
your quiz rests”
4. Complete the post-test evaluation and
click “submit answers”
5. From the “Thank you screen” click “View
letter of participation” to obtain
documentation of your CME credits.
How to Obtain CME
Documentation (Letters of
Participation) for previous
events
1. Go to www.aafp.org/cmecertificate
2. Enter ID number or user name &
password in boxes at upper right side of
page & click on the green arrow to
enter.
3. Click “CME Proof of Participation” on left
side of screen
4. All completed CME will be listed. Click
“Print Letter” next to each event for
which you are claiming credit.
5. Submit copies of this documentation to
your accrediting agency as required.
The due dates for claiming CME credit are
strictly enforced.
15. Event 2013-B P.O.L. Insight Page 15
The material necessary to review to answer the following questions may be found in this
issue of the P.O.L. Insight. Answers may be submitted through the CME Online link found by
clicking the CME link on the left side of your laboratory’s PT Central homepage. The
Accreditation information is located on the inside cover of this issue.
2013-B CME Questions2013-B CME Questions2013-B CME Questions2013-B CME Questions2013-B CME Questions
(Deadline for credit is May 31, 2014 - Only employees of laboratories currently enrolled in
AAFP-PT are eligible to participate in this CME activity.)
1. True or False: A Quality Assurance program pertains only to quality of patient lab testing.
A. True
B. False
2. Comparing patient test results values with previous test results is called a ______________.
A. Lookback
B.Beta Test
C. Delta Check
D.None of the above
3. True or False: Statistical data generated by monitoring data my be used to modify reference
ranges.
A. True
B. False
4. CLIA’88 requires personnel assessment for which of the following positions in the lab:
A. clinical & technical consultants
B. phlebotomists
C. testing personnel
D. A & C only
5. True or False: It is the ultimate responsibility of the Laboratory Director to make use that
personnel are compentent.
A. True
B. False
6. True or False: Performance of proficiency testing alone is sufficient to demonstrate
competency.
A. True
B. False
7. Determining employee competency should include which of the following assessments:
A. direct observation of test performance
B. review of intermediate test results or worksheets
C. direct observation of instrument maintenence & function
D.all of the above
16. Event 2013-BP.O.L. InsightPage 16
8. Communications breakdowns most often occur ____________________.
A. during the pre-analytical phase of testing (test ordering, patient preparation)
B. during the post analytical phase of testing (results reporting)
C. Both A & B
D. during the analytical phase of testing (test performance)
9. True or False: A corrective action plan should be implemented whenever a communication
breakdown occurs.
A. True
B. False
10. Complaint investigations pertaining to the laboratory may include:
A. a log sheet of complaints, investigation & resolution
B. a review committee
C. patient/client satisfaction surveys
D. all of the above
11. Feedback to employees concerning quality assurance issues should be delivered
__________________.
A. At regularly scheduled staff meetings
B. Immediately, for issues requiring prompt intervention
C. Both A & B
D. Never
12. True or False:The use of probes is recommended to monitor laboratory quality assurance.
A. True
B. False
13. __________% of physician & nurse uniforms tested positive for pathogenic organisms.
A. 10
B. 37
C. 63
D. 89
14. True or False: Soft surfaces are not a significant source of transmission of infectious
agents.
A. True
B. False
15. The most common multi-drug resistant organism isolated from soft surfaces is
___________________.
A. MRSA
B. VRE
C. E. coli
D. Both A & B
16. MRSA has been shown to survive for over __________ days on cotton fabric.
A. 5
B. 20
C. 30
D. 60
17. Event 2013-B P.O.L. Insight Page 17
17. True or False: Home washing machines are sufficient to eliminate pathogenic bacteria
from soft surfaces.
A. True
B. False
18. True or False: Multi-drug resistant organisms survive longer on polyester fabric than on
cotton.
A. True
B. False
19. To meet EPA standards, an antimicrobial technology must demonstrate ____________.
A. a decrease in microbiall growth
B. reduce fabric degradation over time
C. control odor
D. All of the above
20. _________ is a conductive material, shown to have antimicrobial properties.
A. Copper
B. Gold
C. Aluminium
D. All of the above
21. True or False: Silane is a coupling agent that has been used to adhere Quaternary
ammonium compounds to fabric.
A. True
B. False
22. Silver has been incorporated into ________________ as an antimicrobial component.
A. Foley catheters
B. Central line catheters
C. Wound dressings
D. All of the above
23. True or False: Best practices call for daily laundering of uniforms & labcoats.
A. True
B. False
Go to
the Online CME link in
PT Central
to take this quiz
and receive CME credit.
18. Event 2013-BP.O.L. InsightPage 18
24. True or False: Soft surfaces cannot be contaminated by transfer from hard surfaces in the
patient environment.
of water.
A. True
B. False
25. On-line training in as increasingly popular way to obtain CE credit.
A. True
B. False
26. Professional organization offering CE courses include:
A. COLA
B. ASCLS
C. CLMA
D. All of the above
27. True or False: Serving as faculty at a continuing education event provides an opportunity
to attend the conference for free and receive assistance with travel expenses.
A. True
B. False
28. COLA presents __________ live training symposiums annually.
A. 1
B. 2
C. 4
D. 12
29. True or False: Webinars provide a low-cost option for education for multiple participants.
A. True
B. False
30. Laboratorians will receive ________ CE credits for completing this POL Insight quiz.
A. 2
B. 3
C. 4
D. 12
19. Event 2013-B P.O.L. Insight Page 19
Your PT Central Homepage:
Login at www.aafp.org/pt/ptcentral
Find your login and password on the packing slip included in your kit
PT Central is your 24/7 home for all your Proficiency Testing needs:
1. Setup Confimation – Click here to view your lab’s demographic information and current
setup.
2. Note: - Look here for important messages from AAFP-PT Staff.
3. Instruments – Look here to verify your instruments/methods.
4. Enter – Click here to enter and submit (Final Save) results.
5. Module Information – Click here to find special instructions, clinical histories and other
pertinent information.
6. Reports – Click here to create a data submission report and certificate and retrieve
evaluations reports.
7. CME – Access the POL Insight and link to the Online CME test submission. See page 19
of the 2013 AAFP-PT Handbook for additional information.
8. Contact Us – Send the PT Staff a message/question – for example requests for
replacment samples, or other assistance.
