Transcript Life in the Rural Lab

Life in the Rural Lab
Constance Stager
Maniilaq Health Center
Kotzebue, AK
Maniilaq Health Center
Kotzebue, AK
Maniilaq Health Center (MHC) is located in Kotzebue, Northwest Alaska, 30 miles above the Arctic Circle. It is part
of a System (MHS) owned and operated by the Tribal Health Organization of Maniilaq Association that serves the
3,500 residents of the native village of Kotzebue, Alaska, and the estimated 8,000 residents of the 10 villages of
the Northwest Arctic Borough and Point Hope (North Slope Borough).
Challenges
• Personnel
• Quality
• Inventory
• Shipping
• Service
Personnel
• Staffing
• Training
• Retention
Staffing
• Maintaining a staff can be difficult
• Cost of living and location make the area
unappealing
• High number of locums/TDY staff
• Living conditions and cost of rents
Training
•
•
•
•
TDY staff often 50% or more of staff
Staff have 13 week contracts
Constantly training new staff
Difficult to get qualified staff who do not
require extensive training
• Maintaining quality standards very difficult
with constant turnover
Quality
• Maintaining quality is a challenge
• Changing staff means retraining every few
months
• Staff come to the lab with different levels of
competency and commitment to quality
• Quality dips with each new batch of locums
Quality
• Must use creative means to ensure quality
– Quality Calendars
• Very helpful for periodic maintenance, QC,
validations, and correlations.
– Structured Training and Competency
– Heavily dependant upon management
monitoring
MONTH:
SUNDAY
5th SUNDAY
31
JANUARY
MONDAY
2010
WEDNESDAY
YEAR:
TUESDAY
1 Pentra
Calibrate Dimension
Blood Bank Inventory
"RE" Pending Log
Pentra QC
Sysmex QC
A-Test
Ck Stratus Calib
Review
2
FRIDAY
4 Dimension
Concentrated Cleanings
Process Incoming Blood
Blood Bank Alarm
Micro QC
Blood Bank Chart Change
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Weekly Maint
Weekly Maint
Send Back Short Blood
"RE" Pending Log
Pentra QC
Sysmex QC Pentra QC
Dim QC/Pt Review
Dim QC/Pt Review
Dim QC/Pt Review
Clean Jewell #1 Frig
8 Pentra
9
Calibrate Dimension
Concentrated Cleanings
Review
Blood Bank Inventory
Process Incoming Blood
Millipore bacteria count
"RE" Pending Log
Micro QC
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
A-Test Pack up monthly QC box
Ck Stratus Calib
Review Dim QC/Pt Review
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
2nd SUNDAY
14
15 Pentra
16
Calibrate Dimension
Concentrated Cleanings
Review
Blood Bank Inventory
Process Incoming Blood
Millipore bacteria count
"RE" Pending Log
Micro QC
Pentra QC
Sysmex QC
Pentra QC
Sysmex QC
A-Test
Ck Stratus Calib
Review Dim QC/Pt Review
Calibrate Dimension
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
3rd SUNDAY
21
22 Pentra
23
Calibrate Dimension
Concentrated Cleanings
Review
Blood Bank Inventory
Process Incoming Blood
Millipore bacteria count
"RE" Pending Log
Micro QC
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
A-Test
Ck Stratus Calib
Review Dim QC/Pt Review
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
4th SUNDAY
28
1st SUNDAY
THURSDAY
3 Sysmex
7
10
Blood Bank Alarm
Blood Bank Chart Change
Pentra QC
Sysmex QC
Clean Jewell #2 Frig
Dim QC/Pt Review
Pentra QC
Sysmex QC
17
Stratus Mo. Maint/QC
Blood Bank Alarm
Blood Bank Chart Change
Pentra QC
Sysmex QC
Clean Revco Frig
Dim QC/Pt Review
Pentra QC
Sysmex QC
24
Blood Bank Alarm
Blood Bank Chart Change
Pentra QC
Sysmex QC
Clean LF225 Freezer
Dim QC/Pt Review
Pentra QC
Sysmex QC
SATURDAY
5 1st SATURDAY
Review
Sysmex QC
Reagent Inventory
Dim QC/Pt Review
Check for Expired
Pentra QC
Sysmex QC
Sysmex
11 Dimension
12 2nd SATURDAY
Weekly/Monthly Maint
Weekly Maint
Send Back Short Blood
Review
"RE" Pending Log
Clean BB Refrig
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Pack monthly Quest results Pack monthly inhouse box
Reagent Inventory
Dim QC/Pt Review
Dim QC/Pt Review
Check for Expired
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Sysmex
18 Dimension
19 3rd SATURDAY
Weekly Maint
Weekly Maint
Send Back Short Blood
Review
"RE" Pending Log
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Clean Sm Revco Freezer
Cleen Polestar Freezer
Supply Inventory
Dim QC/Pt Review
Dim QC/Pt Review
Check for Expired
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Sysmex
25 Dimension
26 4th SATURDAY
Weekly Maint
Weekly Maint
Send Back Short Blood
Quest/SO Inventory
"RE" Pending Log
I-Stat Monthly QC
Review
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Triage Monthly QC
Inventory
Dim QC/Pt Review
Dim QC/Pt Review
Check for Expired
Pentra QC
Sysmex QC Pentra QC
Sysmex QC
Review
Millipore bacteria count
TASK ASSIGNMENTS
morning startup person
mid-morning person
afternoon person
6
night shut-down person
13
20
27
Quality Assurance Calendar
Laboratory Hematology
QA Topic
Monitoring Requirements
Responsible Party
Jan
Feb
Mar
Hematology
Sysmex Daily QC
Daily
Heme Tech
CSS
CSS
CSS
Daily Maintence
Daily
Heme Tech
CSS
CSS
CSS
Weekly
Heme Tech
CSS
CSS
CSS
Bi Annually
Heme Tech
Bi Annually
Heme Tech
CSF QC LOG
Weekly
Heme Tech
Retic QC Log
Weekly
Heme Tech
ESR QC Log
Daily
Heme Tech
Sysmex Weekly
Maintenance
Sysmex 6 Month/As
Needed Maintence
Hematology 6 Month
Calibration
HematologySOP REVIEW Annually
Lab Manager
Coagulation
CA 530 Daily QC
Daily
Heme Tech
CA 530 Daily Maintence
Daily
Heme Tech
CA 530 Monthly Maintence Monthly
Heme Tech
Coag 6 Yearly
Maintenance/PM Review
Heme Tech
Bi Annually
CoagulationSOP REVIEW Annually
Heme Tech
Sysmex Led Calibration
Heme Tech
Quarterly
Urinalysis
Refractometer QC Log
Weekly
Heme Tech
Fecal Occult Blood QC Log
Weekly
Heme Tech
Gastroccult QC Log
Weekly
Heme Tech
Clinitest QC Log
Weekly
Heme Tech
HCG QC Log
Weekly
Heme Tech
Ictotest QC Log
Weekly
Heme Tech
Acetest QC Log
Weekly
Heme Tech
Urinalysis Daily QC
Daily
Heme Tech
Annually
Lab Manager
Urinalysis SOP REVIEW
Apr May
Jun
July
Aug Sept Oct
Nov
Dec
Standing Order Renewal
Streck Standing order for
SYSMEX QC
Biannually
Heme Tech
Service Contract Renewal
Annually
Heme Tech
Standing order for
Reagents
Annually
Heme Tech
Correlations
Manual VS Autodiff
Correlation
Biannually
Heme Tech
Equipment Correlation
Biannually
Heme Tech
Reports
QA Calendar Submission
By the 1stof the Month
Heme Tech
Submission of Peer
Review Data for Heme
Every 10 days and
according to Calendar
Heme Tech
Submission of Coag Peer
Review Data
By the 5th of the Month
Heme Tech
Result Review
Daily Review of QC Results Daily
Heme Tech
NA
Inventory
• Without the proper reagents and supplies
testing comes to a halt
• Maintaining an inventory with changing staff
can be difficult
• Orders take a long time to arrive and need to
be ordered well in advance
• Delays: Weather, post office staffing
problems, lost shipments, FedEx
Inventory
• Creative solutions
– Synchronizing instrumentation and inventories
– Borrowing from other hospitals on your flight
schedule
– Agreements with other hospitals to perform
testing
– Backup instrumentation for critical testing
Shipping
• Multiple specimens shipped from villages and
to Quest, ANMC, or State
• Bags get lost
• Aged specimens
• Specimens frozen
Service
• Limits choice of instrumentation
• Not all companies will service Alaska
• Others will provide service but it may take 34 days for a technician to arrive
• Others may decide that they no longer want
to service Alaska and make getting service
very difficult
Point of Care Testing
• MHC Lab oversees the POC testing program at
Maniilaq Health Center and the 11 villages
• Challenges include:
– Training and competency
– Quality Control and Compliance
– Distance to villages
– Changes in staff
Questions?
17
Credits
Special Thanks To:
Maniilaq Association, Maniilaq Health Center Administration, and the Alaska Native Tribal
Health Consortium
18
Time to Rest