Core LabApril 2007

Staff MeetingPresentation

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

SODIUM 134 136 139

POTASSIUM 3.8 * 3.5 * 4.4 *

CHLORIDE 103 105 104

SUN 13 9 33 *

GLUCOSE 170 * 105 * 122 *

CREATININE 0.8 0.8 1.1

CALCIUM 7.9 7.9 8.8

TOTAL PROTEIN 6.1 5.8 6.4

ALBUMIN 2.5 2.2 3.3 *

BILIRUBIN 0.3 0.3 1.4 *

ALT 14 15 81

AST 54 56 40

ALK / PHOS 575* 484 * 65 *

CO2 18 * 23 26

ANION GAP 17 12 13

SUN / CREAT 16 11 30*

AST / ALT 3.9 3.7 0.5 *

3/13/07 3/14/07

134 33

3.1 * 3.2 *

104 102

12 * 7

102 * 96 *

0.9 0.8

7.1 * 7.4

5.6 5.4

2.4 * 2.2

0.3 * 0.4 *

12 * 16

71 * 69

456 * 439

23 23

10 11

13 * 9

5.9 * 4.3

African-American Male, Age 50

Component 3/10/07 3/11/07 3/12/07

WBC 3860 4420 2130 * A

RBC 3.25 2.64 2.56 A

HgB 9.1 7.5 8.8 A

PCV 29.6 24.1 28.1 a

MCV 91.1 91.3 109.8 * A

MCH 28.0 28.4 34.4 A

MCH C 30.7 31.1 31.3 A

RBC DISTR 15.4 15.4 19.2

PLATELET 56 66 117 A

NRBC NO. 0 0 50 A

3/13/07 3/14/07

5270 3940 *

2.54 2.49

7.2 7.2

23.1 22.8

90.9 * 91.6

28.3 28.9

31.2 31.6

15.4 15.2

81 94

0 20

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 PolicySuspect 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 sample1 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

• iPods - Not permitted

- Safety Issue: Cords

- Volume

- Distraction

Weekend Callouts

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 PhelpsHematology Supervisor

Flow CytometryOncology HematologyMolecular Hematology

• University of Pittsburgh graduate

• Hematology/Chemistry Experience

• QC Technologist• 11 Years JHH

ASCP WorkshopsTues. 5/1 thru Fri. 5/4

70 Attendees over One Week Towson Sheraton Roundtable Discussions to Follow

Lab WeekApril 22-28, 2007

Lunches, BreakfastSpecial CEs: 4/25 (Dr. Hruban) – 10 AM, 6:00 PM, & 7:30 PM

4/27 (Dr. Jackson) – 10:00 AM, Hurd Hall

Fun, Games, ContestsPictures of Staff

Fri. 4/27, Jeans Day for Ronald McDonald House ($1.00 min. donation)

Manic Monday – April 23, 6:00 AM Fells Point (breakfast afterwards at Jimmy’s)

2nd 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 SotoMargo EcholsRhonda ColeTora Ruffin

Debbie BoblitzPolly ShuklaMark Swartz

Christine HostetterKathy Kowalewski

Lydia Nelson & CrewWillie Ferrer & Crew