The Evolving Regulatory Environment and Bedside Metabolic Monitoring of the Acute Care Patient (Part 12)

Special Problems Encountered in the Out-of-Laboratory Testing Site
Nontechnically trained individuals frequently make random, rather than systematic, errors. Sometimes the errors are due to the lack of understanding the test systems. More likely, the multiple duties and priorities of these individuals lead to errors related to distraction or inattention to detail. Their major concern is usually the immediate care of the patient. The laboratory test that they are performing is perceived as an ancillary duty of lesser importance. Because of their lack of technical training, they believe that quality is in the box that they operate. They are unaware of the variability in testing that is introduced by interaction of the analyst and the black box.
They do not understand normal variance in testing nor can they judge when variance is excessive. Quality control measures that could warn them of excessive variance are seen by them as being ‘‘busy work” unrelated to patient care. When QC data are presented to them by the instrument or test system, it comes in the form of data to be interpreted, rather than as information to guide the analyst. Because of their lack of technical background, they are not equipped to appropriately interpret and act on this QC data. These individuals require the QC system to be self-operating and indicate to them whether they can report patients’ results or whether a corrective action is necessary. ventolin inhaler
Because many of our test systems for use at the point of care require whole blood, QC materials should appear and act like whole blood. Most are not. Quality control materials frequently require some preparation by the user prior to use and are usually not packaged in appropriately sized units for testing in this environment.
Regulations are (ideally) the formalization of generally accepted quality management practices. We need new quality management tools for testing performed by individuals without technical training.