iSTAT Quality Check Code Rates
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We currently monitor the quality check code percentage rates as part of our metrics. I have been trying to find information on what quality check code percentage we can expect for the iSTAT in order to determine if our current threshold needs to be adjusted. I haven't been able to find that information so was wondering if anyone else who monitors the quality check code percentages monthly would possibly have information on how they determined their threshold. Thanks in advance!
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I saved this post from Ivy from a couple years ago and I think this is a great explanation!
I think that 5% overall may be reasonable but on a unit by unit basis too tight. We base our evaluations on how many tests are performed. 0-100 tests we look at <15%, 100-250 <10% and high use units <5%. We do not have this listed in policy yet, just use it as a guideline. When I did evaluate several years ago to try to reduce the failure rate some things glaringly came out: new people struggle and often those who get several in a row are often new; low use areas and those who do not have lines to draw from struggle. Let's face it, statistics don't always tell the story. For example, a unit has a 50% failure rate but turns out that they only did 3 patients and one of those got 3 QC codes (6 cartridges run, 3 QC codes). Is that the unit's fault and cause to remove the iSTAT or go through massive retraining or just the one person that had trouble with one patient's clotting sample? Whereas on one of our NICU units, for example ran 1,351 cartridges with 81 failures. That may be <5% failure rate but 81 times a baby had to be redrawn to retest, which I find more disconcerting and cause to follow up, even though percentage-wise would appear nothing to be concerned about. Also, the type of error matters. I'm not going to retrain on multiple code 23's... not their fault. I also had an instance with Creatinine cartridges that persistently gave under-fill errors pointing to bad technique and we determined there was a cartridge issue, not technique, as it was very obvious the increase in that error code correlated with a new lot# and went away when we switched out the lot#. When I evaluate competency at six months, I note how many QC codes people have over that period with a goal of <15 in number but if they go over that number, then I look at how many tests they actually ran and go by <10% error rate. Hope this helps.
Ivy Douglas, LAB Point of Care Coordinator
OU Medical Center