Point of Care Testing - Manual Urine Dipstick Data Definition Tool

advertisement
Point of Care Testing - Manual Urine Dipstick
Data Definition Tool
This audit is to be completed by the manager or designee on a monthly basis. POCT audits are due by the last day of the month.
Instructions: Indicate Yes, No, NA (Not Applicable) for each question below.
Submit 1 POCT audit per month using the Point of Care Testing -Manual Urine Dipstick audit tool.
Updated 8-8-14
QUESTION
1
2
3
4
5
6
7
8
STANDARD
LOCATION
POCT testing book
YES
Yes means you are NOT doing
Has all testing performed in this patient care area been approved by the
any lab tests that you have not
Diagnostic Laboratories?
been approved for. Approval
NOTE: All POCT Testing must be approved prior to implementation. If
WT.01.01.01, EP 4
comes from the POCT
unsure of area approval, contact Point of Care personnel.
WT.02.01.01, EP 1 & 2
committee.
Manager/Educators Person trained by POCT in the
Is there a designated trained trainer with documented current
WT.03.01.01, EP 2, 3, office training records last year to train other staff.
competency?
4, & 6
Emails
Have sent POCT updates when
someone leaves work area or
Has the patient care area notified the Laboratory (POC) of changes in
new staff comes to work area.
the list of testing personnel?
WT.02.01.01, EP 1
Manager/Educators Orientation records must be
WT.02.01.01, EP's 1 & office training records kept permanently, annual
Are current documentation records for training and competency
2
recertifications must be kept for
records readily accessible?
WT.03.01.01, EP 3
2 years.
Can staff produce a copy of the current procedure (hard copy or
Computer/POCT
Can find procedure
online)?
WT.01.01.01, EP 5
manual
Has the manager performed a documented review of patient chart
POCT testing book
Manager has done quarterly
documentation to verify that patient results are properly documented
chart audits.
per procedure? (Review of Manager log)
WT.05.01.01, EP 4
Where supplies are
Controls are kept at RT when in
kept
use and refrigerated prior to
opening, strips are kept at RT
Are all reagents, controls, and kits stored at proper temperature?
WT.01.01.01, EP 2 & 6
Where supplies are
Controls that are open have an
kept
altered expiration date of
31days. Strips are marked with
Are all reagents, controls, and kit boxes labeled with an appropriate
an open date and initials
expiration date and initials?
WT.01.01.01, EP 2
Have QC documentation logs been completed as required by
9 procedure?
10 Have corrective actions been documented?
11 Are all QC records kept for a minimum of 2 years?
QC Log Book
QC has been done on every day
that patient testing was done
Problem log
QC Log Book
QC Log Book
If had problem it is noted
Yes, if you have your records
There is a signature to indicate
reviewed weekely.
WT.04.01.01, EP 1 & 2
WT.05.01.01, EP 1
WT.01.01.01, EP 2
WT.05.01.01, EP 5
WT.01.01.01, EP 2
Has the manager or designee performed a weekly review and sign off of WT.04.01.01, EP 1 & 2
WT.05.01.01, EP 1
12 quality control and other test specific required documentation?
Is all original documentation of patient results retained for a minimum
Log book/EDOCS
13 of 2 years?
WT.05.01.01, EP 5
Are they accessible for last 2
years
Download