Mission Statement

The Program provides a community of cooperation and education to enhance the sharing of resources to improve quality and maximize the efforts of Regional Laboratory Services in providing a high level of service to our member hospitals and communities.

Values

Integrity

We act honestly, ethically and impartially at all times.

Professionalism

We encourage self-improvement and aim for scientific excellence.

Quality Assurance

We ensure that all our work is carried out in accordance with recognized standards.

Teamwork

We recognize the participation, initiative and cooperation of all the laboratories as being essential to our success.

Client Focus

We strive to recognize and anticipate the needs of clients by working openly and cooperatively to meet those expectations.

Board of Directors

Robert Wilson – Atikokan General Hospital
Wade Petranik – Dryden Regional Health Centre
Mark Balcaen – Lake of the Woods District Hospital
Janice Mullin - Red Lake Margaret Cochenour Memorial Hospital
Wayne Woods – Riverside Health Care Facilities, Inc.
Roger Walker – Sioux Lookout Meno-Ya-Win Health Centre

Regional Office

Kenora-Rainy River Regional Laboratory Program, Inc.
P.O. Box 3003, Dryden, ON    P8N 2Z6
Phone:  807-223-8264      Fax:  807-223-7342

Chief Operating Officer: Wade Petranik
Laboratory Director: Dr. J. Kerry MacDonald
Executive Director: Anna Robinson
Executive Assistant: Marilyn Rustan

Organizational Chart

(See Appendix A)

Executive Summary:

The Kenora Rainy River Regional Laboratory Program (KRR RLP) exists to help laboratories meet the diverse challenges associated with the growing demand for diagnostic services. These laboratories provide 1.35 million test results used by clinicians to diagnose, treat and monitor the health of any of the 86,000 residents annually.

We care about sustainable health care and are committed to working collaboratively with any laboratory and hospital service as well as other health care programs to complement patient care.

To support our vision, the Program maintains a comprehensive Quality Management System based on fifteen (15) Quality System Essentials (QSEs) that outline key elements needed by our Laboratories to:

• Meet accreditation, legal and regulatory requirements, recognized standards of laboratory practice, and operational needs
• Continually monitor the quality and appropriateness of our services
• Ensure continuous quality improvement of the Laboratory’s processes
• Consistently provide cost-effective services through efficient, effective business operations

The year 2008 represents the completion of a 3 year plan. The successes have been many resulting in the purchase of appropriate testing equipment, the deletion of some tests but the addition of others, numerous business plans such as the selection of a reference laboratory, expanded education through newsletters and presentations and recruitment through the provision of clinical training. The 2009-2011 planning cycle has begun and will build on those successes.

Education and research activities are driven by the Program in order for the laboratories to carry out the necessary activities of diagnostic testing and continuum of care.  In the last few years education arranged by the Program has entered into the realm of professional career development to set the stage for succession planning.

All laboratories in KRR RLP continue to participate in internal and external assessment processes to ensure testing services meet the requirements of its customers, the Ministry of Health and Long-Term Care Laboratory Licensing Branch, and accrediting regulatory agencies such as QMP-LS.

It is to the great credit not only of the Program’s founders but also those people who have worked through the years to make this Program provincially known and respected.

Detailed Description of Activities

Equipment / Test Menus

Through a series of RFP’s developed by the Program the laboratories have been successful at:

• Identifying a suitable Hematology analyzer for purchase
• Purchasing bacterial culture incubators, ultra low freezers and blood culture incubators for use in 3 Microbiology Laboratories
• Selecting an external quality control program to meet the new OLA requirements for the measurement of uncertainty

When one considers that 70% of diagnostic and treatment decisions are based on laboratory tests, it is easy to see the crucial role laboratory medicine plays in patient care in our hospitals. In 2008 the region performed 1,350,000 laboratory tests, which is consistent with performance in previous years. Menus continue to be streamlined however to make room for newer and more appropriate tests.

Site specific, the Program worked in collaboration to prepare business plans for gas chromatography and Troponin point of care testing. Business Plans were also built for securing a Quality Coordinator and C. difficile, which have been put in abeyance.

Education

The Program organizes continuing medical and technical education in a variety of forums: conferences, teleconferences, workshops, presentations and lectures. It is committed to helping the medical and technical personnel be the best they can be. This year it was the only Regional Program to host an annual Conference in Ontario outside of a provincial initiative.

Details of this year’s Symposium are outlined in Appendix B.

This year the Program continued in its educational commitment by producing a series of newsletters for physicians and technologists to provide authoritative information, advice and instruction on the utility of specific laboratory tests.  Appendix C.

The Laboratory Director continues to provide onsite education to a variety of health care providers. The presentations included topics such as community acquired MRSA and cognitive error.

The Program developed a series of power point presentations for Hospitals to use when training or re-certifying staff using POCT.

Onsite Visits

In addition to monthly or bi-monthly teleconference meetings with the Laboratory Managers, onsite visits have occurred in the region by the Laboratory Director and/or the Executive Director, 3 times.  Appendix D.

The Laboratory Managers also meet with the Laboratory Director and Executive Director bi- annually for 2-day sessions to deal with strategic planning, new initiatives and complex projects.  These meetings provide guidance to the Laboratories in order to meet the clinical needs and established goals in each facility.

A regional Microbiology Committee actively meets to provide a forum for technologists working in this discipline to connect with their peers and discuss related issues. This has led to quality improvements to individual operations and the regional manual.

Recruitment

The Program is committed to the training students pursuing a career as medical laboratory technologists (MLT). Staff members at LOWH worked closely with Cambrian College by helping to train students in their clinical year. The Executive Director of the Program sits on the Professional Advisory Committee (PAG). Red River College in Manitoba has contacted the Program to consider student placements in this Region.

The Executive Director is the Chair of the PAG for the MLA/T Program at Confederation College. The six facilities in the KRRRLP have agreed to work collaboratively with the College to provide students with the training needed to transition them into a MLA/T career path hopefully within North Western Ontario.

The Pathologists also provided training to a fifth year Pathology resident.

EQA Challenges

The Quality Management System-Laboratory Services (QMPLS) provides an external quality assurance program specifically designed for Ontario laboratories. Its goal is to provide a confidential assessment by which a laboratory can compare its internal test results to those of other laboratories.

Based on the OLA requirements a laboratory must have an EQA program for every analyte tested. Since QMP-LS cannot provide all the necessary testing materials to meet compliance the Program searched for other providers. The Laboratories have signed a contract with DigitalPT to secure the additional materials. As with QMPLS, DigitalPT provides a confidential, individualized report to each participant.

A Regional review of EQA challenges has revealed marked improvement in performance when compared to last year.   Appendix E.

This year there were 18 letters of non-conformance received:

Non-Conformances

Statistical/method bias – 2

Technical -misinterpretation of results, calculation errors, QC limits sample mix-up, random error – 2

Materials – defective reagents/unsupported reagents, mishandling QMP-LS samples – 3

Failure to follow SOP – 2

Equipment function – 2

Organizational Factors- communication, training , missing SOP information – 6

Random Error – 1

Corrective actions for the most part included re-education and training of staff, writing/ updating procedures, and contacting manufacturers regarding problems with materials or analytical performance.

Goals Set for 2008:

• Training video for POCT. Promote additional POCT. Training Videos Complete.
• POCT opportunities. Ongoing
• RFP – Hematology analyzer and blood culture incubator. Complete and awarded
• Assess QA at a regional level to establish regional benchmarks. Process designed. Implementation 2009
• Meet with LHINs to promote the Program and market management skills. Incomplete
• Arrange workshops in communication, adult training. Cancelled due to budgetary constraints
• Prepare Program Administrative Manual. Complete

Goals Set for 2009:

• Revisit BNP testing
• Evaluate the availability of Octaplex on site
• RFP–PCR testing in three sites
• RFP -POCT-examine other testing available for small hospital laboratories
• Roll out Regional benchmarks to assist in compliance with the OLA requirements.
• Act as unbiased third party in monitoring laboratory quality processes.

Appendix A

Organizational Chart

Appendix B

Annual Fall Symposium
2008

Summary

The 17th Annual Fall Symposium was held September 9,10 & 11th, 2008, in Dryden Ontario at the Best Western Hotel.

36 delegates, 28 of whom were from our own region, attended this year’s Symposium.  Delegates included technologists and technicians as well as one Laboratory Director.  The breakdown of delegates from our Region includes:

• Atikokan General Hospital: 2
• Dryden Regional Health Centre: 6
• Lake of the Woods District Hospital: 9  (Includes Laboratory Director)
• Red Lake MC Memorial Hospital: 1
• Riverside Health Care Facilities: 6
• Sioux Lookout Meno-Ya-Win Health Centre: 2
• KRR RLP: 2

The educational format consisted of 7 guest speakers who provided presentations relating to laboratory management and medicine.  Samantha Waytowitch of Lifelabs provided a 1 day workshop to introduce the core concepts of Six Sigma with a focus on Lean practices and quality improvement tools.

This was the first time that two other Regional Laboratory Programs were represented at the Symposium. A separate meeting was held to discuss various initiatives and areas of possible collaboration.

The exhibition itself included 18 Booths with 26 vendors

Appendix C

Newsletters

Ova and Parasite Testing of Stool Samples – 2008-01

Stat Testing – 2008-02

Useful Biochemical Markers for the Diagnosis of Non-ST Segment Evaluation CS – 2008-03

Creutzfeldt-Jakob Disease (CJD) - 2008-04

The Emergence of Enterobacteriaceae Producing Extended-Spectrum β- lactamase (ESBLs) – 2008-05

The Clinical Significance of AMPC β-lactamases – 2008-06

Antibiotic Resistance Due to Carbapenemases (Including the Klebsiella pneumoniae Carbapenemases – KPCs) – 2008-07

Antibiotic Use as a Predictor of Antibiotic Resistance – 2008-08

Neonatal Hyperbilirubinemia – 2008-09

Compatibility Testing – 2008-10

Octaplex®  – 2008-11

Appendix D

Regional Meetings
2008

Onsite Visits
2008

Appendix E

QMP-LS Non-Conformances per Discipline

QMP-LS Non-Conformances per Discipline

QMP-LS Non-Conformances per Discipline