2013 Annual Report
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.
We act honestly, ethically and impartially at all times.
We encourage self-improvement and aim for scientific excellence.
We ensure that all our work is carried out in accordance with recognized standards.
We recognize the participation, initiative and cooperation of all the laboratories as being essential to our success.
We strive to recognize and anticipate the needs of clients by working openly and cooperatively to meet those expectations.
Board of Directors
Doug Moynihan – Atikokan General Hospital
Wade Petranik – Dryden Regional Health Centre
Mark Balcaen – Lake of the Woods District Hospital
Paul Chatelain – Red Lake Margaret Cochenour Memorial Hospital
Allan Katz – Riverside Health Care Facilities, Inc.
Dave Murray – Sioux Lookout Meno-Ya-Win Health Centre
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 (up to Sept 2012) – Tanya Knopf (beginning Sept 2012)
Executive Assistant: Marilyn Rustan
This report is dedicated to Tanya Knopf in recognition of her contributions to the Program in 2013. May each day bring her closer to a full recovery.
The Kenora Rainy River Regional Laboratory Program (KRR RLP) is committed to provide quality education, expert advice and technical support to the six hospital laboratories in Northwestern Ontario. In collaboration with professional organizations and government agencies the Program delivers a solid foundation to assist the laboratories in achieving Ontario Laboratory Accreditation. KRRRLP is responsive to the healthcare needs of our communities by ensuring test platforms meet current and future needs.
This year marked the first year of a three year plan. It is evident that these goals were met such as analyzer purchases/installation however flexibility in the Plan allowed for additional opportunities for growth not originally predicted such as expansions in test menus or addition of PCR testing in non-Microbiology sites. All involved are congratulated for their efforts.
The 2013 KRRRLP regional symposium, “Safety First” was a huge success with more than 50 delegates and vendors in attendance. The symposium continues to be the single biggest event of the year for the Program. Other educational activities include regular newsletters on current topics as well as presentations by the Laboratory Director.
A significant amount of time is spent travelling to each lab in addition to regular laboratory manager’s meetings and microbiology teleconferences. These visits and meetings provide a venue with which the laboratories can share their experiences and the Program can provide resources for the revision or implementation of quality processes in the individual laboratories.
All laboratories continue to participate in a wide variety of external quality assurance (EQA) programs. Every test is validated and monitored by comparing results with other laboratories in the Province of Ontario. Any flags require an investigation to determine the root cause and then corrective actions are put in place to reduce the risk of reoccurrence. The Program assists laboratories through this process, by providing expertise and resources.
Audits are an important part of continuous quality improvement initiatives. Each laboratory audits a variety of indicators within their own facility. The Program consolidates the results for those audits that are common to all laboratories. The results are reviewed as a group, and suggestions for improvement are coordinated by the Program.
Due to unforeseen circumstances some of our goals targeted for 2013 may not be fully implemented until 2014. As a consequence our laboratories are more firmly resolved to work together to backfill what needs to be done to achieve these goals. We would like to express our thanks to Brian Patterson who took the lead for Tanya Knopf and all of the time he has given to the Program in addition to his regular duties.
Detailed Description of Activities
Equipment / Test Menus
The Program takes a futuristic approach to determine the most suitable analyzers for our laboratories to meet the demands of today and predict the needs of tomorrow.
The new EXL Chemistry analyzers are in place in 5 laboratories. There have been growing pains as staff adjusted to a different technology. The exact reagent savings has yet to be determined noting not all sites are fully operational. A report on this should be expected in 2014.
Site dependent, an expansion in test menu is expected for the following tests: Vancomycin and Gentamycin. These drugs are the first choice by physicians when treating multi-resistant organisms however patients may experience toxic side effects. By testing on-site the laboratory can quickly determine the patient’s blood level and notify the doctor of any risk.
The use of RapidComm had not been implemented regionally. Brenda Voth should be commended on her hard work in getting this software working at SLMHC. This means that that each facility, when ready, can connect their urine POCT devices to the SLMHC hub and monitor the performance of each POCT user in its own hospital. This is a major criterion when dealing with Accreditation requirements.
POCT troponin testing has expanded out of the Laboratory in Red Lake to ease the callback burden. Preliminary results indicate that callbacks have returned to historic levels and appear more manageable.
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.
The 22nd Annual Fall Symposium, “Safety First”, was held at laPlace RendezVous in Fort Frances on September 24, 25 & 26, 2013. The educational format consisted of six (6) guest speakers who provided presentations relating to laboratory management and medicine. The 2013 Symposium was attended by 33 delegates from all of the hospitals in the region. The exhibition itself included 17 booths from various laboratory product companies with 24 vendors in attendance.
See the detailed program 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. See Appendix C.
The Laboratory Director provided educational “lunch’n learn” presentations to a variety of health care providers, including physicians, nurses and pharmacists, during his onsite visits.
The presentations included topics such as Anti-Factor Xa (Heparin) Testing, Octaplex, Blood Transfusion Reactions and Vancomycin. See Appendix C.
Evaluation forms were developed for the presentations as a mechanism to elicit feedback from the participants and to assist the Program in creating presentations that are of value to facility staff.
Onsite Visits and Meetings
The Laboratory Director and the Executive Director travelled to each site in the region three or four times this past year. These visits provide an opportunity for the Laboratory Director to meet with the individual Laboratory Managers to discuss site specific issues and to review EQA and quality management documentation. See Appendix D.
The Laboratory Managers meet as a group with the Laboratory Director and Executive Director bi-annually 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. In addition, monthly or bi-monthly teleconference meetings with the managers are held to discuss on-going issues.
A regional Microbiology Committee actively meets by teleconference 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 in individual operations and the regional manuals.
Laboratory Medicine is a service and often we think we have no control on our workload such as the number of laboratory tests performed or the number of call backs in a given week. Dr. MacDonald has been a champion working closely with two sites to find solutions to ease call back burden and staff shortages.
Recruitment, retention and succession planning of qualified staff continues to be a challenge for the laboratories of this region. The hard work and concerted effort to recruit has netted some new technologists. Consideration by the Region could be given to opening up its clinical training sites to other educational Colleges besides Cambrian College to ensure a pool of potential employees.
Those sites involved with clinical training found the experience very rewarding. Graduates have reported their overall training as a positive experience.
The Quality Management System – Laboratory Services (QMP-LS) and DigitalPT provide external quality assurance (EQA) programs specifically designed for Ontario laboratories. The goal is to provide a confidential assessment by which a laboratory can compare its internal test results to those of other laboratories.
A Regional review of EQA challenges is performed annually to assess performance to previous years. See Appendix E.
Each discordant result is followed up by a root cause analysis. The discordant results may have more than one root cause. The results are as follows
Statistical/method bias/matrix effect – 16
Technical -misinterpretation of results, calculation errors, QC limits sample mix-up, random error – 14
Materials – defective reagents/unsupported reagents, mishandling QMP-LS samples – 12
Failure to follow SOP – 4
Equipment function – 3
Organizational Factors- communication, training , missing SOP information – 10
Random Error – 5
A significant number of the discordant results were as a result of bias associated with a specific method. These required communication with the vendor and are not within the control of the individual laboratories. Some technical errors required changes to process and/or procedure while others required education and/or training of staff.
Accreditation and Audits
Audits are an intrinsic part of quality management and an essential management tool to be used for verifying objective evidence of processes, to assess how successfully processes have been implemented, for judging the effectiveness of achieving any defined target levels, to provide evidence concerning reduction and elimination of problem areas. In areas where the laboratories are encountering common problems, the Program will assist in collating audit results from all of the sites, analyzing the data and determining corrective actions as required.
Audits at each site may include:
- Test and patient volumes
- Patient wait times
- Turnaround times for operational processes
- Quality assurance metrics, for example rejected specimen rates, edited report rates external proficiency testing results, blood culture contamination rates
- Customer satisfaction – customer satisfaction assessment surveys and complaint
- Specimens received by the laboratory unlabelled or mislabeled, inadequate or incomplete specimens received by the laboratory, failure to follow collection process
- Patient identification
- Failure or delay to receive laboratory test results (e.g. delayed specimen receipt, delayed testing, reports not sent to physician, lost reports)
In summary, the Laboratories are meeting their defined target levels. Any corrective action items have been acted on expeditiously and the Laboratories are in position to meet the OLA requirements.
Goals Set for 2013:
- Complete Internal Audits for all 6 sites – Complete
- Prepare for 2014 OLA Peer Assessments – Complete
- Implement EXL Chemistry/Immunoassay analyzers at 5 of 6 facilities – Complete
- Implement Malaria EQA program – Complete
- Implement RapidComm for monitoring POCT Urinalysis – In Progress
- Implement Ant-Factor Xa (Heparin) testing – In Progress
- Competence Assessment for Managers/ Pathologists – Complete
- Develop procedures for result comparability – Complete
- 2013 Symposium, Fort Frances, ON, “Safety First” – Complete
Goals Set for 2013:
- 2014 Fall Symposium, Kenora, ON, “Partners in Action”
- Develop RFP for hematology analyzer
- Research new methodology for microbiology testing
- OLA – develop and implement corrective actions from findings of peer assessments