Life in the Rural Lab

Constance StagerManiilaq Health Center

Kotzebue, AK

Maniilaq Health Center

Kotzebue, AK

Maniilaq Health Center (MHC) is located in Kotzebue, Northwest Alaska, 30 miles above the Arctic Circle. It is part of a System (MHS) owned and operated by the Tribal Health Organization of Maniilaq Association that serves the 3,500 residents of the native village of Kotzebue, Alaska, and the estimated 8,000 residents of the 10 villages of the Northwest Arctic Borough and Point Hope (North Slope Borough).

Challenges• Personnel• Quality

• Inventory • Shipping• Service

Personnel

• Staffing • Training• Retention

Staffing• Maintaining a staff can be difficult• Cost of living and location make the area

unappealing• High number of locums/TDY staff• Living conditions and cost of rents

Training• TDY staff often 50% or more of staff• Staff have 13 week contracts• Constantly training new staff• Difficult to get qualified staff who do not

require extensive training• Maintaining quality standards very difficult

with constant turnover

Quality• Maintaining quality is a challenge• Changing staff means retraining every few

months• Staff come to the lab with different levels of

competency and commitment to quality• Quality dips with each new batch of locums

Quality• Must use creative means to ensure quality – Quality Calendars• Very helpful for periodic maintenance, QC, validations,

and correlations.

– Structured Training and Competency– Heavily dependant upon management

monitoring

MONTH: YEAR: 2010

5th SUNDAY 31 1 Pentra 2 3 Sysmex 4 Dimens ion 5 1st SATURDAY 6Cal ibrate Dimens ion Concentrated Cleanings Weekly Maint Weekly MaintBlood Bank Inventory Process Incoming Blood Blood Bank Alarm Send Back Short Blood Review"RE" Pending Log Micro QC Blood Bank Chart Change "RE" Pending LogPentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QCA-Test Reagent InventoryCk Stratus Cal ib Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Check for Expired

Clean Jewel l #1 Frig Pentra QC Sysmex QC1st SUNDAY 7 8 Pentra 9 10 Sysmex 11 Dimens ion 12 2nd SATURDAY 13

Cal ibrate Dimens ion Concentrated Cleanings Weekly/Monthly Maint Weekly MaintReview Blood Bank Inventory Process Incoming Blood Blood Bank Alarm Send Back Short Blood ReviewMil l ipore bacteria count "RE" Pending Log Micro QC Blood Bank Chart Change "RE" Pending Log Clean BB Refrig Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC A-Test Pack up monthly QC box Clean Jewel l #2 Frig Pack monthly Quest results Pack monthly inhouse box Reagent Inventory Ck Stratus Cal ib Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Check for Expired Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC 2nd SUNDAY 14 15 Pentra 16 17 Sysmex 18 Dimens ion 19 3rd SATURDAY 20

Cal ibrate Dimens ion Concentrated Cleanings Stratus Mo. Maint/QC Weekly Maint Weekly MaintReview Blood Bank Inventory Process Incoming Blood Blood Bank Alarm Send Back Short Blood ReviewMil l ipore bacteria count "RE" Pending Log Micro QC Blood Bank Chart Change "RE" Pending Log Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC A-Test Clean Revco Frig Clean Sm Revco Freezer Cleen Polestar Freezer Supply Inventory Ck Stratus Cal ib Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Check for ExpiredCal ibrate Dimens ion Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC 3rd SUNDAY 21 22 Pentra 23 24 Sysmex 25 Dimens ion 26 4th SATURDAY 27

Cal ibrate Dimens ion Concentrated Cleanings Weekly Maint Weekly MaintReview Blood Bank Inventory Process Incoming Blood Blood Bank Alarm Send Back Short Blood Quest/SO InventoryMi l l ipore bacteria count "RE" Pending Log Micro QC Blood Bank Chart Change "RE" Pending Log I-Stat Monthly QC Review Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC A-Test Clean LF225 Freezer Triage Monthly QC Inventory Ck Stratus Cal ib Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Dim QC/Pt Review Check for Expired Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC Pentra QC Sysmex QC 4th SUNDAY 28

ReviewMil l ipore bacteria count

morning startup person mid-morning person afternoon person night shut-down person

FRIDAY SATURDAY

TASK ASSIGNMENTS

JANUARYSUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY

QA Topic Monitoring Requirements Responsible Party Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec

Sysmex Daily QC Daily Heme Tech CSS CSS CSS

Daily Maintence Daily Heme Tech CSS CSS CSS

Sysmex Weekly Maintenance

Weekly Heme Tech CSS CSS CSS

Sysmex 6 Month/As Needed Maintence

Bi Annually Heme Tech

Hematology 6 Month Calibration

Bi Annually Heme Tech

CSF QC LOG Weekly Heme Tech

Retic QC Log Weekly Heme Tech

ESR QC Log Daily Heme Tech

HematologySOP REVIEWAnnually Lab Manager

CA 530 Daily QC Daily Heme Tech

CA 530 Daily Maintence Daily Heme Tech

CA 530 Monthly Maintence Monthly Heme Tech

Coag 6 Yearly Maintenance/PM Review

Bi Annually Heme Tech

CoagulationSOP REVIEWAnnually Heme Tech

Sysmex Led Calibration Quarterly Heme Tech

Refractometer QC Log Weekly Heme Tech

Fecal Occult Blood QC Log Weekly Heme Tech

Gastroccult QC Log Weekly Heme Tech

Clinitest QC Log Weekly Heme Tech

HCG QC Log Weekly Heme Tech

Ictotest QC Log Weekly Heme Tech

Acetest QC Log Weekly Heme Tech

Urinalysis Daily QC Daily Heme Tech

Urinalysis SOP REVIEWAnnually Lab Manager

Coagulation

Urinalysis

Quality Assurance Calendar

Laboratory Hematology

Hematology

Streck Standing order for SYSMEX QC

Biannually Heme Tech

Service Contract Renewal Annually Heme Tech

Standing order for Reagents

Annually Heme Tech NA

Manual VS Autodiff Correlation

Biannually Heme Tech

Equipment Correlation Biannually Heme Tech

QA Calendar Submission By the 1stof the Month Heme Tech

Submission of Peer Review Data for Heme

Every 10 days and according to Calendar

Heme Tech

Submission of Coag Peer Review Data

By the 5th of the Month Heme Tech

Daily Review of QC Results Daily Heme Tech

Result Review

Reports

Standing Order Renewal

Correlations

Inventory• Without the proper reagents and supplies

testing comes to a halt• Maintaining an inventory with changing staff

can be difficult• Orders take a long time to arrive and need to

be ordered well in advance• Delays: Weather, post office staffing

problems, lost shipments, FedEx

Inventory• Creative solutions– Synchronizing instrumentation and inventories– Borrowing from other hospitals on your flight

schedule– Agreements with other hospitals to perform

testing– Backup instrumentation for critical testing

Shipping• Multiple specimens shipped from villages

and to Quest, ANMC, or State• Bags get lost • Aged specimens• Specimens frozen

Service• Limits choice of instrumentation• Not all companies will service Alaska • Others will provide service but it may take 3-

4 days for a technician to arrive• Others may decide that they no longer want

to service Alaska and make getting service very difficult

Point of Care Testing

• MHC Lab oversees the POC testing program at Maniilaq Health Center and the 11 villages

• Challenges include:– Training and competency– Quality Control and Compliance– Distance to villages – Changes in staff

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Questions?

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Credits

Special Thanks To:

Maniilaq Association, Maniilaq Health Center Administration, and the Alaska Native Tribal Health Consortium

Time to Rest