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