EXPERIENCE OF IMPLEMENTING QUALITY MANAGEMENT SYSTEM AT KITALE COUNTY HOSPITAL LABORATORY Mr.Daniel Wekesa

Background Quality management system is the Bible for a medical laboratory. It was uncommon in public laboratories in Kenya, and until recently, none of the nation Public Laboratories has been able to attain the SLIPTA necessary requirements to begin the process of attaining international accreditation.

Background The building and maintenance of a quality management system is demanding task for any hospital. However, Kitale county hospital laboratory began implementation of a QMS in 2011. In 2013 it was determined that the laboratory is in the process of conforming to the requirements of ISO 15189:2012 by last regional peer assessment.

Objectives To assess the experiences and practical effects of quality in Kitale county laboratory. To evaluate the effects on analytical quality To estimate the effects of pre analytical factors on patient results.

Methodolgy A retrospective study. Data was collected from 2011 when had baseline assessment up to 2014. Captured processes were noted in each step and analysed. Groups of laboratory staff from the Kitale county hospital laboratory spent time studying quality systems in a certified clinical laboratory, SLMTA trainings, mentorship. Internal and external audits , developed work plans and gap analyze records were verified .

Achievements Increase in confidence on results has allowed for reduction of risks and minimized repetition of examination and duplication. The reliability of examination results has provided the basis for correction and efficient diagnosis and further treatment. Impact of new diagnostic technology Gene Xpert has reduced TAT and Vitek machine (AST) in microbiology has reduced guess work and wastage in treatment.

Achievements The Kitale has monitored its quality indicators and conducted internal and external audits; the graph below demonstrates the measurable improvements observed in 3 years(from 2011 and to 2014) Progressive improvement of lab from star 1 to 3 stars in the recent peer assessment Improved staff competence and skills Increased staff morale

SLIPTA ACCREDITATION PERFORMANCE Points

Old kitale district hospital laboratory

NEW KCH LABORATORY NEW KCH LABORATORY

Vitek 2 compact analyser

VIDEO CONFERENCING AND MDR SURVEILLANCE

challanges Lack of service contractors for equipments Frequent power outages Stock outs of reagents and other acessories Laboratory has not enrolled all tests for EQA High Laboratory manager turn over.

CONCLUSION Although there was improvement in the pre- analytical and analytical indicators analysed. There are still challenges. Instill a culture of continuous quality improvement, benchmarking and setting laboratory on a pathways to towards accreditation.

Recommendation This experience shows that sustainability of the QMS at present is a cause for concern. However, the tiered system of SLIPTA being developed by WHO–Afro may act as a driving force to preserve the spirit of continual improvement

Lessons learnt Strong facility leadership and commitment by laboratory management are essential for sustained laboratory quality system changes. Teamwork between clinicians and laboratory personnel is very important for proper patient management. SLMTA is indeed a steping stone towards achieving laboratory accreditation.

“ If you genuinely want something, don’t wait for it-teach yourself to be impatient’ Thank you