Pathology – Making a Difference To Patient Safety and Quality K Pendry Consultant Haematologist WWL NHS Trust

Quality in the Pathology Laboratory Quality lies at the heart of the delivery of pathology services Incorporation of quality control and quality assurance into all aspects of laboratory practice has become second nature within pathology Supported by CPA with assessment against nationally recognised set of quality standards

New CPA standards are moving towards European harmonisation of quality management systems and introduction of ISO standards The Quality Management system provides integration of organisational structures, processes, procedures and resources needed to fulfil the quality policy and thus meet the needs and requirements of the service users Quality in Pathology

The ultimate objective of accreditation is that laboratories will provide a safer and more robust diagnostic service, founded on quality management systems. CPA standards only detail what should be routine practice in all good laboratories.

Section A standards equate to ISO 9001:2000 section on management responsibility Sections B, C and D standards equate to resource management Sections E, F and G standards equate to product/service realisation Section H standards equate to measurement, analysis and improvement CPA Standards

No amount of inspection will make the product Quality any better.

The only way to improve Quality is to improve the processes.

Make it clear management is committed to quality Raise quality awareness Train supervisors to actively carry out quality improvement programme Encourage individuals to establish improvement goals for themselves and their groups. Quality Management Implementation

Increased operating efficiency Performance improvement Cost reduction Reduction of expectation gap Reduction in lost time Defined service standard Involvement of all staff Benefits of Quality Management (taken from ISO9001:2000)

Quality is fundamentally about people, not products or services – it is the quality and attitude of your people that will determine the quality level of your organisation.

Delivering Quality Setting criteria and standards Comparing performance with criteria and standards Observing practice/data collection Identifying issues Implementing change Staff must have the right level of education, training and skills. Use principles of IPR, CPD, reflective practice

Other Drivers for Quality in Pathology Laboratories Blood safety and Quality Regulations 2005, compliance monitored by MHRA NPSA Safer Practice Notice 14 Right Patient Right Blood NPSA Patient Safety Alert 14: Actions that can make anticoagulation therapy safer Human Tissue Act 2004, compliance monitored by Human Tissue Authority NICE Guidance eg: on cancer services Getting Ahead of the curve 2002 – Inspector of Microbiology and Infection Control

The role of the pathology network – A series of discipline specific network advisory groups and cross cutting priority action groups meet regularly and report to the Pathology Network Board. Each Trust is represented on each of the groups Many of the issues discussed and actions delivered are associated with significant improvements in quality and patient safety

Network Quality Improvements Microbiology / Virology –TB working group –C Diff Working Group –MRSA working group –Urine testing criteria and demand management –Hepatitis investigation

Histopathology / cytology –Sample archiving and storage working group –Cancer reporting working group –Mortuary Staff Forum –Reconfiguration of cytology services Network Quality Improvements

Blood sciences –Rationalising referred tests across GM –Harmonisation of reference ranges, drug units and test codes –Harmonisation of interpretive guidance –Guidance on haematinics – investigation and clinical management –Paraproteins / electrophoresis and myeloma investigation –Anticoagulation group –Genetic haemochromatosis screening –Standardisation of Out of hours reporting Network Quality Improvements

IMT PAG –GP order communications –Lab 2 Lab links POCT PAG –Standardisation of approach to POCT –IT connectivity –Incident reporting –Training and competency assessment QM forum –Network wide specimen acceptance policy Network Quality Improvements

Quality is a journey, not a destination