1. PROFICIENCY TESTING Proficiency testing is a quality assurance test performed at regular intervals

2. PROFICIENCY TESTING 1. All analytes that are reported must be tested 2. All machines in use must be tested 3. All different types of iSTAT cartridges are tested 4. Testing is done 3 times a year, about every 4 months.

3. PROFICIENCY TESTING  The PT (proficiency testing) samples that we use are purchased from the College of American Pathologists (CAP)  Two types are kits are used: AQ kits for blood gas machines and SO kits for co-oximeters  The samples are packaged in individual small glass vials and contain “unknown” values for all of our analytes

4. PROFICIENCY TESTING  All kits need to be refrigerated when received  AQ kits, for blood gases, must be brought to room temperature before testing  SO kits, for co-oximeters, must be tested immediately after removing from refrigeration

5. PROFICIENCY TESTING  There are five separate “unknown” vials for each machine  PT samples must be tested by those individuals actually performing the clinical tests  PT samples must be mixed in with other regular clinical samples

6. PROFICIENCY TESTING Procedure for AQ kits:  Bring samples to room temperature before testing  Shake glass vial several seconds using minimal contact, with finger and thumb at opposite ends of vial  Break off top of vial and present sample to machine under “Other”

7. PROFICIENCY TESTING 4. PT samples for iSTAT should be run as regular samples. 5. Record results on CAP forms in spaces provided 6. Sign roster titled “Testing Personnel”

8. PROFICIENCY TESTING  Procedure for SO kits: 1. Use samples immediately after removal from refrigeration. 2. Shake glass vial several seconds, using minimal contact 3. Break off top of vial and present sample directly to co-oximeter

9. PROFICIENCY TESTING 4. Record results on CAP forms in spaces provided 5. Sign roster titled “Testing Personnel”

10. PROFICIENCY TESTING  After samples are analyzed all results are reported to CAP through an internet site  Our results are compared to other participants using the same equipment and cartridges as us  The results can be judged as “acceptable”, meaning that they are within the upper and lower limits of acceptability as compared to other labs

11. PROFICIENCY TESTING  Results can also be judged as “unacceptable” if they fall outside of the acceptable limits for similar labs  All results are reported to the State of Kentucky, Cabinet for Health Services  Unacceptable results must be investigated and each action taken must be documented.

12. PROFICIENCY TESTING Common actions to resolve unacceptable PT results include:  Recheck for clerical error  Check PM and maintenance logs for machine  Contact manufacturer for assistance  Run calibration validation controls

13. PROFICIENCY TESTING  PT results must be kept for three years.  PT results can be reviewed by accreditating bodies that survey the hospital, such as CAP, JCAHO, or state agencies  PT results are kept in a 3 ring binder in the dictation room, titled “SURVEYS” with the year that it was performed

14. PROFICIENCY TESTING  PT results are reviewed routinely by the Blood Gas Lab director, or designee,when received  PT results are also reviewed at intervals by our Medical Director, Dr. Stark  PT - It’s a quality measure to ensure accurate results.