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Delegates Report 69th Annual Educational Program and National Meeting
American Medical Technologist
July 9 – 14, 2007      Orlando, Florida

I began my week on Sunday with a full day of EQS.  The full EQS Committee meets at this meeting including all sub-committee chairs.  EQS is evaluating the type of questions utilized on the MT and MLT exams.  It is the responsibility of EQS and the sub-committees to maintain a current exam which test for the entry level knowledge base for each discipline.  This is an ongoing challenge.    

On Monday after I picked up my registration I attended the CLIA/Unannounced Inspection workshop which was very informative.  Needless to say it was a full house even though it was on Monday due to the importance of the subject. The speaker gave very informative tips on what the inspectors are looking for and how to be prepared for the unannounced inspections which are being conducted by all regulatory bodies.  Monday night I attended Future Planning Committee meeting where we revisited the AMT 5-year strategic plan to remove items already accomplished, set new goals and wrote a suggested implementation plan to forward to the Board of Directors 

On Tuesday morning President Baker officially welcomed all attendees to the 69tAnnual AMT Convocation.  The Chet Dziekonski Memorial Keynote speaker was Mary Feeley, CSP who spoke on the advantage of humor.  She was excellent and everyone enjoyed learning the advantage of finding the bright side of life as we tackle each day’s challenges. It was a very beneficial presentation.  The next session was a general session on infectious and biological substances and how to transport them safely.  Again, very informative and well presented.  On Tuesday afternoon I attended a workshop on transfusion complications that was very beneficial to me as I am setting up a blood bank in a new hospital.  The general session on Tuesday afternoon was a very interesting session of forensics and the role laboratory plays in assisting the medical examiners.  Tuesday evening brought more committee meetings.  Since Future planning had finished its agenda, I went to State and Federal Legislative for an update on the status of competitive bidding along with other Federal and state issues.  Be sure and keep current by reading the government news updates in AMT Events or going online to amt1.com.The grassroots committee is always on standby via internet for activity regarding legislative issues that could affect AMT members and each AMT member should also be ready to address any issues on the state and national level.   

The “Beach Party” got rained out so it was moved inside where a grand time was had by all.  The music was great and the food was fantastic.  As you arrived you traded your shoes for flip-flops and the party began.  I applaud everyone involved.  The Florida State Society did an awesome job along with AMT Meetings and Convention Planner Diane Powell and AMT Staff!   

Wednesday morning brought a rather different Meet the Candidates in that all candidates would be running non-contested but there was still a very interesting question and answer session in which all candidates presented themselves very professionally.  In Resolutions the proposed resolution from 2006 presented by Vern Hein requesting that AHI and CLC be allowed to sit as voting delegates had been reworded into the proper format and will be sent to the Board of Directors for consideration at the 2008 convocation.  No other resolutions were presented.  I attended the educational session on Compliance with Standards and Regulations Wednesday morning.  The afternoon general session was on Public Health specifically to Florida but covered topics applicable to all of us so it was also interesting.  Wednesday evening was lovely as we honored the OGM and MOM award recipients at the annual dinner.  As always, it was a special evening.  This year’s recipients are Judy Smith, MT (AMT), Order of the Golden Microscope and Bobby-Rose Wilson, RMA (AMT), Medallion of Merit.   Congratulations to both recipients. 

 Thursday I attended the session given by the Council on “How to Run a State Society” which was not only well done but held a packed house.  I also attended “How Full Is Your Bucket” given by Drs. Charlotte and Gerard Boe teaching us how to handle stress through managing the load in our bucket.  As always they entertained us while teaching us!  Great job!  The morning general session was on “Hospice and the End of Life.”  Not a topic we easily address but a very necessary one.  The legal aspects of dying were covered along with the emotional ones.  This was an excellent session.  Thursday evening brought the annual Awards Banquet which is always one of the highlights of the meeting.  This is always special night because there is no higher honor than to be honored by your peers.  Congratulations to our New Mexico State President Hilde Polasky and husband Ray for El Tecnico receiving 2nd place in state publications in the journal category.  Also, congratulations to the State Society on being an honor roll state society and “thank you” Hildie for your many hours of hard work!  Also, congratulations to all award winners – especially those in Western District – we had quite a few! 

Friday morning began with District Meetings and then on to the Town Hall Session.  One of the improvements in recent years is when registrants pick up their registration package they receive the Annual Reports which allows them the whole week to read all the reports.  So, no one has to read their report at the Town Hall Session where the Annual reports are given along with the Legislative report.  Also at this time the proposed by-law changes where explained, which were mainly housekeeping issues. This allows for a more efficient meeting with questions and time for updates to current items.  The Annual Business Meeting began right on time with 187 delegates being seated.  The proposed by-law changes passed. All applicants running for the Board of Directors were elected by acclamation.    They were Nancy Barrow and Paul Brown for the MT/MLT seats and Susanna Hancock for the RMA seat.  The recipient of the Virginia State Society Dusty Rhodes LIFE award this year was AMT Past-president Bobby Stewart.  This award is always given during the Annual Business Meeting and is kept a secret until awarded.  Congratulations, Bobby!  The new officers of the AMT Board of Directors are President Charles Baker, MT; Vice-President Paul Brown, MT; Secretary Roxann Clifton, MT and Treasurer Nancy Barrow, MT.   This was a very well attended meeting with 483 total registrants.  It was an EXCELLENT meeting and everyone involved is to be congratulated!!   

Following the Annual Business Meeting was the annual AMTIE meeting.  AMTIE President Patrick Cuviello reported AMTIE has had a very good year. There have been new modules added to the home study courses.  So go online and investigate your possibilities for continuing education.  The first five year cycle for mandatory continuing education is coming up and everything is on target at AMT Office for this.  It had been a very busy year but productive year for AMTIE.  With the AMTIE meeting adjourned, the 69th annual AMT convocation was called to a close.  

It was a truly great week.  A week to make new friends, visit with old friends, acquire  many hours of continuing education, have lots of fun and attend to AMT business.  I thank you for allowing me to serve as one of your New Mexico State Society Delegates.  It is always an honor and pleasure.

Respectfully,

 Barbara E. Ware, MT (AMT)


2007 National AMT
Convention Delegate Report
By Hildegarde Polasky, MT
July 28, 2007


Ray and I arrived in Orlando, FL for the 69th annual AMT Educational Program and Annual    Meeting mid day Monday, July 9 in time for the Publication and Nominating committee     meetings. There wasn’t much to do for the nomination committee since all delegates running     for positions on the board were running unopposed. The publication committee on the other hand had a lot of discussion about electronic publications. With the high cost of printing and postage, many states would like to publish their state journals or newsletters electronically.  Many questions were brought up of concerns about how the information would get to each and every member of the state societies for some don’t have access to computers. Some live in small isolated communities which don’t even have libraries where they might be able to access the Internet. The general consensus was that the actuality of electronic publications is five to ten years down the road. In the mean time, North Carolina State Society sent out their spring publication via e-mail as a trial and New Mexico will be putting our Fall issue of our journal on our web site as well as printing and mailing it to members.

We attended the opening ceremony and the Keynote Address. The subject of the keynote       address was about using humor in our daily lives dealing with patients, coworkers, family and all others we have contact with. The speaker, Mary Feeley, CSP introduces us to a new disease,     HDD or Humor Deficit Disorder and kept the audience laughing to the point of tears.

I then attended the general session which was about transporting infectious and biological substances. Vivian Montgomery who directs and does training for FEDX handling of these materials explained how to package these substances, what paper work must be completed      and how to make sure everything is in order. She explained the various categories of      substances and how to handle each.

The afternoon general session was given by Michael Bell, MD who is a forensic pathologist.        He presented ten case studies and how the laboratory helped the pathologist decide the       cause of death of these individuals.

Wednesday morning I attended the Resolution Presentation Meeting and Meet the Candidates. Vern Hine, MT gave an update of the resolution he presented at last year’s meeting to allow    AHI and CLC members to be voting delegates from states at the National Meeting. The       wording was not in the proper form to allow it to be presented to the board of directors and     was not modified in time for this year’s business meeting. It will be considered next year. No other resolutions were presented. The three candidates running for the board were all     incumbents and were unopposed. They all answered questions fro Chris Damon, AMT’s CEO      and from the floor.

I attended two other educational sessions. Sexually Transmitted Diseases about the same     ones we have known about for years and the newer ones such as Chlamydia, HPV, resistant      GC and Syphilis. With the advent of drugs for erectile dysfunction, STD’s are being diagnosed more often in the elderly. I also attended the session on an update of old and emerging pathogens. The emphasis was placed on Mycobacterium, mostly TB , Pertussis, and Influenza viruses. Dr. Timothy J. Cleary, PhD explained how these organisms are spread and how they   infect humans and animals to cause disease and how epidemics are spread.

The Tuesday night welcome party was lots of fun even though a severe thunder storm       canceled the out door party and we had to wait while things could be set up in one of the ball rooms. Our own Ray Polasky was presented with a plaque thanking him for all of his  donated work on their web sites by the Florida State Society. Paul Brown, MT, D. Min from Alabama       won our New Mexico gift which was a Nambe Ware bud Vase. The Awards dinner Thursday       was also a fun time. New Mexico was awarded for second place for our journal publication and was one of the state societies that were given acknowledgment of completing all required processes    to be selected as one of the Honor Roll of States.

I attended the District Leadership Forum which was for state presidents and district counselors on Thurs. morning and the regular District Meeting which was for all members on Friday morning. The Town Hall session was held after the District meeting where Annual Report, Legislative reports and an explanation of the proposed bylaw changes were presented. The annual business meeting started at 1:30 PM Friday afternoon, July 13, 2007. Those running for the board of directors were accepted by acclamation and the bylaw changes were approved by the delegates. Everything that was accepted or approved as well as the new board officers will be published in the next AMT Events. The AMTIE board meeting followed.

I thank my state society for selecting me to represent New Mexico at our National AMT meeting.

Respectfully

Hildie Polasky, MT

 


By

Laurel W. Christensen, MLS, CLC (AMT)

Laurel Christensen, MLS, CLC (AMT) is President of Laurel Christensen and Associates, Inc., a laboratory compliance and management consulting firm located in the Farmington, NM area. She received her Master’s in Environmental Microbiology and Laboratory Management from the University of Oklahoma in 1996. Her dissertation focused on chlorine stressed E. coli in the Farmington Wastewater Treatment Plant. Her research resulted in the issuance of municipal bonds for improvements at the wastewater facility. Laurel worked for the Scientific Laboratory Division of New Mexico Department of Health as a clinical and environmental microbiologist in the Farmington Branch Laboratory for 25 years. Upon the closing of the branch laboratory, she was contracted to the Public Health Division of New Mexico Department of Health in 1995 to bring 101 public health office laboratories in New Mexico into CLIA compliance for a moderately complex certificate. She retired from government service in 1999 after 30 years. Laurel has published several articles for industry journals on education of nursing staff in point of care and data management. She received her certification as a Certified Laboratory Consultant from American Medical Technologists (AMT) earlier this year. Laurel is an adjunct professor at San Juan College in Farmington. Currently she represents San Juan College on the Statewide Small Business Development Center Network Advisory Committee. She is active in AACC, CLMA, AMT San Juan Regional Science Fair and Toastmasters. Laurel is a founding director and treasurer for the Southwest Regional Point-of-Care Group, Inc.  This group was founded to assist individuals in the Southwestern states, Arizona, Colorado, New Mexico, West Texas and Utah to network and meet once a year for continuing education activities.

Graduation. The day so long dreamed of has arrived and nursing school is complete. A goal and aspiration are accomplished. For the newly graduated nurse, days of intense labor and love lie ahead as a career begins of caring for patients in various settings. The new employee reports to her new place of employment for orientation, anxious and ready to join the nursing force in healing arts. The skills of nursing have been learned well. A hard stark reality of laboratory testing done by nurses soon sets in as the new job requirements are learned. This part of nursing care is not addressed in nursing schools.

In the health care arena nurses are trained in the skills of assessing the clinical picture of the patient. Interpersonal relationship with their patient is very important to these angels of mercy. They are trained to look at the overall picture of the patient, not just a test result. On the other end of the spectrum is the laboratorian taught the skills of assessing the components of laboratory testing. A primary responsibility of laboratory technologists and scientists is a quality laboratory result from a patient specimen. To these watchdogs of quality, testing is not just a test result. It includes monitoring of temperatures, equipment, storage conditions, testing personnel competency, procedure manuals, quality control, quality improvement, data management, and regulatory requirements for the laboratory testing process. Bringing these two cultures together in the arena of patient care is the field of Point-of-Care or near patient testing. The cultures are entirely different in their approach to patient care, yet each must work together as clinical laboratory testing comes permanently to the patient’s bedside. One key to the solution is education. Both professions bring to the arena of patient care skills that are very necessary for quality patient care. Efforts must be made by both parties to understand the views and approach of the other party to the problem. This article will address the need for educational criteria in nursing curricula equipping the nursing professional with the necessary tools to determine if the results of a Point-of-Care test are valid or needs further assessment.

When the U.S. Congress passed the Clinical Laboratory Improvements Amendments, 1988, (CLIA 88) laboratory testing regulation compliance became a requirement for anyone performing a laboratory test on a patient in a clinical setting. CLIA is very generous in testing personnel educational requirements for moderately complex and waived testing. Moderate complexity testing requires, at a minimum, a high school education with documented appropriate training and orientation to do testing. Most non-laboratory personnel meet this requirement. Waived testing has no educational requirements to qualify to perform laboratory testing. However, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and College of American Pathologists (CAP) have stricter requirements for testing personnel performing waived testing. A minimum of a high school education is allowed but documented training and yearly assessment of employee testing skills is a requirement.

Laboratory testing began as an academic exercise of the basic sciences only performed by physicians. Early testing was done manually and was labor intensive. As the field of laboratory testing expanded and procedures became more complex, the duties of testing were passed on to trained non-physicians to assist in performing diagnostic tests. With the advancement of technology, laboratory testing has moved from the clinical laboratory to the patient’s side, now known as Point-of-Care.

With the introduction of the Ames reflectance meter in 1970 for the measurement of glycemic levels in diabetic patients Point-of-Care was born. As the 20th century came to a close, the direction in patient care steered toward a more patient focused delivery system in health care. Both physicians and patients like Point-of-Care because of the immediacy of response. Point-of-Care brings the tools of laboratory medicine to the patient bedside and the physician. This technology empowers the patient to be more involved in his care. Point-of-Care gives the provider and patient an almost immediate response to a question that requires an answer. The question may be related to diagnosis of disease, screening for disease, therapy monitoring, or treatment outcomes. The testing process allows the patient the answer while in the treatment facility without having to return for follow-up on test results.

Most Point-of-Care testing is considered in the waived category of testing. Waived tests are considered by the Food and Drug Administration to be laboratory tests so simple that error is negligible. An incorrectly performed test would cause no harm to the patient. Since there are hardly any educational requirements, almost anyone with minimal training can do Point-of-Care testing. The major bulk of laboratory testing in the Point-of-Care arena has become the responsibility of the nursing staff. Nurses are the staff that draw the specimens, run the tests and record the results. The sentiment exists that “I can’t remember a time when I didn’t do urine dipsticks.” Nurses have been doing them forever. We’re taught how to do them in nursing school . . . Essentially what happened is the lab people came up and trained us to do something we’d been doing for 20 years, “It was redundant-a waste of time, effort, money and salaries.” Nursing does not like quality control or personnel competency. In the ten years I have been training and assessing personnel competency in the Point-of-Care field, I have seen this resistance first hand. More than once I have been told: “You, and who else is going to make me do this?” The answer is simple, it is the law and it is required if the staff person is going to do Point-of-Care testing.

In most institutions, multi-disciplinary committees oversee the Point-of-Care Testing. Actual laboratory oversight of the program is assigned to a Point-of-Care Coordinator. This individual must meet the requirements in the CLIA regulations for a technical consultant. Most Point-of-Care Coordinators are Medical Technologists certified by the American Society for Clinical Pathology (ASCP) or American Medical Technologists (AMT). Some are clinical laboratory scientists. All must have at least two years of laboratory experience in a clinical laboratory. Nursing staff doing laboratory testing will have direct contact with the Point-of-Care Coordinator.

Most Point-of-Care Coordinators are responsible for the oversight of approximately 50,000 tests a year in their institutions. They must review all records pertaining to Point-of-Care Testing. Their responsibilities also include personnel competency and accurate testing techniques. In a recent small survey of four Point-of-Care programs, two in Texas and two in Arizona, I asked the coordinators if education and training of nursing staff in laboratory testing procedures brought more cooperation from the nursing staff. Bob Newberry, MT (AMT) Point-of-Care Coordinator for Yuma Regional Medical Center in Yuma, Arizona had this to say about education of nursing staff and Point-of-Care, “I agree that EDUCATION is the answer to 99% of the compliance issues I have in POCT. However, more time up front may NOT be the answer, at least not here. My take on what happens to a new RN, LPN, CNA and others when they go through “NURSING PROCESS” is a disservice to the employee. These folks are put through INTENSE training for three (3) days in a classroom. This is a MASSIVE amount of new/hospital specific information on how to take care of patients. It is NO WONDER to me that these individuals remember little or nothing of my one hour class. The REAL education of the employees in POCT occurs in the unit with dedicated educators with whom I have built an outstanding working relationship.”

Near patient testing is not a small business. In the four institutions I surveyed four Point-of-Care Coordinators were overseeing a staff of 5,394 non laboratory personnel. When queried concerning the average amount of time required to perform one laboratory test at a patient’s bedside, the answer was 27 minutes. This included all phases of testing, pre-analytical, analytical, and post-analytical. The average salary paid to members of the nursing profession is $25.00 per hour. When nursing staff performs a Point-of-Care test it costs the institution an average of $11.25 in labor. This cost is for one test. Taking the average number of tests done per institution and multiplying that cost, it will average out to $562,500 for the institution to pay for labor for this testing process.

The nurse quoted in the CAP article on nursing and Point-of-Care struck an interesting chord heard repeatedly by folks involved in Point-of-Care oversight. Yes, the nurse did learn to perform urine dipsticks in nursing school twenty years ago, but in time sloppy work habits develop. As technology evolves, manufacturers’ instructions change on how to do a test. CLIA requires two things of testing personnel. One is to follow manufacturers’ instructions for a test. The other is to maintain competency to continue to test patient specimens. Competency must be tested at least once a year. An improperly performed urine dipstick can yield wrong information to the clinician treating the patient. Sloppy procedure can result in erroneous results. Not following manufacturers’ instructions on the product insert can be just as harmful. A simple task such as not placing the lid firmly back on the container of dipsticks can ruin the entire contents of the container. In the many surveys I have done, this is a common practice among non-laboratory personnel.

Education is a valuable tool in the arena of healthcare. Education is defined in Webster’s Dictionary as “the process of training and developing the knowledge, skill, mind, character, etc., by formal schooling”. While Mr. Webster defines training to be “to instruct so as to make proficient or qualified”, if a basic course in laboratory procedures were interwoven in the educational curricula in nursing programs, the stress of laboratory testing by nurses would be reduced. In the survey, I asked the question “Do you think that if it were possible, nursing students and medical assistants receive education in laboratory practices as it pertains to the Point-of-Care arena during their professional training that it would assist you to do a better job and deliver better quality care for patients?” Mr. Newberry responded, “YES! In fact, after six years of crying to the local college nursing program director, I will present an “Introduction to POCT” at nurse-extern orientation this week.” Pam Green of the Mayo Clinic in Scottsdale Arizona stated “Absolutely! Especially if basic quality control and quality assurance practices are included in the education.” Deanna Bogner, 2003 American Association Clinical Chemistry (AACC) Point-of-Care Coordinator of the Year and of Christus Santa Rosa Hospital in San Antonio commented, “If lab training is included in a training program, it should probably be general knowledge type laboratory information. So many parameters are different in each institution that the information is probably better coming from each institution.” Also from San Antonio, Sheila Coffman of the University Hospital held the sentiment, “Education is always the key and more time to it makes more sense.”

If education is the process of training and developing the knowledge, skill, mind, character, etc., by formal schooling, then it makes sense to incorporate into formal education for nurses the very basic laboratory skills of quality control, quality assurance, basic understanding of regulations and proper testing procedures. This does not mean every test on the market would be covered. The basic way routine testing would be done on the common procedures in use in most institutions, i.e., following manufacturers’ instructions on how to do a test.

Institutions spend vast amounts of money on salaries, instruments and expendables for Point-of-Care testing. With the advent of basic laboratory testing education in nursing programs, error in testing would be reduced significantly. If one institution is spending approximately $562,500 a year in salaries for nurses to do testing, education would reduce the amount of repeat testing in quality control and erroneous patient test results and yield a savings to the hospital in repeated tests and failed quality control. The salary would be spent in other areas of nursing care. It would result in a nursing staff that had basic knowledge of how laboratory testing is performed. The nurse would understand why things are done the way they are. She would begin to view these procedures that have invaded her world of patient care as another tool to give her patients quality care. Ms. Bogner further added in her comments, “When I first started this job, a nurse told me I ‘made her do QC because I just wanted make her life harder.’ Two years later, in a training class with a new grad and a veteran nurse, the same statement was made by the new grad. The veteran nurse essentially gave the new grad a chapter and verse explanation of why QC is absolutely necessary for quality patient care. I sat there…grinned and never said a word…” That is what nursing is all about.

The author gratefully acknowledges the help of Robert Newberry MT(AMT) of Yuma Regional Center, Yuma, AZ, Pamela Green, MT (ASCP) Mayo Clinic, Scottsdale, AZ, Deanna Bogner, MT(ASCP) Christus Santa Rosa Hospital, San Antonio, TX and Sheila Coffman MT(ASCP) University Hospital, San Antonio, TX.

References Cited


Krosnick, Arthur, MD
2002 Five Decades of Diabetes Patient Care: The Time of My Life. Clinical Diabetes 20(4 November 4):173-78.
Demers, Laurence M., and Ehrmeyer
2004 Regulatory Issues Regarding Point-of-Care Testing. In Point-of-Care Testing, Second Edition. Christopher Price, PhD, ed. Pp. 163-69. Washington, DC: AACC Press.
Kurec, Anthony S., MS
1995 The CLMA Guide to Managing a Clinical Laboratory. Malvern, PA: Clinical Laboratory Management Association.
Price, Christopher P., St. John
2004 Point-of-Care Testing: What, Why, When, and Where? In Point-of-Care Testing, Second Edition. Christopher Price, PhD, ed. Pp. 3-9. Washington, DC: AACC Press, 05/07/26.
Titus, Karen
2000 From Nurses, POC Testing Gems. CAP Today, August.
Department of Health and Human Services, Center for Medicaid and Medicare Services
2004 Federal Regulations. CLIA Regulations.
 

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Last modified: 05/02/2008