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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