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WSLH Proficiency Testing

Wisconsin State Laboratory of Hygiene

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WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

New, P.A.C.E. Certified Webinar on Proficiency Testing

Watch OUR webinar for an opportunity to receive a free, P.A.C.E CE credit upon completion

So, you’ve failed a proficiency test–now what? While it may be difficult to move to a course of action in the moment, preparing for this scenario ahead of time can give clinical laboratory professionals the tools we need to do so, with more ease. WSLH Proficiency Testing is offering you access to a new ASCLS P.A.C.E. certified webinar, developed in partnership with the Wisconsin Clinical Laboratory Network (WCLN)

This webinar aims to help participants know how to follow-up, prepare, and prevent common scenarios in clinical proficiency testing. While this webinar was originally created for the WCLN, WSLH Proficiency Testing is now offering you the same educational opportunity. We hope that this webinar will provide you with useful information to share with your staff. You may access and progress through the webinar at your own pace. Upon completion, you will have an opportunity to earn a P.A.C.E. certified C.E. credit. 

At the end of this webinar, participants will be able to:

  1.  Identify clinical proficiency testing best practice
  2.  Increase knowledge of labs’ experiences with conducting proficiency testing
  3. Explain what a laboratory must do when they have a proficiency testing failure

Participants will be able to take away key insights from WSLH Proficiency Testing’s technical coordinators serving on the webinar panel: Ann Hennings, MLS (ASCP) and Rhonda Stauske, MLS (ASCP). This P.A.C.E. certified webinar is graded at an intermediate level, meaning the educational content serves mostly as a refresher course with some basic knowledge of proficiency testing required for a participant to successfully complete the program objectives.

Oh no! I’ve failed a proficiency testNow what? webinar
Please click the following link to access the free, archived P.A.C.E certified webinar
for an opportunity to earn a C.E. credit upon completion: 
https://slhstream2.ad.slh.wisc.edu/Mediasite/Play/72ee607528264590a210cf03037e54241d

Note:
You will need to login (or register for free, if you are not a member) on the ASCLS CE Organizer webpage in order to claim your free P.A.C.E. credit. Once logged in, please click the Claim Credit tab in the top navigation bar. Then click on the ASCLS State and Regional tab to locate ASLCS-Wisconsin. You will find the webinar listed by date for November 2nd, 2022. Check the box to the right to select this credit. You will be prompted to enter in the information needed from there. 

Over the past few months, our technical coordinators at WSLH Proficiency Testing collaborated with other experts at the Wisconsin State Lab of Hygiene (WSLH) to support an educational training opportunity, as part of a series of educational webinars offered by and for a network of clinical labs in Wisconsin. This network of clinical labs is known as the Wisconsin Clinical Laboratory Network (WCLN), which is coordinated by Erin Bowles, MLS (ASCP), who we featured in an article last year about her unique role as a medical laboratory professional in providing outreach and support to clinical labs throughout the State of Wisconsin. We also featured the history of the WCLN, which offers outreach and resources to support emergency preparedness, disease surveillance, laboratory diagnostics, training and education, and communications. WSLH Proficiency Testing collaborates with other entities at WSLH to add value to the labs we serve. From our most recent collaboration with the WCLN, we hope you find this webinar to be a helpful resource for your staff.

As part of WSLH Proficiency Testing’s mission to improve laboratory quality for all, providing educational opportunities to promote career competency and achieve leadership development goals are very important to us in our unique role as a PT provider that is backed by a national public health lab and a Big Ten University. To learn more about other resources we offer labs, please view our resources page on our website at: wslhpt.org/resources. If you are interested in online training and competency courses to offer to your entire staff as a benefit for their professional development, please keep in mind WSLH PT’s comprehensive offerings of online training and competency courses.

If you have any questions about the content we cover in this free PACE certified webinar, please do not hesitate to reach out to WSLH Proficiency Testing: ptservice@slh.wisc.edu. Our team is happy to help yours, anytime. Supporting the quality of your lab is our mission. WSLH Proficiency Testing wishes you all the best as you wrap up 2022 and prepare your lab for 2023.

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WSLH PT Blog

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Paving the way for future MLS professionals

Chemist takes new apprenticeship route to Medical Laboratory Science certification

If you’ve swam at Hoyt Park, or dipped your toes in the water along the Lake Michigan shoreline in Milwaukee, you’ve got laboratory professionals to thank for monitoring water quality day-after-day. For the past four years, Rebeca Pinhancos had been responsible during summers for testing and monitoring microcystins in the city’s lakes. Primarily, she worked in Lead analysis as a chemist at the City of Milwaukee Public Health Department (MPHD). At this point in her life, she knew she needed a change in her career. Nearly a decade ago, Rebeca started her educational journey in Analytical Chemistry at UW-Madison. Then, what drew her to her studies was the desire to solve problems using the power of scientific inquiry and analysis. Today, it is this very same desire that pulls her back to learn more, but this time while she works. 

Rebeca began to research job positions at hospitals, and had discovered that degrees specializing in clinical laboratory science exist! She learned that many, if not most, certified medical laboratory scientists obtained their educational requirement for certification this way. Little did she know that during her research she would find an alternative path to certification through the State of Wisconsin’s first and only Medical Laboratory Science (MLS) apprenticeship program.

Rebeca Pinhancos is one of the first two participants in the MLS apprenticeship program, which was launched in January 2022 by Mike Baron at Milwaukee-based Wisconsin Diagnostic Laboratories (WDL). At the time of hire, Rebeca knew she was going to be an excellent asset and have a lot of growth opportunity from the start, with her degree and 10 years of experience in Liquid Chromatography, Mass Spectrometry (LCMS). She was pleasantly surprised to learn several months later on the job that WDL would be directly supporting her track to certification by offering her inaugural participation in the MLS apprenticeship program. The MLS apprenticeship program, was designed to provide an alternative path to certification for individuals with relevant science degrees. The apprenticeship model, applied as a recruitment and retention strategy within the Clinical Laboratory Science profession, may provide the kind of quality training, instruction, support, and institutional capacity-building to help address the problem of staffing shortages at clinical laboratories.

“When I was approached with the apprenticeship proposal, I thought, wow, you are also going to pay for my schooling too?! That’s great,” Rebeca said. Rebeca added that when she started attending classes at MATC, she ran into one of her former students, who was very surprised to see her there heading to a classroom, and not as an instructor this time. Before coming to work for WDL in 2021, Rebeca also served as an Instructor of Biochemistry at Milwaukee Area Technical College (MATC) for a two years. Attending MATC under the apprenticeship program certainly has given Rebeca a lot of unique perspective, having now both attended and taught classes at the institution.

“I am really grateful that the coursework is an important component of my experience as an apprentice. You really need the coursework to put the bench work into context,” said Rebeca. “You can train people to run the benches; but, if you encounter something unexpected and you do not know why it happened, the coursework aids you in readily identifying the problem, and how to pivot to find a solution.” With just over 75% of the apprenticeship program completed, Rebeca will begin preparing for the exam to become certified in Chemistry in 2023. Afterwards, once she gets enough qualifying hours on the Hematology bench, she will take the exam to become certified in Hematology.

She is looking forward to the next cohort of apprentices at Wisconsin Diagnostic Laboratories. “With any new program, there is more opportunity to improve and grow,” Rebeca said, adding that she is grateful to be a part of that experience, and to extend what she’s learned to the new participants next year. “I really like the idea of alternative approaches to Clinical Laboratory Science. It’s kind of how we have to operate these days,” Rebeca said. “Not everyone starting out school is going to know that they want to be working at a hospital as a clinical laboratory scientist.” 

For qualified candidates interested in joining the MLS apprenticeship program, individuals with a relevant science degree, in chemistry or biology for example, are encouraged to visit WDL’s career webpage and explore their non-certified technologist positions currently open. Apprentices are hired on a rolling basis, as non-certified positions become available. On-the-job training begins once hired, with classroom instruction beginning at the start of the new semester. To learn more about Wisconsin Diagnostic Laboratories, visit: www.wisconsindiagnostic.com

 

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Growing MLS Certified Leadership

New Apprenticeship Program Aiming To Make MLS Career A Dream Come True For Many

It was the 1980s. Mike Baron had freshly stepped out active service in the armed forces, and with a wife, a child, and another child on the way. Mike was hungry for a job, but not just any job. With a Bachelor’s of Science (BS) degree on his resume, Mike had been exploring many different employment avenues, but none of the options that he had encountered at the time were particularly fulfilling, or paid enough to support his growing family. One day, Mike saw an advertisement in a local Illinois paper for the Rockford Memorial Hospital, announcing that they were hiring individuals with BS degrees to become certified Medical Laboratory Technologists through on-the-job experience. Mike was hired, and placed under the supervision of certified Medical Technologists for a year before becoming certified himself. Mike could clearly see that this was a place that could provide him growth in his career, and where he could make a real impact on life-saving healthcare. That is how Mike Baron, Executive Director of Clinical Laboratory Operations at Wisconsin Diagnostic Laboratories, got his start as a medical laboratory professional over 30 years ago. Mike says that he is living proof that taking an alternative route to becoming a certified Medical Laboratory Technologist is a viable and beneficial option, and wanted to extend the same opportunity today. This year, through the establishment of Wisconsin’s first and only Medical Laboratory Science (MLS) Apprenticeship program, Mike is collaboratively repaving the route to certification that he took decades ago, aiming to provide a more sustainable way to address staffing shortages and assure the longevity of the profession.

In partnership with the State of Wisconsin and Milwaukee Area Technical College (MATC), Mike and the rest of his team at Wisconsin Diagnostic Laboratories (WDL) launched the MLS Apprenticeship program in January 2022. Individuals with science degrees from an accredited four-year college or university are recruited to become certified medical laboratory professionals upon completion of the apprenticeship program. Once a candidate is hired, WDL provides the hands-on experience to attain the skills, which is accompanied by on-site or in-the-classroom curriculum provided by MLS instructors at the Milwaukee Area Technical College and Madison College. The MLS apprenticeship program is a Wisconsin Certified Apprenticeship, meaning that the State of Wisconsin’s Department of Workforce Development partners with industries, area technical colleges, and private training centers throughout the state to provide individuals a path to a career. Historically, many technical industries in Wisconsin, from cheese processing to building construction, have been the primary sites for apprenticeships. Mike Baron recognized within the apprenticeship model the kind of quality training, instruction, support, and institutional capacity-building that could benefit clinical laboratories greatly. These are the qualities Mike says, that make the MLS apprenticeship program a key strategy in the recruitment and retention of medical laboratory professionals.

“We are at a critical juncture where we cannot ignore the problem of staffing shortages any longer,” said Mike. “We are working together with the State of Wisconsin to close the gap in staffing our laboratories with certified, experienced Medical Laboratory Scientists.”

Mike’s career path was made possible by the CLIA Amendments of 1988, which served as a national response to staffing shortages by allowing clinical laboratories to hire and train qualified individuals to become certified Medical Technologists after a period of supervised on-the-job training. Three decades later, the recruitment and retention of lab staff is, now more than ever, a perineal problem that has been studied, discussed, and written about many times over. Forbes magazine indicated in their April issue this year that clinical laboratories across the United States are 20-25,000 short on staff, approximating “roughly one Medical Laboratory Scientist per 1,000 people.” Other factors such as the COVID-19 pandemic and the closure of MLS programs and departments across the United States have further exacerbated the recruitment and retention of quality, certified lab staff. Wisconsin Diagnostic Laboratories’ MLS Apprenticeship program was designed, Mike says, to serve as a critical response in addressing the needs of today’s clinical laboratory, by creating with intention a quality program for more individuals to become certified Clinical Laboratory Scientists through the American Society for Clinical Pathology (ASCP).

“We had no problem finding people who are straight out of college, motivated, and looking for some type of work in the science industry, and we can sell it easily in terms of giving them a lifelong career,” said Mike Baron.

The program’s two inaugural participants are about 75% of the way through towards completion of the apprenticeship. Since January, they have been working under the supervision of WDL’s Medical Laboratory Scientists conducting on the job training, and gaining the theoretical knowledge needed through classroom instruction provided by local area technical colleges. Once trained and certified, students are not required to continue working for WDL, but are given plenty of incentives for them to stay, Mike adds. WDL employees who may decide, upon completing the MLS apprenticeship program, to move to another clinical laboratory for work is one way that the MLS apprenticeship program can broaden its positive impact throughout the United States in the future.

For qualified candidates interested in joining the MLS apprenticeship program, individuals are encouraged to visit WDL’s career webpage and explore their non-certified technologist positions currently open. Once individuals submit an application for consideration of a non-certified technologist position, if they meet the requirements, the candidate will move through the selections process for an interview with Wisconsin Diagnostic Laboratories. Apprentices are hired on a rolling basis, as non-certified positions become available. On-the-job training begins once hired, with classroom instruction beginning at the start of the new semester. To learn more about Wisconsin Diagnostic Laboratories, visit: www.wisconsindiagnostic.com

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WSLH PT Blog

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Final rule from CMS & CDC on PT programs

On July 11, 2022, CMS and CDC issued a final rule [CMS-3355-F] to update proficiency testing (PT) regulations related to analytes, acceptable performance for laboratories, and administrative processes for proficiency testing programs established under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The final PT rule considers improvements in accuracy and precision of testing since 1992 and new and emerging technologies.

The effective date of the revisions to PT requirements (§§ 493.2 and 493.801 through 493.959) will be July 11, 2024, two years after the publication date of this final rule in the Federal Register.  The delayed effective date reflects the timeframe PT programs will need to produce or acquire PT samples to meet the revised regulations and incorporate any updates to PT reporting requirements.  In addition, laboratories will need time to prepare and enroll in proficiency testing to meet the new requirements once the samples are available from the PT programs.  However, the regulations related to laboratories performing tests of moderate complexity and high complexity testing that also perform waived testing and proficiency testing enrollment (§§ 493.20 and 493.25) will be effective 30 days (August 10, 2022) after the publication date of this final rule.

WSLH Proficiency Testing will keep you up-to-date in our communications on how we are aligning our PT programs with the final PT rule. If you are not already receiving our monthly newsletter, please sign up here to receive relevant updates and more. You may also follow WSLH Proficiency Testing on LinkedIn to receive information directly to your newsfeed. If you have any questions, please review the fact sheet on the CLIA website, or download the fact sheet directly here

You can download the final rule from the Federal Register at: https://www.federalregister.gov/documents/2022/07/11/2022-14513/clinical-laboratory-improvement-amendments-of-1988-clia-proficiency-testing-regulations-related-to.   You may also go to https://www.federalregister.gov/ and search for “CMS-3355-F.”

WSLH PT Blog

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The Search For CE Credits

Continuing Education Resources for Laboratory Staff

Continuing education instills in us a culture of life-long learning, which is intrinsic to the ever-changing nature of our scientific profession as laboratory professionals. There are a lot of resources available that offer both formal and informal training for a variety of purposes that help us achieve our professional development goals. For many laboratory professionals who work in CLIA certified clinical labs, it is required to complete CE credits to maintain certification with the American Society of Clinical Pathologists (ASCP). Cost can be a big factor in our search for credits, especially for those much sought after ASCP P.A.C.E.® certified credits. In this article, we look at some of the available resources by cost, review some pros and cons commonly associated with those resources, and discuss how lab staff can be supported in their efforts to attain Continuing Education Units (CEUs).

If you are one of those Medical Technologists who works to maintain their “MLS (ASCP)” certification every three years, finding reliable and affordable ASCP P.A.C.E.® certified credits can be a challenge. For many of us, we are constantly on the search, asking our clinical lab peers for recommendations on where to find free or low cost courses. Some companies and organizations that offer free, on-demand PACE® certified units include ARUP Laboratories, Beckman Coulter, and CDC Train, the Centers for Disease Control and Prevention’s training system. To search for free, PACE® certified courses in CDC Train, select the option of “Free Courses” under “Common Filters” and “PACE” under “Credit Type” in the Filters side bar on their continuing education course offering page.

There are certainly pros and cons to individuals finding their own free, Continuing Education Units (CEUs). The availability of courses that are free is certainly one of the primary factors in an individual’s decision to conduct their own search for resources. However, a few of the cons that have encouraged some laboratory professionals to purchase access to online training and course competency tests include “peace-of-mind” and an “easy experience.” For example, many individuals are familiar with ASCP’s continuing education credit offerings; and may choose to pay for their courses. However, if an individual is expected to cover their own costs associated with attaining credits, then monetary investment may be a deciding factor in choosing to “go the free route.” Given such pros and cons in gaining CEUs, laboratory managers are increasingly offering their staff access to CEUs as a job perk, or advantage, to help their employees maintain their certification.

Increasingly, laboratory managers are offering free and easy access to attaining CEUs by purchasing continuing education packages for their staff. With WSLH Proficiency Testing for example, lab management can purchase training and competency bundles at minimal cost with access for up to 30 users. Additional users may be added for a small fee. WSLH Proficiency Testing partners with the University of Washington’s Medical Training Solutions (MTS) to offer online training and competency courses. This low-cost fee helps WSLH PT’s partner instructors assure that the 50+ Continuing Education (CE) coursework is fully customizable and stays in step with emergent learning trends. Full customization means that clinical labs can select their own tests tailored to staff training and individual professional development goals, as well as upload, streamline, and track your documentation. You can also expect high quality multimedia content developed by the University of Washington. Clinical labs can learn more, view products, and request a demo account online on WSLH Proficiency Testing’s website.

Whether or not the CEUs are attained for the primary purpose of maintaining certification, continuing education helps lab staff fulfill their needs and desires to expand their knowledge base and gain leadership skills as they progress in their careers. According to an article published by Lab Manager in 2019, laboratories indicated a variety of preferred training methods beyond the realm of attaining CEUs, such as: monitoring quality trends, conducting annual employee training documentation reviews, taking a class, attending workshops and joining a committee of a professional association. For those who can leave the bench for a day or so, attaining Continuing Education Units (CEUs) at conferences is one of the preferred ways many laboratory professionals receive the CEUs and other forms of training needed to stay current. For those attending conferences this year, ASCP and AACC will be hosting conferences in-person this year. The 2022 AACC Annual Scientific Meeting and Clinical Lab Expo will be held on July 24-28 in Chicago, Illinois. The 2022 ASCP Annual Meeting and 100th celebration will be held in Chicago, Illinois as well on September 7-9. Continuing Education credits will be available for attendees to earn at both of these conferences.

Within the healthcare field, technology and testing protocols are ever-changing to meet today’s needs. To help us navigate our increasingly demanding jobs to gain CE credits, many more online offerings are available than ever before to bridge the gaps in training access. Having immediate access online and studying at your own pace can help to better balance all of the other necessary tasks in your day-to-day workload. Lab managers are also stepping in to provide easy access to their employees through purchasing continuing education packages that can be customized for their staff’s needs. There are a variety of ways people attain CE credits and other forms of training to help them succeed. Our purposes vary as well, from gaining CE credits for maintaining certification to developing our leadership skills needed to progress in our careers and to transition into leadership roles. However you are working towards professional growth goals, WSLH Proficiency Testing wishes your team the all the best in your pursuits and achievements. 

 

 

 

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Developing ourselves, together through service

We all know that making connections and continuing our education matters for our development as clinical laboratory professionals. Joining a professional clinical association can be an excellent avenue for boosting our professional development. There are countless benefits for our membership in a professional association. We network and connect with others at conferences hosted by professionals associations, for various reasons. We obtain continuing education credits (CE) at conferences and year-round online. We also take other avenues to educate ourselves and others through training and competency coursework offered by colleges or other providers dedicated to clinical laboratory improvement. Taking advantage of these learning opportunities help us stay proficient in our knowledge, skills, and abilities and helps us stay up-to-date on industry trends. What we may not always take into account is the beneficial return we receive when investing some of our precious time and energy to take on a leadership role or invest in our education. Clinical laboratorians are very busy year-round; how do we justify the time we spend on our professional development initiatives?

Our time and energy is precious. If you are thinking about volunteering, be sure to spend plenty of time reflecting and discerning why you’re taking on a leadership role. Choosing volunteer opportunities that provide a selections process can help determine if the project or committee goals align with your professional development and leadership goals. Regardless of the organization’s process, understanding why you are getting involved can help determine if the service position is relevant to you, and a nourishing environment for your development. Do you want to deepen your professional relationships? Do you want to find ways to increase knowledge-sharing in the industry? Do you want to develop your leadership competencies to help you step into a managerial role? It is important when considering your involvement in a professional association that you feel an enthusiastic “Yes.” If you are feeling neutral about the subject, you may need more time or different questions to determine your interest. If you are not feeling enthusiastic about getting involved, it may mean that other areas of your work and life need your attention and care instead.

Volunteering can significantly impact our learning experience, assuming that our model of leadership development is based primarily on direct, practical experience. Taking on a leadership role with a professional association can therefore be a great way to supplement our current on-the-job experience. Seeking volunteer experiences outside of our industry and in the communities where we live also provides us learning and leadership opportunities that we can carry with us into our careers. There are so many skills that you already use every day at work and at home. What do you want to learn? When seeking volunteer opportunities outside of work, cross out the “can do” skills and focus on the “want-to” skills – the ones that you could see yourself using every day without getting bored. Learning skills outside of work that you will enjoy will help you develop strengths that can impact your career and quality of life in ways that you may not expect. Start out by recognizing the strengths that you are already using in your everyday life. Print out a list of strengths or gifts, circle the skills and abilities that you have and underline the ones that you want. Don’t forget to add your own, if you do not see your particular strength or gift listed!

If you are interested in getting involved in a professional association, maintaining annual membership is the very first step, of course. There are many national and international professional associations with regional and state chapters where you can get involved. Below, you will find a list of the professional associations known for their substantial membership and volunteer opportunities. Click on the hyperlinked text to discover ways to get involved, including governance councils, program committees, and communications teams.

  • AABB: International, not-for-profit association representing individuals and institutions involved in the field of transfusion medicine and cellular therapies. Formerly known as the American Association of Blood Banks.

    Get Involved: AABB Assessor, Mentoring Program, Committee Membership, Junior (Student) Committee Membership, Social Media Collaboration, Leadership-Run for Office, Transfusion Medicine Section, Cellular Therapies Section, AABB Hub (Knowledge Sharing Forum)
  • American Society for Clinical Pathology: Mission is to provide excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals across the globe

    Get involved: Public Policy, Career Ambassador 2.0, Patient Champions, Partners for Cancer Diagnosis and Treatment in Africa, Center for Global  Health, Choosing Wisely, Social Media Team, Governance and Member Councils, ASCP Product Development, and BOC Exam Committees
  • CLMA: An international association whose mission is to empower laboratory professionals to achieve excellence in leadership through forward-thinking educational, networking, and advocacy opportunities

    Get Involved: Regarding CLMA Chapters, ASCP is now coordinating the activation of CLMA Chapters in your local area. For 2022, ASCP is waiving the Chapter administrative fee, as CLMA members transition to membership with ASCP.

Getting involved by volunteering, whether with a professional clinical association or with a community organization of your choosing, is a great way to reflect on the strengths you have and to gain the strengths that you want. Giving time to reflect and ask ourselves discerning questions can help us frame our thinking in ways that align our achievement values, professional goals, and leadership development choices. Developing our professional selves with more care and intention helps us become more aware of our strengths and areas of improvement as leaders, helping us joyfully grow our impact for ourselves, each other, and for next generation of clinical laboratory professionals. When we purposefully engage ourselves in community-centered, learning experiences, we open up the doors for more leadership opportunities in our career, and beyond.

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Enhancing The Role of Lab Professionals In Patient Care

Every year during Medical Laboratory Professionals Week, we are reminded that 70 percent of “today’s medical decisions depend on laboratory test results.” Medical Laboratory Professionals get the results that make an impact on patient care. How lab test results are interpreted is another story that does not often appear in discussions surrounding this statistic. Having more discussions on the interpretations of lab test results is an issue occupying the foremost concern and attention for many laboratory professionals. Such an issue has certainly received more focus with the release of key reports in professional journals and their coverage by industry media within the past 7 years. In response to the Institute of Medicine’s 2015 report Improving Diagnosis in Health Care, everything from doctoral programs to informational, on-the-job handouts, have been produced to address the interpretation of results with the following solution: enhance the role of the clinical laboratorian on the patient care team. Enhancing the role of clinical laboratorians, with the knowledge, skills, and abilities that they bring, is vital in providing the most informed diagnosis. The kind of problem-solving strategies developed to enhance our role demonstrates that education is at the core of the solution, educating ourselves and educating our colleagues outside of the lab. The solutions that manifest always result in a more highly collaborative team of healthcare professionals.

In 2015, the Institute of Medicine released a report, Improving Diagnosis in Health Care, stating that diagnostic errors affect 5% of US adults seeking outpatient care each year, and contribute to approximately 10% of patient deaths and 6% to 17% of hospital adverse events. The report indicated that diagnostic errors cause patient harm, and attributed the statistical occurrences to a gap in communication between physicians and laboratory professionals.  Increasing intentional collaboration is required in order to close the gap, and, ultimately improve the diagnostic process, the report concluded. Not long before the release of this report, the Center for Disease Control and Prevention (CDC)’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC) conducted a survey to determine the strategies necessary to address this gap in communication. In the survey, family and general internal medicine physicians reported uncertainty in ordering diagnostic tests in 14.7% of patient encounters and 8.3% uncertainty in interpreting results. The survey also found that only 6% of the physicians surveyed consult laboratory professionals at least once a week or daily. In fact, this was the least frequently reported approach to discerning what test to order and how to interpret the test results. Those 6% who did contact laboratory professionals indicated that it was in response to “confusing ordering options on the computer/electronic medical record” or, “when the lab results do not match the patient symptoms.”   It is clear from these statistics that uniting the laboratory with direct patient care is a key component in improving the diagnostic process.

How do we work together to minimize the occurrence of misdiagnosis? Researchers, educators, and others in the field know that the role of the laboratory professional and the knowledge of laboratory science is a vital component on healthcare teams to improve diagnosis. According to the February 2017 issue of Laboratory Medicine, “Some laboratory professionals have become an important member of the clinical team by providing interpretive comments, developing reflex testing programs, and participating on multidisciplinary and diagnostic management teams.” Certainly the creation of the Doctorate in Clinical Laboratory Science (DCLS) program within the past decade has enhanced the role of clinical laboratory scientists on diagnostic management teams (DMTs) today.

Brandy Gunsolus, DCLS, MLS (ASCP)CM, was the first graduate of a DCLS program, graduating from Rutgers University in May 2018. Gunsolus documented her training and her thoughts from the field as a DMT leader in her blog, The Road To DCLS. Here she frequently writes about what many laboratory professionals wonder: what kinds of questions do physicians ask her? She answers that some of those questions may be highly complex, requiring more training on the part of lab staff. However, she says she also answers many questions that “virtually every medical laboratory professional should be able to answer.” Regardless of your official job title in the lab, Gunsolus emphasizes the importance of obtaining CEUs, as they are “essential to us staying current in our profession.” There are excellent online CEUs as well as those offered in-person conferences, like those offered at the ASCLS Joint Annual Meeting. Regarding online resources, WSLH Proficiency Testing, in partnership with the University of Washington’s Medical Training Solutions (MTS), offers customizable online training and competency courses to help labs achieve professional development goals.

“Education is always the key!” Gunsolus says on the importance of including laboratory professionals on healthcare teams. “We must educate ourselves and educate our other healthcare professionals if we are ever going to improve our profession and our patient’s care and safety.”

A brief and compelling look at a few key statistics give us a helpful snapshot of the current climate of laboratory and patient care staff relations. A deeper look at what is being done today will further demonstrate that healthcare teams must work with and include laboratory professionals in order to improve and maintain accurate and reliable patient diagnoses.  Stories of today’s clinical lab trailblazers like provide a unique vantage point regarding what is required to develop mutually-informed, highly collaborative diagnostic teams. Education is required, and takes a two-pronged approach: 1) Educate Others: Include laboratory staff as knowledge-sharers and team members in patient care delivery, and 2) Educate Yourself: Strive to obtain CEUs regularly, and find other professional development opportunities to stay current.  Enhancing the role of the clinical laboratorian in the diagnostic process and on patient care teams will, in turn, greatly impact our visibility to the public as a healthcare professional and as a viable career choice. Laboratory professionals get results each and every day. In honor of your important contributions to healthcare, WSLH Proficiency Testing would like to take this moment to thank each and every one of you for all you do to make a difference.

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Telling Stories

Medical Laboratory Professionals are needed now more than ever. Studies, articles, podcasts, and panel discussions all point to the same primary challenge in the Medical Laboratory profession: clinical laboratories cannot find enough qualified professionals to fill positions. Although staffing shortages have long been a problem, the COVID-19 pandemic has compounded this issue. WSLH Proficiency Testing has also written about the topic of staffing shortages, interviewing instructors and sharing stories from professional associations about student recruitment strategies. These leaders discuss tackling a core problem in recruitment: increasing public awareness of the medical laboratory profession as a viable career choice. More and more, laboratory professionals are emphasizing the potential to build capacity for recruitment through everyone’s ability to leverage social media, at home or at work. As Medical Laboratory Professionals Week approaches in April, we are reminded that each and every one of us can make an impact by sharing our experiences online. 

Public awareness of the medical laboratory profession has increased significantly out of media coverage highlighting lab staffing shortages. Instructors and outreach coordinators emphasize the importance of leveraging this heightened awareness to show the public that the clinical laboratorian plays a vital role in delivering quality healthcare. But how? Through storytelling, says Nadine Fydryszewski, PhD, MS, MLS (ASCP), in a recent AACC article on the need to prepare early-career individuals for clinical laboratory leadership roles. Within this article, she more broadly discusses the importance of building public awareness about the profession as an excellent healthcare career choice.

“Public awareness has increased somewhat due to media covering the shortage of laboratorians, but we also need to tell the story of what we do and how the diagnostic services and patient data we have is critical to quality care,” Fydryszewski said. “Promoting this awareness can contribute to an increasing awareness of medical laboratory science as a career path for those with an interest in science and healthcare.”

Telling our stories as medical laboratory professionals means that we all have an important role to play in attracting students the field. More traditional methods of recruitment, such as career fairs and guest speaking events, are effective for one-on-one connections; but, these methods alone do not provide the broader reach of experience-sharing needed to help individuals come to a decision about their career pursuits. A now decade-old study conducted by Neilson, revealed that 92% of people will trust a recommendation from someone they know while 70% will trust an online recommendation from someone they don’t know. Clearly, the use of social media and other online platforms has grown exponentially. Although this study is specific to advertising, the rise in social media and, in turn, an individual’s presence online strengthens the claim resting at the forefront of this statistic: Sharing our experiences online no matter our age is critical for other individuals to gain the insight and trust needed to make any important decision, especially when financing is factored into those decisions.

Telling our stories on social media is one effective tool in our strategies to attract secondary and older grade school students to the field of Medical Laboratory Science. Marketing studies (and parents alike) illustrate that Gen Z wants deeper interaction with online content, and seeks personalized social media efforts. Professional associations in clinical laboratory science are using social media to let prospective students know what it means to be a clinical laboratorian, and the various career paths that are available. The fact that anyone’s post can influence someone’s career decisions makes social media a very powerful tool to be used with care. Why not be the positive influence in a student’s life by sharing your story? We never know who we are going to impact.

Every medical professional out there can play a part in recruiting students to the profession by sharing their story and resources about the field. This year, Medical Laboratory Professionals Week is April 24-30th, which provides a great opportunity to highlight the role of the clinical laboratorian as a key member of a healthcare team. Take some time to record a 1-2 minute video on your phone about why you do what you do and why it matters to you. Write 50-100 words, and find a picture to accompany your post. Share your story, in whichever form you choose, on your social media using the hashtag #Lab4Life. There are also promotional materials, such as videos and career recruitment toolkits you can share throughout the week on the American Society for Clinical Laboratory Science (ASCLS) webpage for Medical Laboratory Professionals Week. WSLH Proficiency Testing hopes that you celebrate and feel celebrated during Medical Laboratory Professionals Week this year. Thank you for all that you do to impact patient care.

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Steering Clear: Avoiding common PT errors

Words like “failure” can be scary. In the world of medical laboratory science, the word failure takes on a whole new level of serious, real-life consequences, should failures occur during any kind of testing. Thankfully, when it comes to investigating proficiency testing (PT) failures, there is an abundance of information available online to help clinical laboratories develop corrective and preventative actions.

Pre-examination, examination, and reporting checklists that are generated in root cause analysis, like this handy one from Lablogatory, can serve as a “launch pad” for the development of guidelines to take corrective action. Clinical laboratories use root cause analysis to identify, define, and resolve a core issue, so that resulting errors or failures cease in future proficiency testing efforts. This systematic process of analysis can help us ask the questions that give us the full story of why a failure occurred.

Much like journalists, we laboratory professionals ask “who, what, when, where, and why” questions to help us investigate. In the vein of root-cause analysis, WSLH Proficiency Testing has provided detailed scenarios of common PT failures exemplified throughout the proficiency testing process, from pre-examination to reporting. The review of detailed scenarios in specific proficiency testing programs, which are couched in real-world, empirical evidence can aid clinical lab staff in the development of strategies from investigation to action.

Let’s visit the world of hematology proficiency testing for our first scenario. Since hematology proficiency testing (PT) samples are manufactured material, most PT samples for hematology have to be tested in the quality control (QC) mode instead of patient mode to recover the correct values. In one particular instance, a laboratory did not use the barcode provided on the PT sample. Instead, the lab applied their own barcode which triggered the sample to be tested in patient mode, leading to failures on the differential parameters. The barcode provided by the PT provider would have triggered the sample to be tested in the correct QC mode; and, the lab would have recovered the correct values.

This is a common sample handling error seen in hematology PT and is very avoidable. Many times, labs are instructed to perform remedial action as required by their accreditation agency as a result of this handling error. Sometimes it is helpful to see an example, in order to be able to identify the causes that result in a lab testing in the wrong mode. 

Please see the snippet of a 2020 HemeReg1 report, for example.

Here are some key steps and resources to consider in avoiding this common error:

  • Always read the proficiency testing sample handling instructions that come with your PT kit. In this particular instance, there were specific handling instructions provided for each type of hematology instrument explaining how to test the PT samples in QC mode. If you do not understand the handling instructions, call your PT provider for clarification.
  • Your hematology instrument manufacturer can also be a resource to assist you with testing your PT samples in the mode specified by your PT sample handling instructions.
  • The CLIA Proficiency Testing and PT Referral booklet (pg. 7) provides some helpful guidance explaining that, although you are required to test PT samples like you would patient samples, sometimes PT samples require special treatment.

In the world of Blood Bank (Immunohematology) proficiency testing, the need for labs to seek out remedial testing most often stems from compatibility failures. The Blood Bank Comprehensive program includes a set of five samples (unknowns), plus a donor cell for compatibility testing. When reporting online, it is important to list the compatibility testing method used for each sample. Select if an immediate spin or anti-human globulin (AHG) method was used, so that the type of testing matches the situation and your lab protocol. Some labs use a combination of immediate spin (negative screen) and AHG (positive screen) testing. Others may use AHG for all compatibility testing samples regardless of the screen result. Let’s take a look at these two common errors and helpful hints we can employ to sidestep these failures in the future: 

  • If your lab performs anti-human globulin (AHG) crossmatches, you must perform them on the PT survey when warranted (i.e., when a sample has a positive antibody screen). Do not report an immediate spin crossmatch interpretation as your final result on samples that warrant an AHG crossmatch (has a positive screen) or you risk failure.
  • Labs that routinely perform both immediate spin and AHG testing on all samples should report the serologic interpretation as “Not compatible” if either test is positive.
  • Per CMS, labs using antiglobulin crossmatch methods (automated or manual) that employ a technology only designed to detect incompatibilities due to IgG antibodies, must also use an immediate spin crossmatch to detect incompatibilities due to IgM antibodies (i.e., ABO incompatibilities). 

(Please see the snippet of a 2020 BloodBank3 report, for example.)

Immunohematology proficiency testing samples have a shorter shelf life, as they are manufactured to simulate whole blood. When the PT event closes, these samples expire. Therefore, if a lab needs to troubleshoot a failure, the age or expiration of the samples should be noted with follow-up documentation.  

The oversight of any step, however small, can create major setbacks in proficiency testing. One such oversight commonly made among clinical laboratories is the failure to identify a PT sample—in other words, to treat a proficiency testing sample like a patient sample. Recently, one of our proficiency testing program coordinators received a call from a lab requesting replacement of Blood Gas proficiency testing samples. Upon receiving more context from the lab supervisor, the WSLH PT program coordinator learned that the lab had given the sample set and instructions to the selected Point-Of-Care analyst who was to run proficiency testing for the current event. The analyst ran all five samples without inputting the sample ID into the instrument (i-STAT). They then returned their printouts to the supervisor for submission to WSLH PT. When questioned, they reported that the samples had been run “in order”, but had no proof; so, those results could not be submitted for the event. Subsequently, the supervisor had to call WSLH PT to order (and pay for) a replacement sample set to retest with the sample IDs before they could complete the event.

These detailed, real-world instances that WSLH Proficiency Testing program coordinators have provided aim to assist clinical lab staff in the development of their own strategies, which are situated in root cause analysis. Investigation, planning, and communication with all participating staff can help clinical laboratories get to the root cause of common problems, and to make sure such errors do not happen again. WSLH Proficiency Testing offers a corrective action form online for clinical laboratories to use as a tool or guideline for investigating PT failures. Please refer to our Resource page where you can find this form among other helpful resources for clinical laboratories conducting PT. Utilizing resources and learning from scenarios such as these can aid laboratory professionals in initiating conversations, investigations, and trainings with staff so that common PT failures may be avoided in the future.

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Feeling Thankful For The Lessons Learned

5 reasons we’re grateful for those teachable moments of the pandemic 

1. Assuring Laboratory Accuracy
When the pandemic hit, CMS determined that it would be business as usual. Yes, we are thankful for that. It meant more work for us creating different staffing models to do the same work. The reward was knowing that laboratory accuracy was still being measured. We are also thankful for the many lessons learned during this time too.

2. Lessons From The Supply Chain
We learned that the current method of procurement did not stand up to increased demand. In spite of the manufacturer’s ramping up production of needed items, raw materials were unavailable. Even when items could be produced, transportation bottlenecks confounded our ability to get what was needed. Distribution was sporadic; and, some facilities had much and others not enough. There was no system of sharing. We now know that we need better communication as well as a directory of alternate sources. We are thankful that these challenges are being talked about and addressed.

3. Staying Safe At Work
Offices in clinical and other healthcare settings got creative with how they worked, to allow staff and their families to shelter-in-place and quarantine safely. We put our public health values into practice, serving as models for how other workplaces across industries might implement public health measures in response to COVID-19. In particular, WSLH Proficiency Testing was able to shift to a blend of in-office and remote work, so that we could maintain proper social distancing and mitigate the possibility of transmission with less people in the office. We discovered that we could still effectively provide technical troubleshooting and responsive customer service from the safety of our homes. We continue to be grateful for this flexibility.

We learned that biosafety protocols needed review or revision. Clinical laboratories had to discover ways to stay safe, while managing a great influx of tests to process and analyze. From a biosafety standpoint, clinical laboratories had to take pause and assess biosafety challenges, such as how suspected or confirmed SARS-CoV-2 samples should be handled and transported. Clinical labs also had to practice greater care in practicing other testing procedures that are sure not to develop aerosols or droplets in unintentional or undetected ways. We are grateful for the published guidance and resources available for clinical labs to address biosafety challenges.

4. Adapting To Emergent Telecommunication Needs
We also adapted to new telecommunication needs, and to the various tools and platforms that continue to help us stay connected. Across organizations, we are now seeing a successful blending of online teleconferencing and networking platforms with in-person interaction. We hope this hybridization of communication techniques will be furthered in ways to increase inclusivity and promote public health safety in the workplace. We are thankful for the opportunity to learn how to optimize our use of the tools, platforms, and strategies to address emergent workplace needs, both in and beyond the realm of internal and external communications.

5. Everyone Plays A Part In Public Health
Sometimes our lessons learned are difficult to process, especially when we are in the midst of a challenge and might not be able to see how we might move forward. We have and continue to be challenged by disinformation and distrust as the pandemic was politicized from the start. This politicization of the pandemic also, in turn, politicized public health measures that we know work. This has made implementation of a nationwide vaccine program challenging, among other public health measures that we did not foresee would be contested in the political arena. We learned we needed to ramp up our educational outreach and hold media-based organizations accountable for how information about the pandemic was and continues to be disseminated. We learned that we needed to educate the public not just in the face of a pandemic but always in preparation for the inevitable recurrence of new and puzzling infections.

We wish we did not have to learn some of these lessons through the course of a global pandemic; but, such monumental challenges throughout history have been teachable moments for all of us clinical laboratory professionals, the broader scientific community, and champions of public health. The scientific world has pulled together their time, talents, and resources to create new testing platforms, to advance epidemiological tracking, and, through research and diligent work, to develop more than one vaccine to protect healthcare workers and the general population. We are grateful for the individuals and organizations who continue to work at all levels of society to make a changes, at the institutional level, at the individual level, and at the interactional level. We are, most of all, thankful to our customers and laboratories nationwide for not giving up and working together to find a solution. We all have a part to play, and we are grateful for your contributions.

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