Techniques and Skills Test 1 Review

What are the six quality aims for healthcare?

• Safe

• Effective

• Patient-centered

• Timely

• Efficient

• Equitable

What is “safe”?

Provide service which prevents harm to patients and improves healthcare outcomes ( e.g. diagnostic process, ensure continuous quality improvement, etc.)

What is “effective“?

“Use evidence-based knowledge to limit and prevent overuse, underuse and misuse of services“

What is “patient-centered”?

Respond to and be respectful of patient preferences, needs, and values

What is “timely“?

Reduce wait times and delays in providing service for patients, clinicians, and other healthcare professionals

What is “efficient“?

Avoid and reduce waste and inefficiencies (e.g., time, energy, ideas, supplies, equipment, etc.)

What is “equitable“?

Deliver care without variation due to gender, ethnicity, geographic location, and socioeconomic status

Who is responsible for Quality Assurance in the lab?

• Lab managers/directors

• Lab supervisors

• Testing personnel

• Phlebotomists

• Other lab personnel

• Other healthcare providers

• Hospital administration

What is an Individualized Quality Control Plan (IQCP)?

• Looks at TOTAL TESTING PROCESS

• Requires continuous monitoring of laboratory quality

What is the purpose of the Individualized Quality Control Plan (IQCP)?

Identify & minimize risks that could potentially result in erroneous laboratory results

What is the required documentation for IQCP?

1. Risk Assessment

2. Quality Control Plan

3. Quality Assessment

What are policies?

• Written statement of lab’s intent

• Derived from external requirements or organizational mandate

• Describes “what is done”

What are procedures?

Instructions for how to do an activity within the larger process

What are processes?

Written description of “who does what“ and “when”

What are Forms?

Means by which data, information, or results are captured from performance of a procedure

What are records?

Form with data, information, or result entered

What are internal assessments?

• Competency testing

• Monitor processes with quality indicators

• Comparison of performance to similar measures

What are external assessments?

• Participation in assessment conducted by external organizations

  • Proficiency testing

What are the four steps of quality improvement?

1. Plan

2. Do

3. Check

4. Act

What is a fishbone diagram?

• Helps determine root cause using structured approach

• Encourages group participation

• Utilizes knowledge from different disciplines

• Indicates possible variations in process

• Indicates areas where more data should be collected

What is a reportable range?

the lowest that can be detected by analyzer and the highest that can be detected by analyzer

What is a Reference Range?

Range of normal values in patient population

What is assayed QC material?

• most expensive

• all the statistical work has been done

What is unassayed QC material?

• cheaper

• need to run more tests to get reference range

What is in-house QC materials

• materials made at the lab

• typically used in research labs

What is a systemic error?

continuous and/or consecutive errors

What is a random error?

one time error

What is a 1-2s violation?

value falls outside 2 standard deviations 1 time

What is a 1-3s violation?

value falls outside of 3 standard deviations 1 time

What is a 2-2s violation?

value that falls out of 2 standard deviations 2 times (consecutively)

What is a R-4s violation?

where 2 values are 4 standard deviations away from each other

What is a 4-1s violation?

values (consecutively) stays within 1 standard deviation 4 times

What is a 6x violation?

value (consecutively) stays on one side of the mean 6 times

What are the steps (IN ORDER) to perform when controls are out?

1. REPEAT — could be a random error

2. Inspect control material and reagent for problems (i.e. mold haha)

3. Run new control/ reagent

4. Review calibration

5. Contact manufacturer (DEF CON 5 everybody fucked up)

What is a trend?

Gradual change in mean

• Indicates systemic error

What is a shift?

Abrupt change in mean

• Indicates random error

What is a cofactor?

Nonprotein molecule needed for enzymatic activity

What is an isoenzyme?

Different forms of the same enzyme

What is a coenzyme?

Organic cofactor

What is an apoenzyme?

Enzyme without cofactors

What is a product?

Compound(s) formed

What is a haloenzyme?

Complete enzyme-cofactor complex

What is a substrate?

Reactant in enzymatic reaction

What are the functions of enzymes?

In vitro:

• Used in the lab for enzymatic reactions when determining the concentration of an analyte

In vivo:

• Quantitated by catalytic effect on substrate in rxn mixture

What are some qualities of first order kinetics?

• E>S

• Rate of rxn inc as more S is added

• Rate of reaction proportional to S concentration

What are some characteristics of zero order kinetics?

• S>>>E

• Maximum velocity

• Rate of reaction proportional to E concentration

How do COMPETITIVE inhibitors affect enzyme reactions?

• KM increases

• Vmax same

• Reversible

How do NONCOMPETITIVE inhibitors affect enzyme reactions?

• Vmax ecreases

• Same KM

How do UNCOMPETITIVE inhibitors affect enzyme reactions?

• Irreversible

• KM decreases

• Vmax decreases