MT 105 Material Management Lecture 8 PDF

MATERIAL MANAGEMENT -Serves as the authorization for the vendor to ship and bill the MT 105: LECTURE 8 institution. Vid Lecture By: Ms. Lorreine Denise W. Castañares...

MATERIAL MANAGEMENT -Serves as the authorization for the vendor to ship and bill the MT 105: LECTURE 8 institution. Vid Lecture By: Ms. Lorreine Denise W. Castañares REQUEST FOR PURCHASE (**)- additional notes from Reference book and vidlec -the interim document that begins the ordering process. 1. Completed by the requesting unit **Supplies are the second largest expense incurred by the 2. Sent to the purchasing department, which then formally laboratory, overshadowed only by labor costs. issues a purchase order. 3. The request for purchase must include the catalog MATERIAL MANAGEMENT number, the supplier, and a description of the product. -Systematic process of overseeing and controlling the 4. Purchase department prepares and issues the purchase acquisition and utilization of supplies to ensure both order for the item specified and "charges" it to the availability and cost effectiveness. bookkeeping account of the requesting area. ** The supplier then ships the item requested and bills the **In the hospital, centralized material management institution. department is organized into 2 sections: Purchasing Section - oversees the ordering of supplies TRAVELING REQUISITION and the processing of invoices from vendors. The -A catalog of products held in stock by material management. stockroom -“Travels” from the stockroom to each department and back. - This catalog describes the product and the unit of container Stockroom - maintains security and inventory levels and (box, pack, and soon) and provides a place to request the issues supplies throughout the facility. quantity needed. -Helps to keep track of items and to allocate charges for GOALS of Material Management accounting purposes 1. Supplies arrive in a timely manner - These are updated on a monthly basis, and the orders are 2. Spoilage is reduced to a minimum tabulated and charged to the department at the same time. 3. Back orders and delays are avoided -Items included on the traveling requisition are usually articles 4. Storage space is used to the best advantage used by many departments and purchased in bulk. 5. Most economically advantageous price is obtained (Examples: office supplies, cleaning materials, and patient 6. Financial resources are not tied up in inventory care products such as facial tissue. They may also include nonperishable supplies such as microscope slides and SUPPLIES vacuum collection tubes.) -For budgeting purposes, these are products that meet specific time and price criteria. STANDING ORDERS -For products that have a predictable usage level or short shelf The distinction between supplies and capital expenditures is life that are frequently ordered in advance. determined as follows: determined as follows: - may also be issued to reserve a single lot number of reagents 1. Items that are consumed within 1 year or have a shelf or supplies. life of less than 1 year (Ex: Reagents and rapid test -The vendor is instructed to ship a specific amount of product kits) according to an established schedule 2. Items below a certain price level even though their - Also useful for items such as phlebotomy supplies, for which shelf life exceeds 1 year a commitment can be made to buy a designated amount to be delivered according to a predetermined timetable. ** A product costing under $1000, for example, may be counted as a supply item, even if it can be used for several ADVANTAGES: years. A laboratory micropipette, costing $5,000, is actually an ✓ Timely delivery of needed items instrument, but for budgeting purposes it may be counted as ✓ Take advantage of bulk prices or discounts offered by a supply item. vendors and the use of vendors’ storage space ✓ Suppliers can plan production and inventory levels on a CAPITAL ITEMS more predictable schedule - items that fall outside these criteria (Ex. Hematoloy and Chemistry analyzers- costs million pesos and can be used for PRODUCT STANDARDIZATION COMMITTEE several yrs) Purpose: ** Several documents have been developed to both expedite To ensure the best product is obtained and simplify the record-keeping process. To avoid expensive duplication of products Two Common Documents: To take advantage of volume discounts for generic items 1. Purchase Order - used to order supplies from outside vendors The primary mission of this group, which is composed of 2. Traveling Requisition - provides a means to request representatives from all areas of the organization: supplies from the central stockroom. o Review supplies that the hospital uses in large volumes PURCHASE ORDER o Resolve differences between preferences in areas -Represents a commitment by the organization to purchase a that may share a common product product or service. o Develop standards for selection and quality assurance SAYRE 2H - TRANSES 1 ** The purchasing section uses the recommendations of the ** To answer these questions, a specialty of management committee to obtain bids from competing vendors for the best science called operations research has developed several product and price. techniques and formulas for managing inventory: INVENTORY MANAGEMENT EOQ (economic ordering quantity) -answers the - A continual process of checking stock levels, rotating stock question how much to order at one time. to ensure freshness, ordering supplies in sufficient quantities EOP (economic ordering point) - also referred to as the to meet current needs, and minimizing the cost of carrying reorder point (ROP), which provides the Base or Safety inventory (i.e., having too much of the organization's money level for reordering inventory. tied in items just sitting on the shelf waiting for use at some ROT (optimal reorder time) -helps establish the best time in the future). time to order to take advantage of the EOQ & EOP. **every year, the value of the inventory is determined by conducting an annual inventory check INVENTORY MANAGEMENT METHODS In order to determine the EOQ, EOP, and ROT, managers INVENTORY LEVEL CHECKS must understand certain underlying concepts relating to inventory. 1. Perpetual system – keeps account of the inventory each time a product is used. For example, when any item is Annual usage – Historical ordering data based on actual taken off the shelf, the inventory checklist is adjusted by purchases, usage and predictions of future volume, the person removing the product. When it is time to influence the anticipated level of supplies that must be reorder, the checklist is submitted to purchasing without ordered. any need for further checks, at least theoretically. This is Average daily usage – the amount of supplies ordered the procedure of choice in material management in a year divided by 365 days. departments with a well-trained and dedicated stocking Cost of ordering – Expenses of the purchasing section staff. However, it requires detailed attention at the time of divided by the number of purchase orders issued. usage, and this time commitment is not always practical Annual holding cost – also called Cost of carrying at the service or bench levels, especially in the stressful inventory. It involves decisions based on bulk orders, work settings of modern healthcare institutions like ICUs space utilization, and whether it is better to have the and emergency rooms. product on hand or in the supplier’s warehouse. When the 2. Periodic system – more common at the bench or vendor is holding the stock, the institution's money is department level. at a specified time, the stock level is available for other purposes. counted and appropriate supplies are ordered. Cost per unit – A straightforward calculation once the 3. Random checks – used to document the value of decision has been made as to the best price available. supplies at a specific time. especially useful in confirming Dividing the purchase price by the container size provides the accuracy of perpetual systems, which can easily this value. become distorted if not meticulously maintained. (Ex. Lead time – advance notice needed between placing an Annual inventory). order and its arrival. It influences the minimum inventory that must be kept in stock, as well as the quantity that STOCK REPLENISHMENT TECHNIQUES needs to be requested. 1. Minimum – Maximum INVENTORY FORMULAS AND MANAGEMENT TOOLS o establish a minimum level (the reorder point) and a maximum level (the level to be maintained) EQUATIONS: o Ex. Min. stocking level is 20 and max. is 40, when inventory is taken and only 10 units are left on hand, order 30 units of the item in order to bring the item to max level. 2. Just - in – Time o the supplier guarantees delivery of an item at the exact moment of need o a Japanese model in which financial costs associated with stocking and storing inventory items is limited o frequently used for short dated items like reagents and test kits. Several Qs when lab managers tackle the problems EXAMPLES: associated with Financial Control of Inventory: What is the most economic quantity to order? How can the institution take advantage of bulk purchase discounts? What is the best time to place orders to both limit the amount of financial commitment and ensure adequate supplies? SAYRE 2H - TRANSES 2  EOP = (15,000 x 2 days) + 20 bottles 365 = 102 bottles As head of the Phlebotomy department in CDUH, it is your responsibility to manage inventory for all phlebotomy supplies including syringes. SAYRE 2H - TRANSES 3  QUALITY ASSESSMENT AND QUALITY ASSURANCE (QA) **QA developed out of the limitations of the QC approach and PERFORMANCE IMPROVEMENT defined quality in healthcare institutions by the success of the MT 105: LECTURE 9 total organization, not just individual components of the Vid Lecture By: Ms. Noelyn N. Fontanoza system, in achieving the goals of patient care. **JCAHO (Joint Commission on Accreditation of (**)- additional notes from Reference book and vidlec Healthcare Organizations) in 1980, defined quality assurance as the overall activities conducted by the institution **As industry and the healthcare community continue to that are directed toward assuring the quality of the services grapple with this issue and as new assessment methods are provided. proposed the old ways continue to increase in value. The -QA focused on the recipient, namely the patient. analytical tools used in all of the recently acclaimed programs -Risk management, in service and continuing education, look strikingly similar to the statistical methods that have been safety programs, quality control, and peer review were all part used in the laboratory for a long time. of the quality assurance program. In the QA model, the term “quality control” was applied to activities directed towards HISTORICAL PERSPECTIVE: Quality concepts and monitoring of the individual elements of care- for example, Terminology Transition instrument and other test procedures-- whereas QA focused on the monitoring of outcomes or the indicators of care. **Defining “quality” class has proved to be one of the more -One of the major criticisms of the QA program is the absence frustrating efforts of modern management. Quality is like love: of any specific guidelines or reference material for meeting the Everyone knows what it is but no one knows exactly how to JCAHO QC accreditation standards. In 1985, JCAHO finally describe or measure it. published its 10-step QA monitoring process. -JCAHO attempted to provide new terminology to nail down a program that both promotes and measures quality in 10 STEP QA MONITORING PROCESS healthcare institutions. To develop a plan to assess and 1. Assign responsibility for QA plan ensure the quality of the services delivered by the laboratory, 2. Define scope of patient care. the manager must have a full understanding of both the history 3. ID important aspects of care. and philosophy of quality up to this point as well as knowledge 4. Construct indicators. of specific statistical techniques and their application to the 5. Define thresholds for evaluation. laboratory. 6. Collect and organize data. 7. Evaluate data. QC/MBO →QA → TQM/CQI → QA&I/CPI → ?QC/MBO? 8. Develop corrective action plan. 9. Assess action; document improvement **These initials and monikers illustrate the history of the 10. Communicate relevant info. terminology of quality and the programs that were in vogue in the healthcare community from the 1970s until today. With the **The major contribution of QA was to point out that the true 1995 JCAHO standards, the concepts and principles of quality indicator of a quality service was always patient care. management have returned to their roots of QC and MBO (Especially in hospital or even lab set up, it is always patient (Management by Objectives): that is, to set performance care). It is just not the ability of an individual MT which is part objectives and measure their achievement. This is not to say of the entire system inside the hospital to do its job well but it that we have not learned a lot from our pursuit of a definition is to make sure that we deliver the best quality service to our of quality and for ways to measure its existence and intensity. patients. We have actually learned a great deal. -Although an improvement over QC, QA overemphasized outcomes; like the QC model, it failed to improve the QUALITY CONTROL (QC) troubleshooting capabilities of the system or to fully include Historically, the application of statistical methods to the the patient's viewpoint in the definition or measurement of evaluation of the quality of products and services. quality. Example: in the laboratory, controls are processed periodically to make sure that the procedure is within QUALITY CONTROL QUALITY ASSURANCE control limits. If the controls are within range under the QC Focused on Product Focused on Process model, the techs are secure in the knowledge that they Reactive Pro-active are turning out a high-quality result. Line Function Staff Function Finds Defects Prevent Defects **QC relies heavily on quantitative statistical methods that Testing Quality Audits focus on the final product, as defined by standard set by the producer. A managing tool A corrective tool -The strength of the QC approach to quality management is Process-oriented Product-oriented that precise performance standards can be established and Proactive strategy Reactive strategy measured with objective analytic tools. The weakness of the Prevention of defects Detection of defects QC system lies in its emphasis on the evaluation of the final Everyone's responsibility Testing team's responsibility product: this often makes troubleshooting also difficult. Also, Performed in parallel Performed after the final QC relies on standards and techniques that measure the with a project product is ready quality of the product in isolation from the needs of the customer or the patient. **More QA and QC comparison to read: SAYRE 2H - TRANSES 1  TOTAL QUALITY MANAGEMENT (TQM) AND CONTINUOUS QUALITY IMPROVEMENT (CPI) TQM/CQI quickly replaced the QA model because it has expanded emphasis on satisfying the needs of the customer, especially in its ultimate definition of quality: “a delighted customer”. To accomplish the delighted goal, TQM/CQI held that the total enterprise, as well as each unit within the organization (and especially each employee), had to successfully perform, and meet the obligations of, three simultaneous roles: o Customer o Producer o Supplier **The inclusion of each component in the creation process- from the acquisition of supplies to active follow-up after the product or service has been received by a delighted customer- broadens the focus of QC and QA on the end product. This emphasis on total production process helps to correct a major deficiency of QC and QA by providing tools with which to identify and troubleshoot problems that might occur at each stage of production. In Layman terms: TQM- defined as the management philosophy and system that promotes positive organizational change as well as an effective cultural environment for continuous improvement of all aspects of the organization. CQI- defined as a systematic approach to the measurement, evaluation, and improvement of the quality of all products and services through the use of disciplined inquiry and teamwork. TQM PRINCIPLES - focuses on the complete process from supplier to our patient or customers and its analytical and troubleshooting methodology are contributions that remain an important part of all quality management programs. Focus on customer- patients’ well-being has always been the main priority. Employee involvement- it is required so that the best quality of service is given to the patients. Process centered- in order to give our patients their definitive diagnosis, a certain process must be followed like physical exams from the doctor itself and then taking of lab tests that should be done in order to arrive to the proper diagnosis for the patient. To prevent mistakes from happening. Integrated system Strategic & systematic approach- in dealing with Short Recap about MBO: patients. - A program that embodies all of the concepts in the Decision-making based on facts- gathered from the management process. patients and the day-to-day activities. - It incorporates the principles of planning operating directing Communication- the most important among everything. and controlling and even providing a mechanism to bring all No proper understanding and connection between our of these concepts into everyday practice especially when it employers will not give out the best quality of service to comes to working inside the laboratory. the patients. - Core of MBO is through communication and the success or Continuous improvement failure depends on how well the employees inside the laboratory understands the hospital or lab's mission and -after the whole process, it can be used again and again, and objectives. probably make adjustments and have little changes or corrections. SAYRE 2H - TRANSES 2 **to simplify the principles: 6C’s of TQM: **JCAHO has also established nine dimensions of Commitment performance (the what and how of CPI and patient care) that Culture must be included and measured in the design of the Continuous improvement organization's quality assessment and performance Cooperation improvement plan: Customer focus Control 9 DIMENSIONS OF PERFORMANCE 1. Efficacy 2. Appropriateness ACT PLAN CONTINUOUS QUALITY 3. Availability IMPROVEMENT CYCLE 4. Timeliness 5. Effectiveness 6. Continuity 7. Safety 8. Efficiency 9. Care and respect **Even before it has been fully implemented, QA&I is generating harsh criticism from those who point out that the measurement of predetermined goals appears to be just a rehash of management programs such as MBO and standard QC practices. Critics suggest that these programs do not nurture or support the urgently needed creativity and QUALITY ASSESSMENT AND IMPROVEMENT (QA&I) innovation so important to survival in today's rapidly changing AND CONTINUOUS PERFORMANCE INVOLVEMENT health care delivery climate. (CPI) EIGHT DIMENSIONS OF QUALITY by Garvin ** For several reasons including the reluctance of many hospitals to support the requirement to adapt TQM/CQI and acknowledge difficulty in defining quality, in 1992, JCAHO introduced a new monitoring standard that is quality assessment and improvement. QA&I incorporates the concepts of quality assurance and TQM/CQI, especially the idea that quality is a continuous process of improving the system, not just an endpoint measurement, and that it requires the direct support and MAJOR FIGURES IN QUALITY MANAGEMENT active participation of the leadership of the organization. ❖ ARMAND FEIGENBAUM Quality assessment and improvement focuses on the - coined the term “Total Quality Management” success of the organization in designing and meeting set goals and objectives, hence the term “continuous ❖ WALTER SHEWHART performance improvement”. With the implementation of - known as the Father of Statistical Quality Control. the QA&I and CPI in 1994, JCAHO was also able to -his work served as a basis for the multirole-based monitor certain indicators through a computerized Westgard rules. reporting and evaluation system as part of their accreditation process. Several Japanese scholars -Musaaski Imai “Performance”, as the reader has no doubt observed, is that developed important -Kaori Ishikawa a much easier concept to define and measure than the workplace models for the -Shigru Mizuno elusive “quality”. principles taught by Deming -Genichi Taguchi JCAHO has defined the steps for improving and Juran: organizational performance through standards that The most famous -Philip Crosby monitor each stage of the CPI process. "gurus of quality": -W. Edwards Deming 1. Plan the CPI process. -Joseph Juran 2. Design the assessment and monitoring system. 3. Measure the performance. ❖ KAORI ISHIKAWA 4. Assess performance. - designed the Cause-and-effect diagram 5. Improve performance. SAYRE 2H - TRANSES 3 ❖ PHILIP CROSBY -Quality circles and project teams, which use a wide -Frequently referred to as the “evangelist” of quality variety of employee inputs, are 2 methods that trace their management, he preached the need for quality practices origins to the teaching of Juran. in the book “Quality is Free” and through the worldwide -Juran was a leader in promoting participatory consulting network of quality colleges, he propounded management styles. He pointed out that it was necessary that: for all employees to be included in, and committed to, the o Quality is free. Poor quality is expensive. continual process of designing and producing a quality o Do things right the first time product. o “zero defects” is the only legitimate goal of a quality program. ❖ JAMES O. WESTGARD -These ideas are also prominent in the writings of -a professor at the University of Wisconsin Medical Westgard and other laboratories who were addressing School and associate director of Clinical Laboratories- quality issues before TQM gained popularity in the Quality Assurance with the University of Wisconsin healthcare community. Hospital and Clinics in Madison, applied Shewhart's multirole system to the evaluation of the quality control ❖ W. EDWARDS DEMING data in the medical laboratory, particularly the multirange - Introduced the use of statistical tools in decision controls used in Clinical chemistry. making, problem solving, and troubleshooting the -Westgard Rules, the six rules for accepting or rejecting production process. He was a statistician who worked a control run. with Shewhart. - Often credited with providing the Japanese with the QUALITY MONITORING AND ASSESSMENT TOOLS information and training that brought them to their position **The precise techniques and mechanisms of quality control as the world's leader in the production of quality products. are familiar to every technical professional in the laboratory. Deming is also frequently cited as the Source of most of The objective of this topic is to present a short survey of the the concepts and methods contained in the TQM model. concepts and terminology frequently found on professional -Among Deming's more prominent contributions to the examinations at the supervisory level. These concepts language of TQM are the “fourteen points”, the “delighted provide a baseline for the discussion of quality management customer” definition of quality, the “seven old tools”, and in the medical laboratory. the “seven deadly diseases”. Tools for the measurement of quality and performance in DEMING’S FOURTEEN POINTS the lab can be reviewed in 5 groups: 1. Create purpose for improvement 1. Statistical techniques that establish performance limits for 2. Adopt the new philosophy the analytical accuracy and precision of testing protocols. 3. Cease dependence on inspection to achieve quality 2. Graphic and monitoring methods that aid in review, 4. Work with one supplier to reduce cost troubleshooting, and decision-making systems. 5. Continuous improvement 3. Interpretative strategy for evaluating statistical and 6. On-the-job training monitoring methods. 7. Leadership 4. External programs that provide resources for the 8. Drive out fear independent assessment of the technical performance of 9. Break down silos the lab. 10. No slogans 5. Methods that are intended to monitor the delivery of the 11. No quotas or numerical goals overall services of the laboratory as part of the health care 12. Remove annual ratings or merit system team. 13. Institute education and self-improvement programs 14. Involve all workers in the transformation BASIC QUALITY CONTROL STATISTICS From the multitude of statistical calculations available to DEMING'S 7 DEADLY DISEASES of MANAGEMENT the analyst, four measurements constitute the base for 1. Lack of constancy of purpose most quality assessment efforts. These statistical tools 2. Emphasis on short-term profits are quite familiar to laboratorians and are particularly 3. Evaluation by performance, merit rating, or annual applicable to situations in which performance criteria can review of performance be quantified. These four measurements are: 4. Mobility of management the mean (x̄) or arithmetic average 5. Running a company on visible figures alone The standard deviation from the mean (SD) 6. Excessive medical costs The coefficient of variance (CV) 7. Excessive costs of warranty, fueled by lawyers who the percentage (%) - most widely used statistical work for contingency fees calculation of all. ❖ JOSEPH JURAN ACCURACY - established the concept that quality is a continuous - Closeness of a result to the actual value of an analyte improvement process that requires managers’ active when performing a test pursuit in reaching and setting goals for improvement. -more commonly called “hitting the bull’s eye” -Pareto Principle or 80/20 rule – states that 80 percent PRECISION of serious problems arise from only 20 percent of the - Determined by how well procedure reproduces the same causes or trouble points. Managers should focus their values. time and efforts on identifying and solving 20%. SAYRE 2H - TRANSES 4 **For example, if you analyze a triglyceride standard with a The individual values of a population fall within these known value of 200/mg dL five times and obtain values of 169, following boundaries: 167, 170, 168, and 169, you could say you that your o 68.2% are within ±1 SD of the mean methodology is extremely precise. However, its accuracy is o 95.4% are within ±2 SD of the mean – way off and the procedure needs to be recalibrated. accept/reject decision o 99.7% are within ±3 SD of the mean PERCENTAGE (%) AND PROBABILITY (P) P is usually expressed in statistical notation as a decimal (0.0 to 1.0) according to the likelihood of an event occurring the nearer to 0, the less likely it is to occur; the nearer to 1, the more likely the event is about to happen. DATA POPULATION Probability may also be expressed in the negative; for Used to describe and define the items that are being example, the likelihood of an acceptable control value studied at a particular time. falling outside the ±3 SD range is only 0.003 (1-0.0997). Defined by the interest of the person doing the statistical In more common language, probability is often expressed study. as a percentage: “there is a 50% chance of rain,” or a 0.5 probability of rain. POPULATION SAMPLE A part of a population that is used to analyze the MEAN characteristics of that population. Arithmetic average for all the data contained in a sample To be truly representative, and also to avoid bias, samples population. should be selected at random, in a manner that ensures Obtained by computing the sum of the values contained that each unit of the population has an equal chance of in the population and dividing by the number of values being included in our study. included in the calculation. The letter capital N indicates the number of observations The mean is easily confused with the median. Both of (ex.: individuals, measurements, or values) that make up this describe the midpoint of a population. However, the the sample used for calculating statistical indexes. mean is a calculated value, whereas the median is obtained by aligning the population from the smallest to **The pool of individuals from which a statistical sample is the largest unit and selecting the midpoint, the point at drawn for a study. Any selection of individuals grouped which exactly 50% of the population falls on both sides. together by a common feature. -It is a particularly useful technique when evaluating a population with a large number of entities, which makes it impractical to include every member in the study. In general, the larger the sample selected, the more representative of the population; however, as a general rule most statisticians hold that a sample size of at least 30 is satisfactory for most studies. **For example, the laboratory and the pharmacy may be interested in reviewing the causes for a seemingly high frequency of gentamicin trough levels that exceed acceptable level. (they always check the peak and the trough levels of each medication). The laboratory may have done several hundred gentamicin trough levels during the period of interest, of which 100 exceeded acceptable dose levels. Instead of an in-depth review of every assay or every test class, the study may need to investigate only the 30 cases (N=30 out of the 100 to find the cost of the deviations. STANDARD DEVIATION Measurement of precision, or the tendency of the values GAUSSIAN DISTRIBUTION in each population to cluster, center, or scatter around the Terms associated: “bell-shaped curve”, “normal mean. distribution”, “frequency polygon” and “Levey-Jennings A range of 2 standard deviations (±2 SD) is generally chart” considered as the minimal limit for an individual control value to be acceptable, because 95 of all legitimate **All of these terms describe the statistical phenomenon that values should be within this range. The mean and the the members of a population are usually evenly dispersed standard deviation form the guidelines delineated in the around the population mean. (Note: there are exceptions such Westgard rules and the points plotted on a Levey- as when extreme values are included in the calculations, Jennings chart. In calculating the SD for a particular causing the curve to appear skewed.) This important concept control. The difference (or variance) of each value from is the foundation upon which the acceptance or rejection the mean is used to establish the acceptable range for criteria of the Westgard rules and the performance limits of each control level. Levey-Jennings charts are derived. SAYRE 2H - TRANSES 5 COEFFICIENT OF VARIANCE BASIC STATISTICAL GRAPHS Calculating the CV for each control level and procedure The three most basic methods of presenting information- allows the comparison and check on the precision and circle or the pie chart, the bar, and the line graphs-- these variability of each method. are used to illustrate the comparative size of different The smaller the CV value, the more precise the components or factors. Most other graphical display procedure. techniques are already modifications of these three methods The interpretation of CV numbers must be placed in the context of the methodology of each procedure. Tests that closely follow Beer's law for end-point reactions are expected to have very tight CV percentages, whereas the rate reactions used to measure enzyme activity usually experience a much larger range. CIRCLE/ PIE GRAPHS - are circular figures with areas marked off, shaded, or sketched according to the percentage of each component, GRAPHIC AND SYSTEMATIC compared to the entire whole. (the correct way has the values PRESENTATIONS OF INFORMATION outside the pie with an arrow pointing at the area.) **One of the more difficult yet important tasks of any quality management program is turning the data collected from the BAR GRAPHS monitoring process into information that can be used to - may be helpful in presenting comparative inter-population troubleshoot and improve the production process. Data alone and intra-population factors. This may range from showing the have no particular interpretative value. If placed within the makeup of a population to comparing different populations context of other data points or material, however, they can with a key indicator or measurement. The bars on the graph become extremely useful in the decision-making process. may extend vertically or horizontally according to the This section outlines the most popular techniques in quality preference of the preparer. The point is to present the management for organizing, grouping, and sorting data into information in a manner that best demonstrates and clarifies formats that assist the manager in evaluating the situation and the information being detailed and that assists the users in in taking the necessary action to bring about improvement. their evaluation. **With the advent of computer technology and desktop LINE GRAPHS publishing, the boundaries for the graphical display of - are particularly useful for plotting and tracking data over a information have exploded. Bar and circle graphs are now period of time. If you connect the dots on a Levey-Jennings being drawn in three-dimensional, multi-colored, chart, for example, you have a line graph. Line graphs are very topographical, schematic figures that can incorporate and adaptable for displaying historical data. Control values, demonstrate the relationships between numerous factors on instrument parameters, workload volume, and blood bank a single graph. The future of the graphical presentation of data refrigerator temperature monitoring are only a few of the many is limited only by the imagination of the analyst. uses of the line graphs in the laboratory. When these values are plotted over a period of time (ex.: shifts, days, weeks, etc), STANDARD DATA PLOTTING TECHNIQUES the patterns may be quite revealing about areas that need First task: arrange and present the data in a manner that attention and require improvement, especially trends or facilitates further analysis. “Orderly array of data” – from deterioration and reagent or instrument performance. lowest to highest value, chronologically by run or date, in groups of sex and age, etc. GAUSSIAN DISTRIBUTION DISPLAYS This step is usually part of the data collection plan; with - there are two popular methods of displaying the frequency continuous monitoring systems such as for a laboratory distribution characteristics of a population; histogram and instrument, it is accomplished class by plotting the QC frequency polygon. both illustrates the features of the bell- data on a chart or graph as the test is being performed. shaped gaussian distribution curve. Once the data have been arrayed in an orderly manner, the results can be presented in an informative format as HISTOGRAMS a chart, graph, or other pictorial display intended to bar graph to show the relative size or frequency of each demonstrate problems and potential solutions. “class interval”. Class interval- statistical term **Most of the methods are familiar already both in the for each part of the population. laboratory and from everyday life because they frequently appear in news broadcast, advertisements, classroom training material, and anywhere people may desire to make a certain point or pitch a product. Examples include a bar and pie charts and graphs, as well as the control charts used to plot the QC data. -The lists of standard data plotting techniques are from Deming’s “seven old methods”, which have been around for a long period of time and has formed the basis of most quality FREQUENCY POLYGONS assessment and management programs The very familiar line graphs that give the frequency distribution its descriptive name, “bell curve”. SAYRE 2H - TRANSES 6 **In both histogram and frequency polygon, A relative RUN CHARTS frequency scale represents the vertical axis of the graph; the Line graph used to display data over a period of time. values of the variable being studied are located on the Show patterns of performance. horizontal axis. Other names: trend charts - The values for each class interval are then plotted on the Used: tracking missed phlebotomies or redraws, data graph using the heights of the bars on the histogram to show entry errors, or the number of tests that have to be rerun. the relative size and dots connected by a line for a frequency Charts can be as general (shift, section, department) or polygon. If the distribution of the population follows a normal as specific (individual, instrument, AM collection). pattern, the classic bell shape appears. DEMING’S SEVEN OLD METHODS **Many other methods may be used to organize and summarize information in quality management studies. Each has its own distinct advantage and analytical purpose. Deming has suggested seven techniques with which the quality manager should be familiar, one of which is already the SCATTER DIAGRAMS histogram and the remaining six is as followed: This method is used to show the relationship between one variable and another. FLOW CHARTS A study, for example, review the level of an antibiotic - quality management borrows the techniques and symbols of maintained in a patient compared to the time a sample logic flow charts used by management information system was collected (peak and trough studies). A graph is specialists to chart and analyze the specific process of prepared with the concentration of the drug on the vertical information flow. axis and the time of collection after administration as the -Serve the same purpose in quality management programs by horizontal base. The results of each sample are plotted at identifying describing the exact sequence of work tasks and the appropriate site on the graph and the pattern analyzed checking out ways for improvement by modeling work routes. to check dosage and collection timing procedures. Advantage: all data points, not just the summary statistical indexes, are plotted on the graph. Example: flow cytometry instrument in the laboratory usually a hematology analyzer. STORY BOARDS Technique of using a pictorial sequence on a flip chart or other visual aid to “tell a story” Of a quality management CONTROL CHARTS project. The presentation may be very elaborate, -Used to plot control measurements against standards (i.e containing many of the previously discussed methods to upper and lower limits) used to identify whether a process is illustrate how the investigators conducted the study, or in or out of control. may be a simple outline of each stage of the project. -Example: Levey-Jennings Chart Example: The Handwashing Steps PARETO CHARTS - Term used to a bar chart that is designed to illustrate the SPECIALIZED LABORATORY classical pareto principle, which states that 80% of all DATA EVALUATION METHODS problems can be attributed to 20% of the possible causes. - according to this concept, if the problems are matched with **From the basic methods of organizing, presenting, and their causes and plotted on a bar graph, the area in which analyzing statistical information, three techniques have been managers should devote the majority of their attention and developed that have proved to be especially useful in the energy become readily apparent. medical laboratory: LEVEY-JENNINGS CHART - Control charts used to plot QC values against previously set limits to determine if a procedure is out of control. CAUSE-AND-EFFECT DIAGRAMS Other names: “Ishikawa diagrams” (after Kaoru Ishikawa), “fishbone diagrams” Used to identify the possible causes or contributing YOUDEN PLOT factors of problems or quality defects. Used to demonstrate and compare the performance of a HEAD- problem is placed laboratory on paired samples with other laboratories BACKBONE- possible causes using common control lots or survey material. SAYRE 2H - TRANSES 7  Use the mean and SD from all participants to prepare a chart on which each lab’s results can be marked to show its performance in relationship to the whole group. Divided into 4 areas with a 45-degree line drawn from X- Y intercept separating the graph into 2 halves. Depending on the location of lab’s results on the Youden plot, the degree of accuracy, precision, and type of error may be inferred. Are now frequently discontinued or replaced with other graphical or numeric displays because of the voluminous amount of computer paper it takes to print out a plot for each analyte and the expense associated with mailing this bulky material. The Instrument Performance Matrix used by Coulter Hematology Reports for its interlaboratory QA program is an example of a technique that has replaced Youden Plots. MULTIRULE ANALYSIS Commonly referred to as “Westgard Rules” The 6 rules proposed by Westgard and Barry for accepting or rejecting a control run are based on the expected Gaussian distribution of sample values. Implementing a multirule program involves management choices about the degree of error that the laboratory finds acceptable when making decisions about the possibility of correctly accepting or rejecting a control run. Each rule is designed to detect or warn off an impending error or malfunction that may either halt the reporting of results until the problem is corrected or signal the need for preventive maintenance. Westgard Multi-rule Analysis Two levels of control at different concentrations will be Westgard - 10x Rule more efficient in monitoring the method when evaluated requires control data from previous runs statistically ten consecutive QC results for one level of control are on By running and evaluating the results of two controls one side of the mean, or together, trends and shifts can be detected much earlier both levels of control have five consecutive results that Westgard and associates have formulated a series of so are on the same side of the mean called "multi-rules" to help evaluate results from Gaussian distribution both within a level of control and between INTERPRETATIVE STRATEGY control levels - The detection and correction of errors, both technical and administrative, are a major mission of quality management programs. - all of the preceding methods are useless if the technologist or the laboratory manager is not aware of the types of problems, errors, malfunctions that can occur in a process and of the clues that may trigger their recognition and resolution. The old microbiology adage states that, “we tend to find what we are looking for,” applies here as well. Following is a list of some statistical terms and clues that may tip the medical technologist or even the analysts to possible problems. ERROR -concept is to accept / reject and problem / no problem decisions. - a decision can be made to accept a run incorrectly with the laboratory reporting out incorrect values, or a legitimate test result that may be rejected, resulting in a loss of time and reagent expense. Control limits must be set with both potentials in mind Classified into two types: SAYRE 2H - TRANSES 8  RANDOM ERRORS- may occur at any time and place DISPERSION within the testing or service process. Indicative of -occurs when control values are widely scattered in an imprecision in an analytical problem. unusual and unexpected pattern around the control chart; SYSTEMATIC ERRORS- occur in a consistent direction particularly, with increasing out-of-control (±2SD and ±3SD) or pattern (problems of inaccuracy). results and Westgard rule violations 22s and R4s. It is a sign of loss of precision and may be caused by inconsistency in such **Identifying the type of error is crucial to determining the areas as a malfunctioning automatic dispenser or variations in extent, nature and timing of action necessary. E.g: a random technique by testing personnel. error may need not only to be closely monitored for possible recurrence; a systematic error may need immediate remedial SHIFTS action. -sudden switch of data points to another area of the control chart away from the previous mean. They are usually MANIPULATION OF DATA associated with a change or replacement of some component decisions about what to include in a population or sample of the analytical system, such as new lot of reagents, repair or are often criticized by those who question the validity of installation of an instrument part, or recalibration of the statistical figures. method. STATISTICAL BIAS- having a set of numbers that do not - not necessarily bad and may reflect only some action taken truly reflect the characteristics of the whole population, to correct a problem previously noted. which may be either circumstantial or intentional. OUTLIER- the exclusion of a number that does not SHIFT QC data results are distributed on one side of appear to belong in a group of data, a purposeful the mean for 6-7 consecutive days manipulation of data. TREND Consistent increase or decrease of QC data Manipulation is not an uncommon occurrence in the lab. points over a period of 6-7 days Ex.: If a control were run 30 times and all the values were between 19 and 31 except for one, which was 54, the EXTERNAL QUALITY ASSESSMENT PROGRAMS exclusion of the outlier from statistical calculations is an example of an intentional bias. **The laboratory may participate on a voluntary or mandatory This may also be called “cleaning up the data”, a term basis in external programs initiated through the laboratory particularly attractive to the person doing their refinement. community, such as Proficiency testing, accreditation, and licensure activities in hospital programs such as PRO, Risk EXAMINATION OF CONTROL CHARTS Management, JCAHO, Medicare and facility licensing. This clues about data problems are often revealed in the topic focuses on laboratory-based programs, and the other shape of the gaussian distribution curve. plans as part of the indicators of the overall quality performance of the institution. SKEWED CURVES- deviations from the symmetrical bell-shaped appearance of a frequency polygon and External quality assessment programs may be roughly divided serve as a signal that the data do not accurately reflect into two types for review purposes: the parameters of the population. o Proficiency Surveys- blind specimens are sent by Distribution curves can be skewed in either direction (left an external agency for analysis and comparison with or right from the mean) because of a non-representatively other laboratories small sample size or by the inclusion of data that are o Licensure and Accreditation Programs- involves flawed because of sampling or process (technical, on-site inspections. administrative) errors. problems that are not rectified may translate into **The line between these two groups is often blurred because misleading inferences or incorrect range limits on the they are closely intertwined, but the division provides a means Levey-Jennings control charts. This, as every tech for review. Accreditation and licensure plans, for example, knows, may trigger unnecessary out-of-control flags, may frequently produce their own proficiency surveys or use causing much frustration and wasted troubleshooting participation in these plans as a major evaluation criterion. time. -Possible conflicts of interest arise from the requirement that only the proficiency survey products of a specific inspection PROBLEM-RELATED PATTERNS agency are acceptable. Frequent complaints are also **There are three problem related patterns that can be expressed over the interpretation and enforcement of detected by studying how data appear when plotted on a arbitrarily set “successful” performance levels by some control chart; trends, dispersions, and shifts. These government licensure agencies, despite disclaimers issued by patterns have also been matched with probable causes for almost all proficiency plans that the results should not be used their occurrence. The analyst must also be aware that these as a sole indicator or assessor of performance because of the patterns may all occur at the same time and be constantly alert intended design and unreliability of the material for this to the clues provided by each type of change in data purpose. configuration. PROFICIENCY SURVEYS TRENDS **Proficiency surveys are programs that allow a laboratory to –marked by a systematic drift in one direction away from the compare its performance on a common sample with a group established mean. May be detected by 41s or 10x Westgard of peers based on size (number of beds, specimen volume) rule failures. It signals the gradual deterioration of procedure and methodology (instrument, reagents). The most widely components such as reagents, standards, or instrumentation known programs are those issued by the American (e.g light bulbs, electrical elements, filters and so on). SAYRE 2H - TRANSES 9 Association of Bioanalysts (AAB) and the College of INDICATORS OF QUALITY PERFORMANCE: American Pathologist (CAP). Some state health INSTITUTIONAL PROGRAMS departments may produce specialty proficiency material for monitoring syphilis or infant thyroid testing facilities. Most **the discussion of quality management has, up to this point, suppliers of commercial quality control samples also include, reviewed programs with which the laboratory evaluates itself. as part of the report the inter-laboratory comparison statistics. The laboratory has also begun to play an increasing role, starting with the advent of quality assurance and the indicators -These organizations offer a variety of surveys, which can be of care, in the assessment of the overall care that patients tailored to the specific requirements and needs of each receive in the hospital. This has happened because of the type laboratory based on the sophistication and extent of services of information the laboratory provides and its relative ease of offered. Survey material may range from basic packages for quantification and monitoring potential. This role has physician office laboratories or satellite testing stations to coincided with the renewed realization that the laboratory’s comprehensive options for the highly specialized procedures success can be measured only within the context of the total performed in areas like toxicology and microbiology. care received by the patient. -Although the selection and enrollment in a proficiency survey -The laboratory's increasing participation in these institutional service may be theoretically voluntary, participation is programs is reflected in the JCAHO’S QA&I and CPI normally required for accreditation and licensure. Failure to programs, and in the issues associated with caring for, and meet designated performance criteria or to demonstrate receiving reimbursements for, patients covered by their appropriate corrective action may lead to sanctions including insurance such as Medicare, Medicaid, and so on. The major loss of accreditation or license. hospital-based quality activities and their historical transition -In addition to providing an objective means to assess the are reviewed now. effectiveness of internal quality control procedures, the studies provide the laboratory community with information UTILIZATION REVIEW AND PEER REVIEW about the performance of different methods and instruments. ORGANIZATIONS This allows managers and manufacturers to make more informed selection and marketing decisions. **The federal government, aligned with the states, has devised programs that are designed to assess the quality of LICENSURE AND ACCREDITATION PROGRAMS care delivered and provide some means of cost containment LABORATORY INSPECTION for the patients enrolled in their plans. These efforts and their terminology have followed a route similar to that of quality **The laboratory may justifiably feel bombarded with a management. multitude of entities seeking to inspect its facilities. This may -Beginning as a utilization review plan in 1966, local range from those seeking voluntary compliance with physician committees were required to review the medical professional standards to the local code inspector looking to necessity of care, with the main focus on reducing the enforce fire and safety regulations. Often rules and missions patient's length of stay in the hospital. In 1972, noting the may appear redundant or even in conflict a complaint shared failure of utilization review to curtail rising health care costs, by the laboratory with all business organizations. Congress made major changes and passed a law providing for professional standards review organizations (PSRO). AABB and CAP – professional lab organizations that This act emphasized cost containment and strengthened the have been leaders in offering inspection and accrediting role of individual physician's participation in developing local programs. They both provide extensive educational and norms, criteria, and standards of care in a peer review resource material about their review processes, including process. accreditation standards and inspection guidelines. This information has proved useful for developing and **Many of the methods for assessing the total quality of care monitoring quality management plans for the laboratory received by patients and identifying indicators of the quality of as well as preparing for site inspection. performance by the institution were developed under the JCAHO- maintain standards for the laboratory and also PSRO program. This was particularly true of techniques for includes a designated member of their site visit team to identifying records for chart audits and guidelines for review the laboratory. In addition to these professional utilization review committees. activities the laboratory has also attracted increasing -Ten years later, as part of the Tax Equity and Fiscal regulatory interests at both federal and state levels, most Responsibility Act (TEFRA, 1982), the same act that notably for CLIA’88 and Medicare certification. ushered in DRGs, PSRO was replaced by peer review organizations (PRO). Under TEFRA this program moved -Driven by the criticisms and complaints about redundancy from a local orientation to a single contracted PRO association and costs, many of the government and private inspection responsible for an entire state or region. The current program agencies are working on reciprocal, equivalency, and deemed is based on the PRO review of a nationwide beneficiary- status agreements or attempting to coordinate site visits to specific sample representing about 10 percent of the patients avoid frequent repetitious inspection of the same services. enrolled in federally sponsored plans. However, because of territorial issues (not an uncommon characteristic of most organizations), progress in this area has -This action does not relieve the local hospital of conducting been very slow, especially among competing laboratory utilization review studies. On the contrary, this activity and its organizations. methods are still a major part of the overall quality management program of hospitals required to meet JCAHO and state standards and to defend or challenge reimbursement decisions made by the PRO. SAYRE 2H - TRANSES 10 The federally mandated PRO for each region is charged with their time, what attracts and consumes their attention, and reviewing hospital case records for quality of care and to whom they issue rewards. If the proper philosophy is reimbursement decisions in the following areas: not present, efforts expended on the remaining two 1. Validity of diagnosis and suitability of services ingredients-- the operational and quality management provided systems- will be wasted tokenism and symbolism are not 2. Completeness, adequacy, and quality of care character traits of quality. received by the patient 3. Necessity of admission and appropriates of TOKENISM DIVERSITY discharge Someone of a "minority" (in Someone of a "minority" (in 4. Congruous care given to “outlier cases”, exceptional representation) is invited representation) is invited to cases because either cost-of-care or length-of-stay join a majority. This may be become a permanent and criteria are exceeded. for a specific event or topic. contributing part of a team 5. Appropriateness of transfer of patients between usually temporarily. that includes a wide range of facilities represented groups. CRITICAL-CARE PATHWAYS (CARE PATHS) OPERATIONAL SYSTEMS Quality management begins with how well managers **A major hospital-wide quality care management program incorporate quality practices into their management has developed that places emphasis on the outcomes of functions. treatment received by the patient as the definition of quality. Operational systems represent the actual practices taking This program, called critical-care pathways, or simple care place in an organization- not good intentions, wishes, or paths, was driven by the total-care concept lessons of QA, future plans. TQM/CQI, PRO, and the specific performance improvement Lundburg (1976) and Bozzo (1991) point out that the indicators of QA&I/CPI. This plan incorporates all the laboratory’s testing cycle begins with the doctor’s request resources of the health care system into the delivery of an for lab services and continues when information is exact series of interventions or treatments that are to be received by the physician and new requests are issued. received by the patient in a designated time period in the laboratory must have operational systems in place response to a specific set of symptoms. that ensure that every step flows smoothly and continually toward the final delivery of a high-quality service. the -Under the critical-care pathways, the patient is expected to following model illustrates the steps in the testing cycle respond and progress along a specific care plan. This includes that are part of the operational systems and quality the coordination of both patient-initiated activities (eating, practices of the laboratory. breathing, exercise, and so on) and treatment plans (laboratory tests, medications, x-rays, physician care, and so From patient needs to patient needs: on), usually related to a DRG classification. For example, in a o Service Assessment → patient manifesting the symptoms of pneumonia (Southwick, o Physician Utilization → 1994) a chest x ray is performed within 1 hour of arrival and o Service Requisition → sputum collected for culture and evaluation within 2 hours. o Specimen Collection → o Specimen Processing → MANAGEMENT OF QUALITY o Analytical Process → o Results Assessment → **Many entities offer advice and programs for the o Information Report → management of quality in an organization. These include the o Service Assessment → promise-all, pre-packaged programs designed by expensive consultants and the theory-based concepts of MBO, QA, QUALITY MANAGEMENT PROGRAMS (QMS) TQM/CQI, and CPI. QMP – address specific issues and goals and are plans 3 areas must be properly aligned if the institution is to for ensuring compliance or bringing about change achieve its quality performance goals: Operational Systems- represent the final results of all o The philosophy or attitude of the people the efforts and are the actual practices taking place o The operational system of the enterprise o Actual quality assessment and monitoring program The wide variety of high-quality management programs in place available to managers includes MBO, quality circles, and, of course, the elements of THE PHILOSOPHY OF QUALITY QC/MBO →QA → TQM/CQI → QA&I/CPI → ?QC/MBO? The attitude of the people toward their work, themselves, the organization, and their customers is reflected in how they treat each other, view their shared interest in QMP also include the specialized fxns that are part of the achieving common goals, and view their professionalism technical operations of the laboratory and so crucial to the in the delivery of their product or service delivery of a high-quality service. Ongoing activities that can be defined directly as part of QMP include: The philosophy of caring and commitment to the delivery o Preventive maintenance (PM) of a high-quality service starts at the very top and o Policy and procedure manual writing and review permeates every crevice of the institution. It is directly tied o Quality control functions to the priorities placed on quality by the organization's o Staff orientation, Continuing Education, and leadership and is demonstrated on how managers spend development SAYRE 2H - TRANSES 11  o Participation in proficiency testing o Problem solving and troubleshooting o Laboratory inspection, accreditation, and licensure process Philosophy, operational systems, and quality management programs combined to the integrity of the quality management plan. each is crucial to the success of the laboratory in achieving its goal of delivering high quality services to its patients. SAYRE 2H - TRANSES 12  SAFETY MANAGEMENT **Clear separation of different work zones to prevent cross- MT 105: LECTURE 10 contamination and ensure the safety of the personnel is very Vid Lecture By: Ms. Kristine Abegail important. (**)- additional notes from Reference book and vidlec FIRE PREVENTION HAZARDS OF THE WORKPLACE: FIRE PREVENTION PLANS A MATTER OF ATTITUDE **the goal of the fire prevention is to control or eliminate these elements to reduce the risk THE ROLE OF THE INDIVIDUAL of fires. Must ultimately assume responsibility for his/her health and safety Fire Triangle: Know and comply with the established laboratory work Ignition Source – To consider: and safety methods. o Equipment inspection, health work permit system, Have a positive attitude towards supervisors, co-workers, smoking policies, training and awareness, and the facilities, and safety training. control of the open flames. Give prompt notification of unsafe conditions or practices Oxygen - the ventilation, the oxygen storage, the to the immediate supervisor and ensure that unsafe controlled atmosphere, and the emergency response. conditions and practices are corrected. Fuel - proper storage and handling, segregation of Engage in the conduct of safe work practices and use of materials, housekeeping, and also the equipment personal protective equipment (PPE). maintenance. **The attitudes of both employers and employees play an Main Fire Prevention Strategies: important role in maintaining a safe workplace. Keep flammable substances in separate rooms and -If the employees and employers become complacent about storage cabinets safety measures, they may also overlook potential hazards. Use fire-resistant building products, explosion-proof For example, it would happen to mean mindset can lead to a refrigerators and hoods; lack of diligence in terms of safety protocols Perform procedures that result in highly combustible -The lack of awareness, ignorance or lack of awareness about reactions under water or in a vacuum chamber the potential hazards could always contribute to the accidents. - Employees need to be educated and contentiously reminded HANDLING OF FLAMMABLE SUBSTANCES about the risks associated with their work and also the Most obvious method for preventing fire is to control the importance of safety guidelines. union of fuel and ignition sources. Key Rules: THE ROLE OF THE EMPLOYER -For a laboratory or given area (per 5000 square feet of Establish laboratory work methods and safety policies. space) Provide supervision and guidance to employees. o maximum of 10 gallons of flammable liquids can Provide safety information, training, personal protective be in use or stored in the open, outside of a equipment (PPE), and medical surveillance to safety room, cabinet, or safety can employees. o 60 gallons of flammable liquids can be stored in Provide and maintain equipment and laboratory facilities a safety cabinet that are adequate for the tasks required. -Safety cans used for: o more than 1 pint of class A flammables STRUCTURAL REQUIREMENTS o more than 1 quart of class B flammables Separation of non-testing functions, such as clerical and o More than 1 gallon of most other flammables administrative offices, from areas containing hazardous Flammable gas cylinders - stored separately from other materials by means of structural barriers and control of flammable materials traffic patterns. Persons working with flammable material must be trained Delivery and storage of potentially hazardous chemicals, properly in handling, storing, processing, cleanup, and such as flammables and corrosive materials. accident control. Processing of specimens, from their collection and arrival in the laboratory to their final delivery to the testing site. FIRE-FIGHTING STRATEGIES Ventilation back-up plan. Critical in Histology and Microbiology - heavy concentrations of chemical and Construction Fire-Fighting Equipment biological material. *Major deterrents to fire: *Required: -Structure of a building -Fire-resistant building materials Location, ease of use, and rapid availability of any special -Materials used -Automatic sprinklers safety equipment (fume hoods, decontamination facilities, -Layout plan for entrances and -Self-closing doors and first-aid stations.) exits -Fire hydrants -Storage of flammable materials **It is really important that space could be considered to have **These factors are also crucial in an adequate space allocation for various functions within the the quick isolation and extinction laboratory. These are workstations, storage, equipment, and of any fire and in the control of the also the circulations area. number one cause of fire death: smoke inhalation. SAYRE 2H - TRANSES 1 Fire Extinguishers Classes: TRAINING and PRACTICE Orientation and In-service training - cover all aspects of the fire plan, with individual hands-on training in the use of: o Fire extinguishers o Fire blankets o Emergency Eyewash o Shower Stations o Fire Isolation Techniques o Identifying fires o Sounding the alarm o Fighting Fires o Evacuating according to emergency plans ELECTRICAL SAFETY -it is important to protect personal equipment and the integrity of experiments. Two Major Hazards in the lab: 1. Physical harm from shocks or burns when a person comes into contact with an electrical source 2. Dangers form fore caused by heat and sparks generated by malfunctioning wiring or equipment SAFEGUARDS RECOMMENDED By: NFPA (Adopted BY CAP, JCAHO, most Fire Districts) No extension cords or outlet adapters. All equipment in the break room - checked for compliance with electrical safety standards upon arrival or beefier being placed into use. Electrical safety checks - part of the laboratory preventive maintenance programs for each piece of equipment Examination for proper voltage and grounding, current leakage, and broken, worn, or frayed ends on plugs and cords. Circuit breakers conveniently located and labeled in case of a major water spill or other accident requiring that power be cut off immediately Electrical equipment should not be used in areas with flammable materials because of sparks or ignitions, unless the equipment have been checked. Electrical safety should be part of the orientation and educational program of the laboratory. Procedures and directions for cleaning up water spills around instruments and rescuing a coworker who may have come in contact with a live wire or malfunctioning electrical equipment should be part of the train