ASCLS Today Volume 33, Number 4

Stephanie Mihane, MLS(ASCP)^CM, ASCLS Region VIII Director

As healthcare becomes more consumer focused, the need for immediate results continues to drive the ever-increasing demand for point of care testing. Photo credit: Philips Communications

I have been a point of care coordinator for Kaiser Permanente for over 12 years, and a lot has changed since I first started in my position. Here’s a little history regarding point of care (POC) testing—testing performed outside the traditional core or central laboratory, or medical diagnostic testing performed “at or near the patient” to facilitate improved patient care. CLIA ’88 provided the first laboratory regulations, defining anyone who performs testing on a human specimen for diagnostic, prevention, and treatment of disease or health problems to be covered under laboratory regulations.

As CLIA ’88 developed, tests were categorized as waived, moderate complexity, and high complexity based on technical difficulty and potential harm to the patient. Waived tests were defined as simple laboratory procedures that are cleared by the FDA for home use and that incorporate methodologies that are so easy and accurate it is unlikely that mistakes would occur. Another requirement is they would pose no reasonable risk of harm to a patient if they were performed incorrectly.

Originally only nine analytes were approved as “waived.” They included dipstick or reagent tablet urinalysis, fecal occult blood, ovulation tests, urine pregnancy, ESR, and hemoglobin testing. Shortly after, spun hematocrit, and blood glucose were added. The chart below shows the explosion of POC testing over the years.

The current list of waived tests can be found at www.cdc.gov/clia/waived-tests.html. There have been 16 new tests approved in 2018 alone.

As healthcare becomes more consumer focused, the need for immediate results continues to drive the ever-increasing technological advances in POC. The tricorder in the original Star Trek movies once thought to be science fiction is now being realized in microprocessors and wireless communication. Smaller, more compact, sophisticated testing will drastically alter how and where care is delivered. Evidence-based medicine and patient care will be supported by this POC data and provide faster, safer outcomes for the patient.

With the trend for POC testing to grow an estimated 9.3 percent between 2013 and 2018 and exponentially increase in growth as the need for infectious disease and chronic condition POC testing takes precedence. Emerging technologies and more specific molecular tests for influenza, RSV, malaria, blood gases, lactic acid, and Dengue fever are driving this explosion.

As the laboratory testing expands outside the laboratory, the number of medical laboratory professionals is shrinking. The expanding roles for medical laboratory professionals as part of an interdisciplinary healthcare team of today is emerging. The new “face of the profession” is the point of care coordinator. Our mission is to provide resources, knowledge, guidance, and oversight for what once was our scope of practice. If we do not embrace this new mission, we cannot guarantee the safety of our profession and the safety of our patients.

Our opportunity is now to embrace the future and our new role as an integral part of the healthcare team, providing the expertise only we can. The respect, recognition, and visibility we have always wanted and needed is within reach. Embrace your future and that of our profession. Point of care is the future, like it or not!

Stephanie Mihane is point of care coordinator at Kaiser Permanente in Aurora, Colorado.

For more on point of care testing, join the Point of Care Testing Scientific Assembly.

THE IMPORTANCE OF SELF-CARE

Kim Von Ahsen, MHA, MLS(ASCP)^CMSLS^CM, ASCLS Region VI Director

Doing little acts of kindness are another form of self-care, which is essential to your overall health.

I love the ritual of having a cup of coffee in the morning. Like, I really, REALLY love starting my day with coffee. Often, I’ll make a cup at home or take a quick morning drive to a local coffee shop on the weekend, which is what I did on our first beautiful spring morning after a long Iowa winter.

That morning my coffee cup was asking me, “How will you be amazing today?” It a took a moment to read all the ideas listed. I’ll be honest, my first reaction was, “Ugh. Who has time to be amazing? Some days I struggle just to take care of myself.” This is when I had one of those ah-ha moments—doing little acts of kindness are just another form of self-care, and that kindness and care for myself is needed.

“Self-care is giving the world the best of you, not what’s left of you.” - Katie Reed

Self-care is any activity that takes care of one’s mental, emotional, or physical health. As professionals in healthcare, we are exceptional (and I mean exceptional) at taking care of patients. We stay late, take on another project or shift, and go out of our way to provide safe and quality laboratory services. However, we tend to lack attention to ourselves—especially that ever-important care that is directed to our self through deliberate activities that reset us mentally/emotionally/physically or through acts of kindness that brighten our soul.

Practicing self-care is essential to improving your mood, relieving stress, and strengthening personal and professional relationships. Make a commitment to your well-being today, and if you need some ideas of how to incorporate activities of self-care, here’s some ways to start.

1. Create dedicated self-care time. This can be as easy as listening to your favorite album or podcast on the way to work, or a more structured scheduled activity such as attending a yoga class once a week.
2. Keep it simple. Don’t plan on highly complicated activities that you won’t be able to accomplish. Self-care is not about completing a bucket list.
3. Do what you love. Self-care is also about joy, which means you should love doing the activity you choose. It’s probably not a great idea to take up camping in a tent if you are more of a luxury cabin type.
4. Find self-care balance. Make sure to select activities that balance your mental, emotional, and physical health. Look to activities that bring peace to your mind, engage your heart, and move your body.

Most importantly, remember that self-care is a vital tool that can assist you in maintaining a life-work balance in a profession that has the highest demands.

Kim Von Ahsen is manager of client services for UnityPoint Health-Des Moines Clinical Laboratories in Des Moines, Iowa.

Beth Warning, MS, MLS(ASCP)^CM, ASCLS Region IV Director

The Area Health Education Center (AHEC) organizes the Health Careers Showcase (top) and Health Career Explorer program (bottom) to recruit high school students into healthcare careers, including medical laboratory science.

We are often asked to share our story of how we became a medical laboratory professional. For me, I made my decision as a junior in high school, while participating in a program called Health Career Explorers. Each month, a group of us visited a local hospital and spent time in a different department. While the details have blurred over the years, I remember leaving the lab session set on finding a college with a program in what was then medical technology. And, as they say, the rest is history.

Fast forward several years, when I was the supervisor of education and safety at a large medical system. I became the face of the lab, attending high school career fairs or speaking to individual classes about medical lab science. It was then that I noticed the same presenters attending the same career fairs and connected with the team from the North Central Kentucky Area Health Education Center (AHEC). Now, as a member of the advisory board for the same AHEC, we work together to not only promote health careers, but also team up to promote medical laboratory science (MLS).

In Kentucky, like many states, we have eight centers throughout the commonwealth. Per the AHEC website, the centers work with a common mission—to improve the health of communities by developing partnerships through educational support to health profession students and practitioners, promote community health education, and support and promote health profession career choices.

There are three target areas of the Kentucky NC AHEC. The first is to support training needs of future healthcare professionals by assisting medical, PT, PA, and pharmacy students with identifying preceptors for clinical placement or rotations and assisting with housing within the community, especially in rural and underserved areas. The second is to provide community education opportunities in rural and underserved areas. Some of these educational programs include tobacco cessation and prevention outreach, diabetes type 2 and cardiovascular disease prevention, as well as other community health education classes. And the third area, where we in the MLS profession can partner, is in recruitment of professionals for the workforce. Let me elaborate on promoting the MLS profession in partnership with Kentucky students and our regional AHEC.

Classroom Presentations
AHEC staff have developed free, 45- to 50-minute presentations that can be brought into the classroom ranging from an overview on health careers, to presentations on epidemiology, blood typing, karyotyping, and even autopsy. These are just a few of the lab-related offerings.

Embedded into the hands-on activities are discussions on aseptic technique, anatomy and physiology, and overall health and wellness. Something that is always a big hit with students is the Metiman Patient Simulator, a life-sized sim patient that travels along with the AHEC staff to demonstrate patient assessment and vital signs, again with a review of the circulatory and cardiovascular anatomy and physiology.

Health Career Explorers
I was excited to be in a clinical setting when the North Central AHEC started its Health Career Explorer program. I was able to invite this young group of high school students to tour our lab, perform simple manual tests, like UA dips with non-infectious samples, mocked-up strep screens, and microscopic observations. One year, there happened to be a formalinized brain in histology, and the pathologist shared this with the amazed students. Many students had never seen a unit of blood processed and ready for transfusion. Just simply walking through the lab dispelled the concept of a high school biology or chemistry setting.

The North Central AHEC continues to work closely with the same healthcare system and in the fall of 2018 had 64 students from 18 area high schools enrolled in the Explorer program. Interested students must apply to the program, which is open to sophomores, juniors, and seniors in the regional high schools. A minimal fee is charged, and education on HIPAA and bloodborne pathogens is provided.

The Explorers have now morphed into a case study-based interprofessional experience, involving more than just tours. They link test outcomes with diagnosis. A situational case “family” has the most unfortunate health issues, but the same “family” is revisited as the case unfolds in each of the various disciplines throughout the hospital. The health careers spotlighted include clinical lab, radiology, PT, OT, and other disciplines.

Another Explorer group was formed in a rural high school as a club and has an additional 25 students. AHEC staff members are present throughout, alongside the professional presenting the designated topic for the evening. During the clinical lab visit, informational flyers are distributed regarding the University of Cincinnati Medical Laboratory Science Bachelor of Science program.

A second group, Health Explorers II, invites past students to delve deeper into related health careers that may not be as visible in a hospital, such as paramedics, public health, or molecular biology.

Health Career Showcase
Another benefit of the partnership with the NC AHEC is involvement in the Health Career Showcase. Each fall, students throughout the northern Kentucky area have the opportunity to attend this career-type fair, where numerous healthcare representatives have tables to provide hands-on experiences and career information.

This event, drawing over 600 students from more than 20 high schools, is one of the most efficient and organized career events I have ever attended. Students are bused into the event on a rotating schedule and filter through the auditorium speaking with over 30 healthcare professionals, including medical lab science. Where else can we as lab professionals encounter such an inquisitive audience, in one place, for a few short hours?

Gateway to Health Careers Summer Camp
Each year, the North Central AHEC hosts a five-day summer camp filled with education and hands-on opportunities for 15 to 20 high school students, in partnership with a local medical center and community college. In the past, I have been invited to represent the field of medical lab science, providing a brief overview presentation along with mock urine dips or blood typing. While this may only be one hour out of my summer schedule, the opportunity is priceless.

The AHEC also publishes a Health Careers Resource Guide highlighting each healthcare discipline, education, average salary, state colleges and universities offering the major, and provides websites of interest (ASCLS of course!) for more information.

I encourage you to reach out to your state AHEC and develop a partnership for promoting the profession of medical laboratory science. The AHEC team has connections with teachers, guidance counselors, and schools, reaching students who may be unaware of the medical laboratory profession. They welcome the expertise of lab professionals to impart wisdom and knowledge to the students. The partnership that was established many years ago is truly a win-win for everyone involved.

Special thanks to the North Central AHEC staff Rose Mueller, Juliana McGuinn, and Vivian Lockstead.

Beth Warning is assistant professor in the medical laboratory science program at the University of Cincinnati-College of Allied Health Sciences.

For more information about Area Health Education Center (AHEC), visit www.nationalahec.org.

Carolyn Sabady, PBT(ASCP)

Top: Graduates of the ACL Laboratories (AdvocateAurora Health) phlebotomy training program. Bottom: Author Carolyn Sabady is phlebotomy supervisor at ACL Laboratories.

There is an urgent need across the country for phlebotomists. According to the Bureau of Labor Statistics, the employment rate of phlebotomists is projected to grow 25 percent between 2016 and 2026. In 2017, ACL Laboratories (AdvocateAurora Health Care) performed 26 million tests, and 730 phlebotomists performed 2.5 million venipunctures. In response to the urgent need for phlebotomists, ACL Laboratories (AdvocateAurora Health Care) created a phlebotomy training program. The program has benefited the organization by promoting growth and engagement and has filled numerous empty positions within the organization.

How We Got Started
The extensive planning for the phlebotomy training program started in the summer of 2017. Given that AdovcateAurora Health Care is one of the largest healthcare systems in the Midwest, the group of individuals that met to discuss the phlebotomy training program included representatives from Wisconsin and Illinois. A group of 14 individuals (supervisors, educators, senior directors, and human resource partners) throughout the organization met weekly to discuss the essentials that were needed to build this program and align it with the Clinical & Laboratory Standards Institutes (CLSI) standards. In addition, three additional subgroups were formed to construct a curriculum, assess location, and evaluate human resource logistics.

The Program Structure
The phlebotomy training program is a paid two-week program. The potential candidates apply online to the phlebotomy trainee position and are interviewed by our talent acquisition team. After the applications are reviewed and the candidates are interviewed, a job offer is made. The candidate accepts a position within the organization. Upon completion of the two-week program, the students are placed into open phlebotomy positions within the organization. The classes are eight hours a day and include four days of clinicals. Over the course of the two-week program, the phlebotomy students learn:

• Introduction to Medical Lab and Clinical Roles
• Capillary Collection
• Patient Assessment-Patient Care
• Soft Skills
• Safety and Infection Control
• Medical Terminology
• Blood Specimen Collection Process and Venipuncture Technique
• Procedure Documents
• Phlebotomy Equipment
• Collection of Nonblood Specimens
• Specimen Handling

While this may seem like a short span of time to learn phlebotomy, the phlebotomy students that graduate the program continue to improve their skills and are partnered with a seasoned phlebotomist at their job site for continued training.

The Start of Success
After months of planning, the two-week phlebotomy training program was piloted in January 2018 in Wisconsin, with two phlebotomy students. Upon completion of the program, the two phlebotomy students were placed into open positions within the organization. Since the pilot of the program in Wisconsin in January 2018, ACL Laboratories (AdvocateAurora Health) held six additional classes in Wisconsin, four in Illinois, and had a total of 57 successful graduates. In 2019, Wisconsin has had two classes and Illinois has had one class, with a total of 25 successful graduates. The feedback received from the phlebotomy trainee candidates has been enlightening, capturing areas where we can improve the program and the flexibility to allow them to acquire new skills while promoting work/life blend.

Benefits for the Organization
The success of this program has empowered many internal team members as well as external candidates to fill the vacant phlebotomy positions within the organization. The phlebotomy training program has also assisted with the growth of team members within the organization, including the creation of a new position—phlebotomy training specialist. There is no greater reward then to promote growth and development within your organization and to find a positive solution for our substantial need for phlebotomists.

Carolyn Sabady is phlebotomy supervisor at ACL Laboratories in Milwaukee, Wisconsin.

For more on phlebotomy topics, join the Phlebotomy Scientific Assembly.