Conquer Your QC Fears: Quality Control in the Modern Lab

With constant advancement in medicine, laboratory professionals are trained in numerous new technologies, techniques, and instrumentations. For professionals just coming into the field of medical technology, the fast-paced, ever-changing techniques and policies are normal. For both more seasoned and new techs, the changes in policies and quality control (QC) can be challenging. And to the untrained eye, QC requires a commitment to quality that can be daunting. This commitment to quality requires monitoring, adjusting appropriately, and gaining confidence regarding QC results, which verify the validity of the hospital’s analyzer and overall patient testing. Constant change means constant improvement, which at times can be overwhelming to the inexperienced employee.

Laboratory values account for much of a patient’s diagnosis. As departments throughout the medical laboratory grow, so does the need for monitoring and assessing instrument performance and the quality of the results that are reported to clinicians. If this quality goes down, so does the quality of health care provided to the patient. Laboratories must know whether their results are high quality, and providers need to feel comfortable making diagnoses based on the results the laboratory releases. This requires managers, supervisors, and directors not only to constantly monitor the performance of the instrumentation, but also to maintain quality assurance throughout the clinical laboratory.

Education Improves Quality
One of the key indicators of quality assurance throughout the laboratory is the ability to track and monitor results. The amount of education given to laboratory professionals is limited in the realm of QC and quality assurance. This causes a huge gap in professional development for new and even seasoned laboratory professionals who have never been taught exactly how to monitor, track, and regulate QC throughout the laboratory. A need for more education and training is apparent, which would provide laboratory professionals the tools to understand what they are looking for, and how to validate and correct QC is crucial. When a laboratory can assure a clinician that it is properly monitoring the performance of its instrumentation for errors and quality, this fosters confidence throughout the hospital that the laboratory is releasing high-quality results.

As many laboratory professionals know, the majority of laboratory staff is not sufficiently educated and trained in QC and quality assurance. QC is a huge portion of the modern lab, and unfortunately only a small portion of techs actually understand it. As leaders in our career field, it is our responsibility to educate our peers in the principles of QC in order to create future leaders in the medical laboratory.

Conquering the fear of QC is the first step to having a successful department within the laboratory. As supervisors and leaders, we need to provide all the tools needed for our peers to learn and understand the material. These tools are crucial to ensure the success of the next generation of technologists and our laboratory. Tools for QC include access to resources such as courses on QC, troubleshooting guides for when QC fails, and time with a supervisor to explain and review peer data and other QC reports.

Here are some examples of good questions to check quality indicators throughout the laboratory:

1. Which QC material is best for my laboratory/­instrument?
   • Typical QC materials to choose from include assayed, unassayed, and standards
     
     
2. What monitoring rules am I going to follow?
   • Westgard rules, ±2SD, TEa (total error allowed), or 6 Sigma
     
     
3. What troubleshooting steps am I going to take?
   • Repetition, new QC, new reagents, maintenance, calling the hotline
     
     
4. When do I calibrate?
   • Provide staff with a thorough troubleshooting flow chart that shows them exactly what steps to take in order to get to a good result
     
     
5. How do I validate my QC processes?
   • Review peer data, establish in-house validations, use manufacturer’s QC claims, and perform proficiency testing of peer data
     
     
6. What is peer data telling us?
   • How do we look compared to other labs throughout the country?
   • How does our laboratory’s bias/accuracy look? (standard deviation index is used to measure bias and accuracy)
   • How does our laboratory’s precision look? (coefficient of variation ratio is used to measure precision)
     
     
7. How are my proficiency testing results?
   • Proficiency testing should not be just a pass or fail report. Laboratories should utilize proficiency testing to its full extent by tracking instrument performance through the peer data that are given.
     
     
8. How can I improve?
   • Share proficiency testing throughout the laboratory so everyone can see exactly how to utilize the information.
     
     
9. Can we create a strong training program for new employees?
   • Designate a trainer or group of trainers
   • Standardize all to ensure consistency
   • Keep training consistent to minimize technical errors
     
     
10. How can I stay compliant and up to date with new methodology within my departments?
    • Provide training and competency assessment to all employees
      
      

These are all methods that can be utilized to create a stronger foundation for not only new employees, but also support existing employees’ knowledge and understanding of QC establishment and monitoring. Laboratories that share information, provide resources, and create a consistent training program not only build stronger teams, they create a culture that helps cultivate stable relationships.

It is essential for employers and supervisors to take time to educate their employees. Employees that feel valued will not only be successful in their assigned duties, but will feel empowered to learn and share their knowledge with their peers. Sharing knowledge and encouraging teamwork to solve QC problems easily dispel the fears of the unknown. So join us in the revolution to educate! Conquer your fears of the unknown and learn how to pick, establish, and maintain quality control throughout your laboratory. Remember, we are here to help!

Special thanks to Lauren Gage, MLS(ASCP)^CM, Immunology Lead at Colorado Mental Health Institute-Pueblo, for editing help with this article.