Details of CLIA Final QC Regulatory Changes
description
Transcript of Details of CLIA Final QC Regulatory Changes
Details of CLIA Final QC Regulatory Changes
Division of Laboratory ServicesCMS
Overview Consolidates Subpart J, K, and P into:
– J-Facility Administration for Nonwaived Testing.– K-Quality System for Nonwaived Testing.– Creates one set of Nonwaived requirements.– Parallels the flow of a specimen through the
laboratory.– Reflects the Total Testing Process:
• General Laboratory Systems• Preanalytic Systems• Analytic Systems• Postanalytic Systems
Subpart AGeneral Provisions
Revisions:– Definitions for calibration, FDA-cleared or
approved, reportable range & test system.– Replaced National Institute for Drug Abuse
(NIDA) with Substance Abuse & Mental Health Services Administration (SAMHSA).
Subpart IProficiency Testing
Revisions:– Changed consensus for PT program grading
from 90% to 80%.• Reduces number of ungradables.• Permits labs to “get more for their money”.• Facilitates better laboratory education; e.g., error ID
& correction.
Subpart JFacility Administration
Revisions:– Applies to moderate & high testing.– Facility requirements.
• Safety precautions are accessible.• Uni-directional workflow for molecular
amplification procedures.• Comply w/ Federal, State & local laws.
Subpart J Facility Administration
Revisions:– Transfusion Services
• Report transfusion reactions/fatalities to laboratory & authorities.
– Record/Specimen Retention• Preservation.• Record retention for closed facilities.• Keep test procedure & performance specifications
for 2 years after use.
Subpart KQuality System
Applies to moderate & high testing.– General Laboratory Systems.– Preanalytic Systems.– Analytic Systems.– Post analytic Systems.
• Emphasizes Quality Assessment.
Subpart KQuality System
Quality assessment (QA) requirements – Monitor and assess quality.– Correct problems.– Review effectiveness of correction.– Discuss with staff.– Document assessment activities.
Included in each phase of testing
Subpart KQuality System
General laboratory Systems: – Confidentiality of patient information.– Specimen identification & integrity.– Complaint investigations.– Communications.– Personnel Competency Assessment Policies.– Evaluation of PT performance.
Subpart KQuality System
Evaluation of PT Performance:Verify accuracy of:- Tests w/ no evaluation or score.- Tests when PT score doesn’t reflect test
performance.- Any test not included in Subpart I. - Regulated analytes for which compatible PT
material isn’t available from PT providers twice a year.
Subpart KQuality System
Preanalytic Systems
Test request:– Solicit patient’s gender, age or DOB.– Solicit specimen source, when appropriate.
Specimen submission, handling and referral:– Date and time of receipt in laboratory.
Subpart KQuality System
Analytic Systems
Procedure Manual:– Director must sign procedures & changes prior
to use.– Retain test procedures with the dates of initial
use and discontinuance.
Subpart KQuality System
Analytic Systems
Test systems, equipment, instruments, reagents, materials, and supplies:– Removed the FDA product dating information
to guidelines. – Follow manufacturer’s instructions for storage
of reagents, specimens & test systems.
Subpart KQuality System
Analytic Systems
Maintenance and function checks:– Follow manufacturer’s instructions for
maintenance & function checks. Calibration and calibration verifications:
– Provides flexibility for calibration verification material.
Subpart KQuality Systems
Analytic Systems
Establishment and Verification of Performance Specifications:– Applies to new or modified nonwaived tests.– Verify/establish accuracy, precision, reportable
range.– Verify/establish manufacturer’s normal values.– Determine calibration & control procedures.– Establish analytical sensitivity & specificity.
Subpart KQuality System
Analytic Systems
Control Procedures:– Detect immediate errors and monitor over time.– Requires a control system capable of detecting
reaction inhibition for molecular amplification.– Test 2 controls/day or acceptable alternative.– Use of calibrators as controls.– Rotate QC testing among all operators.
Subpart KQuality System
Analytic Systems
Bacteriology:– Check each batch, lot number and shipment of reagents,
disks, stains, antisera, and identification systems when prepared or opened for positive and negative reactivity (and graded reactivity, if applicable).
• Less stringent for catalase, Cefinase,Tm coagulase, oxidase, bacitracin, optochin, ONPG, X,V and XV disks or strips
– Check each batch, lot number and shipment of antisera for positive and negative reactivity when prepared or opened, and once every 6 months thereafter.
• Less stringent
Subpart KQuality System
Analytic Systems Mycobacteriology:
– Check fluorochrome acid-fast stains for positive and negative reactivity each time of use.
• More stringent – Check acid-fast stains for positive and negative
reactivity each day of use.• More stringent
– Each day of use check all reagents, test procedures for mycobacterial identification using positive and negative acid-fast organisms.
• More stringent
Subpart KQuality System
Analytic Systems
Mycology:– Check each batch, lot number and shipment of reagents
and fungal identification tests (germ tube) when prepared or opened for positive and negative reactivity (and graded reactivity, if applicable).
• Less stringent - frequency• More stringent - added negative control
– Check each batch, lot number and shipment of lactophenol cotton blue when prepared or opened for intended reactivity with a control organism(s).
• Less stringent
Subpart KQuality System
Analytic Systems
Parasitology:– No changes.
Virology:– No changes.
Routine Chemistry:– No changes.
Subpart KQuality System
Analytic Systems
Syphilis Serology and Immunology:– Control testing reduced to each day of testing.
Hematology:– Reduced automated hematology QC to
once/day.– Manual hematology requires QC each 8 hours
of testing.– No change to QC for coagulation (manual or
automated).
Subpart KQuality System
Analytic Systems
Immunohematology:– Includes only specific cites for FDA BB
(21 CFR) requirements under CLIA. Histopathology:
– Check immunohistochemical stains for positive & negative reactivity each time of use.
– Allows individuals trained in neuromuscular pathology to report neuromuscular path results.
Subpart KQuality System
Analytic Systems
Cytology:– Workload limit for liquid-based slide
preparatory techniques reduced from 200 to 100 for gynecologic preparations.
– Provision for automated, semi-automated screening devices added to require manufacturer’s instructions (including individual workload limits) be followed.
Subpart KQuality System
Analytic Systems
Clinical Cytogenetics:– Resolution is appropriate for type of tissue or
specimen & study required based on clinical information provided.
– Requires full chromosome analysis for sex determination.
– Utilize the International System of Cytogenetic Nomenclature on report.
Subpart KQuality System
Analytic Systems
Histocompatibility:– Requires in-house prepared reagent typing
inventory to indicate reagent specificity.– Requires a technique that detects HLA specific
antibody w/ a specificity equivalent or superior to the basic microlymphocytotoxicity assay.
– Requires using a method that distinguishes antibodies to HLA class II antigens from antibodies to Class I antigens.
Subpart KQuality System
Analytic Systems
Histocompatibility cont’d:– Have available monthly specimens for periodic
antibody screening & crossmatch on all potential transplant recipients; and develop a policy consistent w/ clinical transplant protocols for frequency of such antibody screening.
– Define test protocols for each type of cell, tissue or organ to be transfused or transplanted.
Subpart KQuality Systems
Analytic Systems
Histocompatibility cont’d:– Follow policies that address when HLA testing
& final crossmatches are required for pre-sensitized non-renal transplant recipients.
– Establish technique to optimally define HLA Class I & II specificity.
– Eliminates monthly evaluation of a specimen as an unknown by each testing person.
Subpart KQuality System
Postanalytic Systems
Test Report:– State date of test report on report & include
specimen source, if applicable.– Include name & ID no. or unique patient
identifier & ID no.
Subpart MPersonnel
Applies only to doctoral degree (non-MD) qualifications:– Represents only remaining complexity-
dependent requirements.– As of 2/24/03 “grandfathers” individuals
currently as high complexity directors.– Requires board certification for new directors.– Approved Boards to be listed in Appendix C of
Surveyor Guidelines and on website.
CLIA FINAL QC REGULATIONS
CONTACT INFORMATION:
– CMS WEB SITE: www.cms.hhs.gov/clia
– CMS LAB DIVISION: 410-786-3531(phone) 410-786-1224 (fax)
THE ENDTHANK YOU!!
QUESTIONS????