LIVING THE LAB LIFE
A BLOG FOR ASCLS REGION V
Here is the full update from the ASCLS National office:
"It is our great pleasure to inform you that the efforts you made to alert the VA to problems with the agency's proposed rule expanding the authority for APRNs to "perform and supervise" laboratory testing has met with success.
"Tomorrow, the VA will publish the final personnel regulations in the Federal Register with changes ASCLS and its members pursued.
"We have successfully convinced the VA to adjust the language to better protect patients while expanding access to care for our nation’s veterans. Further, the VA calls out the "crucial role" laboratorians play in the care of VA patients. The key language explaining this change is below (with our emphasis added).
“Several commenters stated that they were concerned with proposed § 17.415(d)(1)(i)(B), where we stated that a Certified Nurse Practitioner (CNP) may order, perform, or supervise laboratory studies. The commenters stated that the proposed language does not “adequately appreciate the levels of complexity involved in laboratory testing” and that there are rigid standards for laboratory tests that require rigorous academic and practical training, which are not part of the training for APRNs. Another commenter stated, “While the VHA uses the word ‘interpret’ in reference to laboratory and imaging studies,” the commenter “…infers that the VA’s intent is to grant the ability for CNPs to interpret laboratory and imaging results, not to interpret or report raw images or data.” The commenter suggested that VA amend the term “‘interpret’ and recommends instead to use ‘integrate results into clinical decision making,’ or some other phrase” in order to avoid confusion between the duties of an APRN and those of a
laboratory specialist. We agree with the commenter in that the proposed language might be construed as allowing CNPs the ability to perform laboratory studies. It is not VA’s intent to have APRNs take over the role of laboratory specialists. These specialists perform a crucial role at VA medical facilities and are skillfully trained in performing the various testing techniques that allow health care professionals to properly treat a veteran’s medical condition. We are amending proposed § 17.415(d)(1)(i)(B) to now state that a CNP may be granted full practice authority to ‘Order laboratory and imaging studies and integrate the results into clinical decision making.’”
"Congratulations to everyone who worked so hard and with so much passion to address this issue!"
Thank you to everyone who voiced your concerns about this rule. This is a great example of what we laboratorians can do when we stand up for ourselves and our patients.
For more information, please visit: http://www.ascls.org/communication/blog-society-news-now/343-speaking-with-one-voice-laboratorians-convince-va-to-change-rule
We all know that as lab professionals we play a large role in the assisting of doctors to determine which medication will best treat a patients illness or infection. But did you know at the same time we play just as large a role to the pharmacy? I mean, that would make sense, but I guess in the minimal amount of time I've been a Medical Laboratory Scientist I've never really put the two together. And from what I've learned at the 2016 ASCLS-SD Fall Symposium we're going to be working a lot closer together! Yay for teamwork!
One of the key topic points during this presentation was in regards to Antibiotic Stewardship. The mission statement for Antibiotic Stewardship (Infectious Diseases Society of America) is as follows...
"Antimicrobial stewardship refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains."
Following the Antibiotic Stewardship Program is already required for ALL hospitals who wish to be accredited by the Joint Commission and the Centers for Medicare and Medicaid Services may also require a version of this, but the official rules and regulations will be available January 2017.
You may be thinking how does this affect the way doctor's practice or how the lab runs? Well, here is how. In regards to affecting practice, doctor's can no longer use any and all antibiotics they so wish. They must now only prescribe antibiotics that are most appropriate for each patient. Therapy for each patient must tailored within 48 hours and there is an emphasis on discontinuing medications if cultures are negative. This is great! Now each patient will only be treated at the minimal level to fight off whatever may be ailing them. This will salvage future generations from dealing with a vast number of antibiotic resistant bacteria and it will save not only the hospitals money, but most importantly the patient!
But wait, what about the lab! How does this affect me! Well, we will need to optimize trough and peak antibiotic level draw times to reduce chance of contamination so that the pharmacists and doctors get the most accurate information. Working with all staff, not just those in the lab (aka nurses), will be critical. Timing is very important, not only for drug level checks, but for cultures and gram stains as well. If we collect a specimen for culture after antibiotics have been started, we may not get the answers we need. So it is essential to get whatever specimen collected BEFORE antibiotics are working their magic inside the patient. The first critical step pharmacists look at for a general impression of what "bug" they are dealing with is the gram stain results. Knowing whether something is gram negative or gram positive can immediately help them begin tailoring a drug regimen for the patient. After that, the culture results including a Bacterial ID & MIC give them solid answers to continue, discontinue, or switch a patient's medication.
What a great feeling it is to know how important of a role lab professionals play in a patient's care! Remember this every time you streak a MacConkey Agar or draw a Vancomycin Trough or review a result on your computer screen. We play a LARGE ROLE in healthcare, but one of many. So always be a team player, because no matter what department you're from, the end goal is exceptional patient care!