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Canadian
Coalition for Quality in Laboratory Medicine (CCQLM)
by: Linda
Crawford, Dan MacFayden, Anne Raby, Harold Richardson and Sharon Webb
In 1991, the first meeting of the provincial authorities responsible for
the accreditation of medical laboratories met in Saskatoon as the
Interprovincial Quality Assurance Group (IPQA). The purpose was the
exchange of information and approaches to the quality improvement of
medical laboratory services. Annual meetings have occurred since that time
and, recently, in Halifax preceding the Canadian Society for Medical
Laboratory Science (CSMLS) Conference in Moncton, New Brunswick. Some
years ago, discipline working groups were created to foster national
consensus and the development of standards of practice.
In 2004, IPQA was officially incorporated as the Canadian Coalition for
Quality in Laboratory Medicine (CCQLM). The By-laws were developed prior
to the Halifax meeting and were adopted with minor revisions at that
meeting. The election of the first officers took place with Georgia Hearn
from Saskatchewan as President, Linda Crawford from Ontario as
Vice-President, Barb Unger from Alberta as Secretary-Treasurer and Dr.
Harold Richardson was elected to the Board to serve for one year as a
Director.
The working groups currently cover Hematology, Transfusion Medicine,
Clinical Chemistry, Microbiology, Anatomical Pathology, Information
Technology, and Accreditation. Ontario has responsibility for Information
Technology and Accreditation. It is likely that the Transfusion Medicine
working group will be inactive this year.
Working
Groups’ Meeting Highlights
Clinical
Chemistry
Ten members attended the Chemistry working group session. The provinces
represented were Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New
Brunswick, Nova Scotia and Newfoundland. A representative from the
Northwest Territories also attended.
Terms of Reference specific to Clinical Chemistry were drawn up. They are:
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1.
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To coordinate projects with other national societies, such as the Canadian
Association of Pathologists, the Canadian Society of Clinical Chemists,
the Canadian Association of Medical Biochemists, the Canadian Diabetes
Association and other national organizations, as appropriate.
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2.
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To develop guidelines for laboratory practice.
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3.
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To promote appropriate laboratory utilization.
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Hematology
Eleven members attended the CCQLM Hematology working group meeting with
representatives from Alberta, Saskatchewan, Manitoba, Ontario, Nova
Scotia, and Newfoundland. The following encapsulates the working group’s
activity since last years meeting:
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1.
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A paper reviewing previous CCQLM morphology surveys, Blood Film
Morphology Surveys: A National Proficiency Testing Initiative, was
submitted for publication. This paper highlights similarities and
differences between provincial reporting practices.
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2.
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Following an extensive literature review a proposed publication regarding
abandoning neutrophil band reporting was presented. Discussion followed as
to how this position should be presented to Canadian laboratories.
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3.
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The results from the 2005 cross-Canada blood film morphology survey
(MORP-0502) were reviewed. This survey included a blood film obtained from
a patient diagnosed with infectious mononucleosis. The variation in
reporting reactive lymphocytes and smudge cells was discussed. Depending
on the provincial reporting practice, these cells were included with
mature lymphocytes, as a number per 100 leukocytes, as a qualitative
comment and/or as part of the leukocyte differential.
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4.
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In conjunction with the 2005 morphology survey, an overview of current
terminology used to report lymphocytes in a blood film obtained from a
patient diagnosed with infectious mononucleosis was presented to the
working group. This PowerPoint presentation prompted a lively discussion,
which emphasized the lack of standardization of terminology and the need
for a published recommendation.
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5.
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In an effort to standardize the quality of future EQA morphology
peripheral blood films, a glass slide screening protocol was presented and
will be developed in 2005.
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6.
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Lastly, the working group discussed the need to provide repeat morphology
cases to determine if the EQA morphology surveys have resulted in improved
laboratory practice.
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Accreditation
The Accreditation working group’s purpose is to work towards a common
process of medical laboratory accreditation and a common standard, to
allow us to share resources across the country.
In 2004–5, its original priorities were to:
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assess existing programs
against ISO 17011 and ISQ Alpha standards; |
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prepare an article on
the status of medical laboratory accreditation in Canada and; |
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translate the l’Ordre
professionnel des technologistes médicaux du Québec (OPTMQ)
January 2004 guidelines for good laboratory practice (from French
to English). |
Three teleconferences
and one face-to-face meeting were held during 2004-5.
Accomplishments
in 2004–5
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The standards for
accreditation bodies from ISO 17011:2004 and ISQua were compared
for the following activities: |
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surveyor selection,
training and performance evaluation |
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assessment management
and the certification process |
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It was determined that these two documents are complementary and
their differences are philosophical. The ISQua standards tend to
be generic, goal-oriented statements of performance excellence and
performance improvement, and are more general in nature. The ISO
standards appear to be clear, prescriptive statements for quality
management, which may be easier to implement and prove to have
greater practical application when assessing operations of
existing programs.
It was noted that the Canadian Council on
Health Services Accreditation is seeking ISQua accreditation. ISQua has a
toolkit supported by the World Bank and the World Health Organization
available on its Web site
(http://www.isqua.org.au/isquaPages/Accreditation.html).
British
Columbia is targeting ISQua standards, while Alberta, Ontario, Quebec
and Saskatchewan favour ISO. Manitoba is undecided.
Best
practices for surveyor training were drafted.
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The focus
of an article on the status of medical laboratory accreditation in
Canada will be Who holds the conformity assessment bodies
accountable? The first draft in 2005 will explore topics such as;
who accredits the accreditors, the value of accreditation itself, and
identify our core business. |
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A proposal
for commercial translation of the OPTMQ January 2004 guidelines for good
laboratory practice was rejected as the cost was over our budget.
Johanne Lefebvre will tackle this translation in the spring of 2005. |
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Common
issues regarding standard adoption, challenges that the accreditation
bodies face regarding the current human resource shortage, and
performance measurement, were discussed. |
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Useful
meetings/conferences for accreditation personnel were discussed. |
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Draft new
terms of reference: |
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To
work towards a common accreditation process and common accreditation
standard to facilitate sharing of resources across the country.
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To
liaise with other organizations involved in the establishment of operating
standards and guidelines for accreditation programs.
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To
act as a resource for and to promote the implementation of laboratory
quality management systems based on recognized standards.
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Focus and
objectives for 2005/2006: |
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Prepare
an article on the status of medical laboratory accreditation in Canada
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English translation of OPTMQ January 2004 guidelines for good laboratory
practice
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To
play a role on the national front, to collaborate with organizations like
Health Canada, Canadian Society for Medical Laboratory Science (CSMLS),
Clinical Laboratory Management Association (CLMA), Canadian Society for
Transfusion Medicine (CSTM), Canadian Society of Clinical Chemists (CSCC),
Standards Council of Canada (SCC), Canadian Standards Association (CSA),
Canadian Council on Health Services Accreditation (CCHSA), and Canadian
Association for Environmental Analytical Laboratories (CAEAL).
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Meeting
schedule: |
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Four
teleconferences (September/November/January/March–April)
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One
face-to-face meeting at CCQLM in spring
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Information
Technology
The Information Technology (IT) working group meeting had attendees from
Nova Scotia, Alberta, Saskatchewan and Ontario. All provinces agree that
information technology is critical to laboratory services and that the
working group requires representation from all provinces/territories to be
viable. The IT working group agreed to submit a budget and operating plan
for providing support to the CCQLM organization and for the maintenance
and further development of the CCQLM Web site (http://www.ccqlm.org).
Ontario agreed to continue as the chair of this working group through 2005–6.
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