Monthly QC Data Tool

Hospital

 

Month of Data Collected:     Year: 

Note: Test Sites have been updated to reflect changes after hurricane Ike!
 If your site is not listed, notify POC office.

Point of Care Test:             Test Site: 
  

No Patient Testing Performed This Month??? Check Box (skip questions 1 through 8), scroll down to bottom of page, enter your name & date, THEN click on "submit Data"

1.    Was the Quality Control performed as prescribed by the SOP and are QC Logs filled out appropriately (all information
       documented)?
        Yes                 No               

2.    Have  patient test results been charted with respective reference ranges  (what's this?)?
        Yes                 No             N/A     

3.    If QC was outside established limits, is there documented corrective action taken as
       prescribed by the SOP?
        Yes                 No                        No outside limits established

4.    Did nursing supervisor on-site review QC data and sign-off monthly?
        Yes                 No                

5.    If a new box(es) of testing material was opened this month, was QC performed per testing policy and documented?
        Yes                 No                         No new box(es) opened  

6.    If a reagent used for this test must be stored in the refrigerator, was the temperature of the refrigerator checked
        Yes                 No                       No reagent is refrigerated

7.    Is YEARLY competency via 2 methods current and on file for operators performing the test?
        Yes                 No        

8.    If a reagent/control is used for this test, did the operators follow discard and expiration dates, as stated in the SOP?
        Yes                 No              No reagent used for this test 

Submitted by:                     Date:

 
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