Monthly QC Data Collection Tool

Primary & Specialty Care Clinics

 

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 QC outside of limits     

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 two 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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