Preparing to Be a Clinical Laboratory Peer Inspector

What are the dos and don'ts of being a clinical lab peer inspector?

Photo portrait of Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ)
Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ)

Darryl Elzie has been an ASCP medical technologist for over 30 years and has been performing CAP inspections for 15+ years. He is also a certified quality auditor (ASQ). He...

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Published:Oct 07, 2022
|Updated:Nov 09, 2022
|4 min read

There are currently numerous resources that advise laboratory administrators and managers on how to prepare for an inspection. From ensuring employee folders have the required training and assessment documents and verifying that all quality control data have been reviewed and signed, to arranging lunch for the inspection team, good guidance is easily gathered.

What is missing (or at least hard to find) is information on preparing to be a peer inspector. How does one go about applying checklist standards to a laboratory they have never visited? What are the dos and don'ts of being an inspector? How does one remain objective and not act on personal feelings? These are some of the questions a person seeking to be an inspector needs to answer to be able to conduct a fair and objective inspection.

Peer inspections for clinical labs

Laboratories accredited by the College of American Pathologists (CAP) are obligated (once they have received their accreditation) to perform an inspection of another similar-sized laboratory every two years. This often means medical technologists, clinical laboratory scientists, laboratory supervisors/managers, and pathologists may be asked to form or join a team of inspectors to assess a laboratory.

The peer inspection is a great way to learn about and share laboratory processes. When asked or selected to be a part of a CAP inspection team, many first-time inspectors wonder what they should do to prepare to be good inspectors. Fortunately, CAP has online tools first-time inspectors can use to familiarize themselves with the inspection process.

Clinical lab inspector training

The Inspection Team Member Training provided by CAP is a required course all inspectors must take before performing an inspection.1 The training seeks to prepare the future inspector in several areas of the inspection process, including interpretating checklist items, properly citing of deficiencies, and understanding the policies related to on-site inspection.

The training also incorporates other aspects of the inspector experience. From understanding situations that may cause or place a patient or staff member in immediate jeopardy, to applying the Read-Observe-Ask-Discover (ROAD) principles, team member training provides an individual with the primary tools to be a fair inspector.

The ROAD method

Read

The read portion of the acronym directs the inspector to read a sampling of quality documents (including proficiency evaluation results), testing policies and procedures, and any manually recorded worksheets and instrument printouts. If an inspector is responsible for the Lab General Checklist, they should be prepared to review an appropriate sampling of personnel folders and competency.

Observe

A great deal of information may be gleaned from simply observing lab staff while they handle patient specimens. For example, after reading the laboratory's procedure, an inspector should observe employees aliquoting samples to ensure they follow the procedure and that the processes are adequate to avoid cross-contamination or a mix-up of specimens.

Ask

An inspector should be prepared to talk to lab employees. Asking testing personnel what they do when they receive hemolyzed or unacceptable specimens is an excellent way to determine if they know what's in the procedure manual. Other good questions to ask are how comfortable they are with the laboratory information system, or LIS, and if they feel quality control monitoring is effective for the testing they perform.

Discover

The last letter of the acronym mandates the inspector to inspect the laboratory and review function checks and maintenance logs to discover any patterns of incompleteness or a lack of proper oversight and review. Inspectors should also check all storage areas (including refrigerators and freezers) for expired reagents and controls used in patient testing.

A collegial event

An essential aspect of the CAP peer-inspection process is that it should be a collegial learning event for the inspector and the inspected lab.2 Individuals chosen to be inspectors should enter the process with an open mind and a dedication to objectively applying the checklist standards. There are often several ways a laboratory can meet the intent of a checklist item, and an inspector should be open to learning different ways to provide excellent patient care.

Mental prep for clinical lab inspectors

Psychological preparation is also part of becoming a CAP inspector. There’s potential for past personal experiences to in turn affect how an inspector performs inspections. For example, an inspector may have had their own poor experience during an inspection, where they felt that their lab was not fairly assessed. However, being an inspector means you must let go of past experiences and aim for objectivity and not seek to cite a deficiency with another lab simply because yours may have received it in the past.

Inspectors should strive to make the inspection experience a reciprocal learning event for the inspected laboratory as well as themselves.

Clinical laboratory ambassador

When interacting with laboratory personnel, an inspector must remember that they represent not only the CAP inspection team, but also their own health care organization. It is imperative to remain calm and project professionalism. Even though there may be times when the staff of the inspected laboratory may disagree with a deficiency, an inspector should discuss the problem and explain why the deficiency was cited. One of the great things about the CAP checklists is that most of the standards have the evidence required for compliance written below the standard.

Lab system inspections

Laboratories that are part of a system of laboratories with the same anniversary date and within a three-hour drive of each other often take at least a week to be fully inspected and require a large, diverse team of laboratorians.3 These inspection teams frequently have members from various laboratories to ensure subject matter experts review each discipline. System inspections are wonderful opportunities for you to network and make connections that can span the lifetime of your career.

Sharing knowledge

Medical laboratorians are aware of the stress inspections bring. It is an all-hands-on-deck event—the clinical laboratory has dedicated significant human and financial resources to ensure everything is prepared ahead of time. Inspectors must always remember that the peer-inspection process seeks to share knowledge while ensuring the laboratory provides quality results. Inspections are as much about teaching and learning as inspecting a lab to ensure it maintains employee and patient safety.

References:

  1. College of American Pathologists. Inspection Team Member Training - LAPITMT12Q.2019. https://estore.cap.org/OA_HTML/xxCAPibeCCtpItmDspRte.jsp?section=10144&item=643367&sitex=10020:22372:US. 
  2. College of American Pathologists. Peer Inspections: Power of Peer Inspections. https://www.cap.org/laboratory-improvement/accreditation/peer-inspections.
  3. College of American Pathologists. System Inspection Option FAQs. https://www.cap.org/laboratory-improvement/accreditation/system-inspection-option/system-inspection-option-faqs.
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Photo portrait of Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ)
Darryl Elzie, PsyD, MHA, MT(ASCP), CQA(ASQ)

Darryl Elzie has been an ASCP medical technologist for over 30 years and has been performing CAP inspections for 15+ years. He is also a certified quality auditor (ASQ). He currently works for Sentara Healthcare. Darryl provides laboratory quality oversight for four hospitals, one ambulatory care center, and supports laboratory quality throughout the Sentara system.


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The peer inspection is a great way to learn about and share laboratory processes.
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