POCT Quality Questionnaire

Fill in the form below.

Once the form has been completed, it can be submitted by pressing the following button:


 
 
PQ
POCT QUALITY QUESTIONNAIRE
This Point of Care Testing (POCT) Quality Questionnaire is sent to you in an effort to keep up with the quality monitoring of ZTAS POCT sites, while options for on-site monitoring are limited. Online POCT quality monitoring intends to assure that expected regulatory standards for quality of Point of care testing can continue to be met and the quality of your results remains at a satisfactory and trustworthy standard to allow for the dispensing of Zaponex treatment to your patients.
 
The completion of this POCT Quality Questionnaire may be followed up by a 'virtual' or physical monitoring visit at later date, as is appropriate.
Organisation
Location/Site Name
Trust/Health Board
Staff
Please tell us which staff are involved in the POCT clinic and indicate the staff members operating your ZTAS PocHi system
    Pochi   Trained    
Name (first name and last name) Role Operator   Sysmex Locally   Date of last online assessment
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
     -  - 
Please also note any PocHi trained staff that have left in the past 12 months
Name (first name and last name) Role  
 
 
 
 
 
 
 
 
 
 
Are there any changes anticipated to the staff (i.e. staff joining or leaving the clinic)?
General Clinic Info
Number of service users and general clinic set-up
i.e. how many clozapine patients are served by your clinic; briefly describe set-up
What days each week/month is the clinic run?
Facilities, Equipment
Are there any changes anticipated to the facilities
e.g. clinic moves, relocations, etc.
YesNo
If Yes, please explain
Is the room housing the PocHi secure and lockable? YesNo
When is the last time your PocHi instrument has been serviced by a technical engineer?  - 
If unsure of date please note approximate timeframe here
Have there been any recent changes to the computer equipment? YesNo
If Yes, please explain and note date
Do you have a printed copy, or know where to locate a copy of the trust Clozapine / PocHi Policy or Standard Operating Procedure? YesNo
If Yes, please provide date it was last reviewed?  - 
Have you had any issues with your receipt of the QC or NEQAS samples? YesNo
If Yes, please explain
How long do you keep the patient's blood after testing?
Supplies and Logs
Do you receive enough Pochi packs/supplies each quarterly delivery? YesNo
How do you ensure the oldest packs are used first?
Do you keep a log sheet with the PocHi analyser / clinic? YesNo
Do you keep a temperature log for the refrigerator that has QC samples? YesNo
Quality Assurance
Do you ever meet with the trust POCT coordinator or Clozapine Lead? YesNo
If Yes how frequently?
Who would you contact in the event of a quality issue/concern in your organisation, and what is that individual's role?
What Local Laboratory is used as backup for your PocHi?
i.e. in the event the PocHi system breaks down, where would you send your samples for processing?
Miscellaneous
Please indicate which, if any, videoconference options are available to you
MS Teams Zoom
Webex Skype
Other:
None
Please write any comments or note anything you believe we should be aware of.
Declaration
I certify that, to the best of my knowledge, the information provided is true and accurate.
 
Signature
Name
Email address
  Example: john.smith@nhs.net. Please do not use group email addresses or gmail/yahoo, etc.
Submission Date 02-Dec-2022 Signature

PSS.F04.S19.001