Norme en iso 15189

In the vast majority of instances, risk cannot be eliminated. The ISO accredited laboratory will take appropriate steps to control risks. This may require mistake-proofing of an existing process or complete redesign of a process if risk is severe.

Care must be taken that process changes do not introduce new, unanticipated risks. We find that the management requirements are often more difficult to implement, but we cannot stress enough that their implementation, driving effective outcomes and improved patient care, are the most rewarding aspect of an ISO QMS. When a laboratory applies to the CAP accreditation program, the assessment team first conducts an off-site review of the laboratory's documents in order to evaluate the components of the QMS and the laboratory's readiness for accreditation.

The laboratory also performs an internal audit in order to assess readiness on its own. Prior to the on-site accreditation assessment, the laboratory has the option to undergo a gap assessment. A gap assessment is a detailed on-site assessment against the ISO standard and adherence to the laboratory's QMS that reveals holes in the system and issues that need to be addressed before accreditation could be granted. Nonconformities have to be addressed before accreditation can be granted, requiring an RCA, a plan on how to fix the problem, and a plan to check whether the fix was effective.

A committee, comprised mostly of practicing pathologists, renders an accreditation decision after review of the laboratory's corrective actions. If accreditation is granted, the laboratory is ISO accredited for three years. The literature is sparse. Firstly, variability in the medical laboratory industry is high. Secondly, it would be difficult to show statistically significant differences in outcome measures because of this complexity.

Furthermore, what constitutes appropriate outcome measures is controversial in itself. Over the last nine years in which we have been involved with laboratories that implemented ISO quality management systems, we have found the following elements to be of value to laboratories. Engaging in ISO is a journey that requires many years of commitment.

Staff engagement improves and morale improves, as there is no blame and staff members are part of the solution.

Financial reward is a desirable and most-often-sought argument in favor of ISO Although the literature of money-savings in an ISO system is sparse, cost-of-quality models have demonstrated potential cost savings [ 6 , 7 , 8 ].

Such models consider the cost of trying to be the best you can be cost of pathologists' continuing medical education or money spent on process design , the cost of maintaining a quality operation eg, accreditation program expenses or enrollment of pathologists in PT programs , the cost of correcting process failures before the result is reported eg, cost of histology having to recut skin biopsies to obtain a full face , and the cost of resolving problems after reporting results eg, cost of pathologist's time to amend a report because operating room staff indicated the wrong site on a requisition form.

Using ISO methods to reduce the cost allows laboratories to estimate expected cost savings and financial benefits to gain high-level management support and stakeholder buy-in.

Authors' Disclosures of Potential Conflicts of Interest: No potential conflicts of interest relevant to this article were reported. National Center for Biotechnology Information , U. Journal List Ann Lab Med v. Ann Lab Med. Published online Jun Frank Schneider , M.

Friedberg , M. Find articles by Frank Schneider. Find articles by Caroline Maurer. Richard C. Find articles by Richard C. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Corresponding author: Caroline Maurer. This article has been cited by other articles in PMC. Abstract The College of American Pathologists CAP offers a suite of laboratory accreditation programs, including one specific to accreditation to the international organization for standardization ISO standard for quality management specific to medical laboratories.

Instead, laboratories implementing ISO strive to: Create systems that are as failure resistant as possible, will catch mistakes before they become a problem, and reduce errors by getting things right the first time Identify opportunities for improvement at all times Involve and empower their staff by involving them in the solving of problems and the implementation of solutions ISO encourages full involvement and utilization of the abilities of all employees at all levels to improve the organization.

Components of the ISO quality management system The ISO requirements, or clauses, fill merely 31 pages plus a few pages of definitions and appendices.

ISO Management requirements Part 4 Technical requirements Part 5 Quality System Essentials Organization and management responsibility Personnel Organization Quality management system Accommodation and environmental conditions Customer focus Document control Laboratory equipment, reagents, and consumables Facilities and safety Service agreements Preexamination processes Personnel Examination by referral laboratories Examination processes Purchasing and inventory External services and supplies Ensuring quality of examination results Equipment Advisory services Postexamination processes Process management Resolution of complaints Reporting of results Documents and records Identification and control of nonconformities Release of results Information management Corrective action Laboratory information management Nonconforming event Preventive action management Continual improvement Assessments Control of records Continual improvement Evaluation and audits Management review.

Open in a separate window. Occurrence management Occurrence management refers to the resolution of nonconformities. Document control Most laboratories are struggling with document control, evidenced by its being a common deficiency cited in CAP LAP inspections. Insights into existing or potential risks come from several sources.

Footnotes Authors' Disclosures of Potential Conflicts of Interest: No potential conflicts of interest relevant to this article were reported. References 1. Schneider F, Maurer C. ISO Quality management in anatomic pathology: Strategies for assessment, improvement, and assurance. Medical laboratories - Requirements for quality and competence. Geneva, Switzerland: International Organization for Standardization; International Standard under systematic review.

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Got a question? Customer care. ISO means the international standard titled ISO , Medical laboratories -Requirements for quality and competence as amended from time to time.

Sample 1. Process wastewater means any water which, during manufacturing or processing, comes into direct contact with or results from the production or use of any raw material, intermediate product, finished product, byproduct, or waste product. Ambient air quality standard means an established concentration, exposure time, and frequency of occurrence of air contaminant s in the ambient air which shall not be exceeded.

Technical Standards means the technical standards set out in paragraph 2. Technical standard means a document that specifies design, predicted performance and operation and maintenance specifications for a material, device or method. Guide dog means any dog that is trained to aid a person who is blind and is actually used for such purpose, or any dog owned by a recognized guide dog training center located within the state during the period such dog is being trained or bred for such purpose.

General air quality operating permit or "general permit" means an air quality operating permit that meets the requirements of ARM