Facility Assessment check list for Placement Laboratory machines

Purpose: To assess Beckman Coulter Unicel DXH 800 Hematology Analyzer Types of Test
Requested, Daily reagent usage, Available stock and Facility daily test
volume.

Facility Name: ___St. Peter specialized hospital___________Facility Telephone: _____________

Name of Laboratory Head Yonas Tafa Telephone: 0911811118

Name of Working on Analyzer __Moges (train on the analyzer)__ Telephone: 0912373736

Supplying EPSA hub: __Central EPSA

Date of Visit: 11/10/19

Section 1. General Data of Hematology Test Volume and Type of Tests Requested.
(They don’t begin working on Beckman Coulter Unicel DXH 800) Work on sysmex
No Question Detail Answer of the responder
1 For how many days did you use one (1) Diluent? N/A
2 For how many days did you use one (1) Cell Lyse? N/A
3 For how many days did you use one (1) Diff Pack? N/A
4 For how many days did you use one (1) Retic Pack? N/A
5 For how many days did you use one (1) Cleaner? N/A
 Item No Question Detail Quantity (Amount) (sysmex)
1 Patient Sample per Day (the average patient sample 200
you work per day)
2 Repeat Rate per Day (Average amount of samples Don’t known
repeated per day)
3 Working Days a week 07
4 Startups/Shutdowns per day (How many times the 02
analyzer shutdown in 24 hour)
5 CBC per Day (Only CBC test done from the total one 200
day sample)
6 CBC/Diff per Day (Critical Question) (CBC and 200
Differential test requested at the same time per day )
7 CBC/Diff/Retic per Day (CBC, Differential and Retics Don’t known
test requested at the same time per day)
8 Retic per Day (Only Retics test per day) Don’t known
9 Body Fluids per Day (Only Body Fluid tests per day) Don’t known

Section 4. Beckman Coulter Unicel DHX 800 Haematology Analyzer Available

Reagents at the Facility.
No Reagent Name Available on Stock
1 COULTER® DxH Diluent (10L) 156
2 COULTER® DxH Cell Lyse (5L) 09
3 COULTER® DxH Diff Pack (3L) 06
4 COULTER® DxH Retic Pack (3L) 06
5 COULTER® DxH Cleaner (5L) 15

Section 5. Other Comments and/or Observations

The hospital didn’t begin work on. Beckman Coulter Unicel DHX 800 Hematology
Analyzer but begin at the time of assessment we can find consumption data on
the next assessment.