POCT Flashcards
What is point of care testing?
In-vitro analytical testing performed by a non-laboratory healthcare professional for a patient outisde the conventional lab setting.
What are some advantages to using POCT?
Quick turnaround for rapid results
- No transport delays and quick methods
Consequences of reduced turnaround time
- Early treatment and improve patient empowerment
Less invasive
Portability/accessibility
- Reaching remote places
- Improved healthcare access
What are some disadvantages to using POCT?
Increased risk of adverse incidents and ligation
- Ease of use -> lead to FN and FP
- Less sophisticated
Pre-analytical, analytical and post analytical errors
- e.g. capillary shut-down (aka bad blood supply), sample processing errors, documentation
Comparability of methodology
POCT is expensive compared to conventional lab testing
- Cost of consumables
- Economics of scales: EQA, ITA, supporting equipment, duplication of equipment
- Staff resources for patient-facing staff
Where is POCT used?
Across all healthcare services Acute services - Referral centre - general hospitals - ambulance services - Out-patient departments
Community services
- Intermediate care
- GP
- Outreach services
Other POCT venues
- High street pharmacies
- Prisons
What are some common POCT?
- Glucose monitoring
- Complex blood gas analyser
- Blood gas portable
- Warfarin monitoring
- Urine screening
- HIV screening
- Fetal fibronectin
- Flu testing
Describe the following POCT: Glucose analyser
Increase frequencies of diabetes means this form of testing is especially important for patients receiving treatments or have illness altering the glycaemic control
- Advantage: improved patient monitoring
Examples:
- Patients on insulin: need to assess insulin requirements and control
- Capillary blood glucose
- Sensor under skin: Automatic measure with storage of results
Describe the following POCT: Complex blood gas analysers
Most common benchtop device
- Uses arterial, venous or capillary samples and can examine within 15-20 min
Advantage: immediate clinical care
Describe the following POCT: Blood gas portable
This device is especially important for the ageing population where there is an increase in COPD. Easy to travel to homebound patients and test using earlobe sample
Describe the following POCT: Warfarin monitoring
Warfarin therapy (anti-coagulant) is becoming more common, but severity is dependent on metabolism. - Commonly used prior to endoscopy
Adv: cost saving and improved patient experience
Describe the following POCT: urine screening
Screen for multiple conditions using one sample producing semi-quantitative results.
- Useful in patients with acute disorders, infections, renal function, or underlying conditions
Good screening, but not absolute values are give - can direct further testing
Describe the following POCT: HIV screening
Patients with HIV or potentially have it are less likely to visit hospitals so outreach programs are important
Describe the following POCT: Fetal fibronectin
Used to determine the risk of delivering pre-term labour. Detectable in vaginal secretions prior to delivery.
- Assess the risk of delivery in following weeks. Guide treatment of steroids, admission or transfer to tertiary units
Adv: avoid admission where very low risks, specialist care for extreme and ability to prematurely discharge patients
Describe the following POCT: Flu testing
Nasopharangeal swab. Rapid porcessing time
Describe the following POCT: Multi-purpose analysers
This tool is flexible to local needs. Applications include auxiliary to core lab services e.g. ambulance services.
- Advantages are varied
Example, D-dimer, BNP, Cardiac, Tox DS used in the same device
How is POCT developing? with regards to COVID
Think about the lateral flow test, antigen or even PCR used to quickly assess possibility of disease to reduce stay in hospital etc.
What is the aim of POCT governance?
Provide structure to capitalise on the advantages of the technology while keeping the inherent risks to a minimum
What are some general POCT requirements by NHS?
POCT is subjected to the same level of public, professional and judicial scrutiny as conventional lab testing
- The assessment by the NHS is mandatory and can include device training, device maintenance, indicents reflection
CareQualityCommission is the body carrying this out
What are some examples governance examine?
Clinical and cost effective Use valuabel resources most effectively Fit for purpose Accuracy of results Define responsibilities of users/accountability
State some specif c POCT guidances.
- MHRA
- ISO22870: POCT requirement for quality and competence
- Assessed by UKAS, an organised infrastructure, clinical need/cost benefit analysis, device selection/verification, IQC/EQA
What is included in the quality management system?
POCT policy, commitee, MDT membership, role, coordinator/team
What is POCT policy?
Ensures patient safety with respect to POCT
What is PCOT committee?
Responsible for defining POCT scope
- Representatives from people
What is MDT membership?
Clinicians/nurses, lab professionals, support services
What is the POCT coordinator/team?
Deliver the POCT
What does the clinical need/cost-benefit analysis investigate?
Necessity of the POCT
- Can current services be modified to meet request. E.g. POCT for creatinine due to CT scan needing contrast (renal function has to be assessed) - patients left waiting for 1h+ which caused delays in system
- Solution: add urgency label to speed up testing
Impact on patient care - Specific patient group - Benefit of POCT vs lab Is there a suitable location for devices Additional staff? Finance - Capital: device, connectivity and alterations - Fixed recurrent: IT , maintenance, EQA - Varibale: consumbales and staff
Once a clinical need has been established how is device selection determined?
Analytical quality of devices
- Comparability with lab results, accuracy, precision and limitaitons and interferences
- Suitable for screening (less accurate) or monitoring (accuracy needed)
Infection control
- Waste disposal, cleaning
Minimal operator dependent steps
- Ease of use in correct way
- Volumes (blood vs urine), timing, reading - Guide implemented
Governance features
- Password access
- QC lockout
- Barcode readers
- Connectivity
Describe the verification process of the selected devices
Standard operating procedures (SOPs)
- Comply with lab standards
- Non-lab audience (lay language)
- Accessibility
- Controlled
Risk assessment: Control of substances hazardous to health (COSHH)
- Safety of POCT end users
- Safety
Maintenance:
- End user/POCT team/lab support
- Complexity
- Compliance/recording
What is some quality assurance of new devices?
Internal quality control
- Routine accuracy/precision check
- Frequency dependant on test, e.g. once a day high and low QC is adequate
- Blood gas iQM, QC is built in and is autonomous
External quality assessment
- National peer review
- End users (then reflects better) or lab staff
- Scheme availability
Training and competency assessment
- Re-assessment interal
What is the importance of POCT training?
Most POCT errors are operator dependent..so important to train staff to produce accurate readings
POCT operators vary in qualification and training
What does the training include?
- Basic principles and theoretical knowledge
- Sample colletion and handling
- Quality control/EQA
- Documentation/reporting results
- Infection controls
- Limitations of the systems
- Responsibilities
How is the training content tested?
Theoritcal knowledge
Practical observations
E-learning
What is the importance of data management?
Ensure the qualified individuals are using the POCT, maintenance/calibrations have been made periodically
What is audit and what is examined?
Examine full scope of services Practice - Cleanliness - Storage - IQC and EQA - Documentation - Trained staff and numbers
Clinical effectiveness
- Workload
- Impact of test
Follow up
- Feedback
- action plans
Describe incident reporting.
Root cause analysis
- ID system failures not placing blame
- Corrective action/preventative action: systemic improvements, education
- Follow up
E.g. users sharing unique barcode with each other
