Point of care testing Flashcards
What is POCT?
Defined by the MHRA:
‘Any analytical test performed for a patient by a Healthcare Professional outside the conventional laboratory setting’
There are numerous governing bodies for POCT:
o United Kingdom Accreditation Service (UKAS)
o International Organisation for Standardisation (ISO)
o Royal College of Pathologists (RCPath)
o Association for Clinical Biochemistry and Laboratory Medicine
• Protect patients
IBMS POCT
Development of a new IBMS POCT qualification
Goals of POCT
The main goal is to generate rapid results allowing treatment to be initiated and to improve the clinical outcome for the patient
o Ideal in urgent situations
o Simpler sample collection
o Simpler pre-analytical process
o Helps to guide to a diagnosis whilst the patient is still present
o Allows urgent clinical decisions and treatment to be commenced and monitored
o For POCT outside hospitals, it allows you to react upon the result e.g. alter drug therapy
Key requirements of POCT include:
o Easy to use
o Reagents and consumables are robust
o Results should be concordant with the Pathology Laboratory
o Safe to use
Give some examples of POCT
Name some sites of POCT
- Outpatient clinic
- Walk in centre
- GP surgery
- Care homes
- Hospice
- District nurse
- A&E
- ICU
- Transplant wards
- Theatres
- Admission wads
Types of POCT machine: Hand-held
- Hand held portable devices
- Strip-based (blood/urine)
o Glucose, pregnancy, urine chemistries
o Reacts with a reagent – value
Types of POCT machine: Bench top
- Larger, fixed analysers
- Analytical principles: Spectrophotometric, immunoassay, sensor based blood gases
o Electrolytes o Blood gases
o Cardiac enzymes
o Troponins
o Drugs of abuse
Precision Xceed Pro
Blood Glucose Meter
Sample Type: Capillary, Venous, Arterial or Heel Prick
Result: 20 seconds
Sample Volume: 0.6 µL
Assay Range: 1.8-27.8 mmol/L
Quality Assurance: Daily IQC and WEQAS
Barcode Scanner: Test Kit and Staff ID
Core cascade trainers
Documentation
iSTAT
Emergency Medical Device
Sample Volume: 2-3 drops of blood
Result: 2 minutes
Quality Assurance: WEQAS
Automatic Calibration
Barcode Scanner
Core cascade trainers
Documentation
Results can be downloaded
iSTAT
Emergency Medical Device
Sample Volume: 2-3 drops of blood
Result: 2 minutes
Quality Assurance: WEQAS
Automatic Calibration
Barcode Scanner
Core cascade trainers
Documentation
Results can be downloaded
ABL Gas Analyser
Emergency Medical Device
Sample Volume: 2-3 drops of blood
Result: 60 seconds
Quality Assurance: WEQAS
Automatic Calibration
Barcode Scanner
Core cascade trainers
Documentation
Results can be downloaded
Urine Dipstick
- Result: 1 minute
- 11 parameter test: Bilirubin, Urobilinogen, Ascorbic Acid, Ketones, Glucose, Protein, Erythrocytes, Nitrites, Leukocytes, specific gravity and pH
- Compare results to the tube
Urilyzer 100 Pro
Result: 1 minute
7 metabolites: Bilirubin, Urobilinogen, Ascorbic Acid, Ketones, Glucose, Protein, Erythrocytes, Nitrites, Leukocytes, specific gravity and pH
Barcode Scanner
Cascade Trainers
Documentation
Data downloaded
Monthly
IQC NEQAS
Management of POCT
- Advising on the selection and procurement of new POCT equipment
- Introduction of new equipment
- On-going support
Implementation of POCT
There are a number of things to consider
- Reporting of adverse incidents
- Quality Assurance
- Involvement of the Pathology Laboratory
- Clinical Governance
- Training and Health and Safety
- Costs
Standard Operating Procedures
- Principle of the test
- Pre-analytical considerations
- Test procedures
- Assay limitations
- Controls
- Contacts and Assistance
Training
- Trainers
- Re-training
- Competency Assessment
Health and safety
- Sample handling
- Risk assessments
- Reagents
Quality
- IQC and EQA
- Spot checks
- Auditing
What are the advantages of POCT?
- Reduced Hospital Adm/Stay
- Convenient
- Reduces Lab Workload
- Rapid Result
- Reduces waiting Times
- Portable
- Small Sample Volume
- Connectivity
- Avoids unnecessary procedures
What are the disadvantages of POCT?
- Complexity of data management
- Expensive
- Unnecessary/ inappropriate testing
- Increased workload for existing staff
- Potentially incompatible with laboratory methodologies
- Potential errors – lack of expertise and QC
- Staff training and competence
What are the potential patient outcomes of POCT?
- Reduced number of clinic visits
- Reduced stay in hospital
- Fewer unnecessary admissions
- Faster treatment
- Improved quality of life
The future of POCT
- Multibillion - £34 billion by 2026
- 70% of all diagnoses are performed by Biomedical Scientists in the laboratory
- Drive for primary care
- More chemistry testing at the bedside, clinic and GP surgery
- Pharmacies providing screening tests
- Preventative medicine for at risk groups
- Home testing
- Beneficial for an aging population
