Point of care testing Flashcards
What is the definition of point of care testing?
Testing that is performed near or at the site of a patient
Outside of normal laboratory setting
By staff member who is usually not laboratory trained
What are the 3 broad categories to consider when deciding whether to implement a POC test?
Clinical need - what in place currently, how does this help or replace current methods
Clinical effectiveness - is the testing actually good? Needs to have good evidence it will provide benefit
Cost effectiveness - does the benefits justify the cost?
You are proposing a new POC test to help your clinical needs
How would you find out evidence to prove its potential effectivenss?
Data from manufacturer
- sensitivity/ specificity
- Turnaround time improvement
- throughput
Data from other sites which have already implemented the testing
There are many POC tests.
What are key factors about a test that need to be considered?
ASSURED QP acronym
Affordable
Sensitive
Specific
User friendly
Robust/ reliable
Equipment - minimal equipment
Deliverable to those who need them
Quality - are there processes in place/ staff available to do this
Personnel - skill level/ staff training
What are advantages of POCT?
Improved TAT which helps with -
- discharge/ admit patient discharge
- Abx/ antiviral decision
- IPC decisions
Out-of-hours diagnostic test availability
Cost benefits - POCT usually move expensive. But may save costs with Abx/ discharge/ HAI
Fits in with current hub and spokes model of laboratory organisation. Each spoke can have POC, to mitigate some problems with lack of on site lab
What are disadvantages of POCT?
Potential poor quality of analysis – need careful training
Poor record keeping
Lack of result interpretation
Failure to detect erroneous results
Availability may tempt users to perform unnecessary or inappropriate testing
Incompatibility with laboratory results – reference ranges and results
may differ for those used by established lab service making comparisons difficult. POC may use different target than lab test
LIMS system - need to be able to put results onto current laboratory reporting systems
Not suitable for screening or testing large numbers of people as there is a limit to number of tests that one user can read at one time
– automated lab testing more suitable
Not UKAS accredited usually. Is a lot of effort/ finance to get UKAS accredited
There are several POC tests running in the hospital.
Who should be involved in the committee overseeing the running of POC?
users - ITU/ A&E
lab staff - micro/ biochem
clinicians
nursing staff performing test
IT - link into hospital systems
finance
Health and safety - COSHH risk assessment
There are several POC tests running in the hospital.
You are in the POC committee
What is the role of a virologist in this committee?
Key role in development and management of POCT
service. Provide advice on:
Devices
Training
Interpretation of results
Troubleshooting
Quality control
Quality assessment
Health and safety
What costs need to be considered in POC?
Capital costs
- Initial purchase cost
- Accessories e.g. centrifuges, incubators
- Provision of safe environment–health and safety improvements, -space Interface with information management systems
Fixed costs
-Service contract
- IQA and EQA participation
- Accreditation scheme compliance
Variable costs
-Consumables
- Record keeping
- Waste disposal
- Cleaning
Professional costs
- Laboratory support
-Management of the POCT
- Operator time
-Staff training
Which ISO accreditation is related to POC testing by UKAS?
ISO 15189:2022, which was published in December 2022 now incorporates requirements for Point of Care Testing (PoCT) when carried out in hospitals, clinics and by healthcare organisations offering ambulatory care.
