Point of Care Testing Flashcards
What is Point of Care Testing?
•Working definition: “any in-vitro analytical test performed for a patient by a non-laboratory healthcare professional outside the conventional laboratory setting”
What are advanatages of POCT?
- Rapid turnaround for results (No transport delays, faster methodologies): Earlier treatment initiation, Reduced patient waiting, Improved patient empowerment, Financial efficiencies
- Less invasive: Smaller sample volumes
- Portability/accessibility: Reaching remote places – including sample stability, Improved healthcare access (mobility, socioeconomic)
Where is POCT used?
Acute services:
- Complex tertiary referral centre
- District General Hospital
- Out-patient departments
Community services:
- Intermediate Care
- GPs
- Patient’s Homes
- Outreach services
What is disadvantages of POCT?
- Increased risk of adverse incidents and litigation: Ease of processing test and obtaining a result can mislead healthcare professionals into thinking that nothing can go wrong, Less sophisticated equipment
- Pre-analytical, analytical and post-analytical errors e.g. Capillary shut-down, sample processing errors, documentation
- Comparability of methodology/results: Lab-POCT and POCT-POCT
- POCT is expensive compared with conventional laboratory testing: Cost of consumables, Economies of scale (EQA, IT, supporting equipment, duplication of equipment). Staff resources (patient-facing staff)
What are examples of settings where POCT methods used?
- High Street Pharmacies
- Prisons
- Employment screening
- Sports Teams
- War zones
- Natural disasters
What are advantages of glucose meters?
- Improved patient monitoring
- Sample volume
- Empowerment
What are types of glucose meters for patient self testing?
Patients on insulin: Assess insulin requirements and Better glycaemic control
- Capillary blood glucose
- Sensors under skin: This is a small sensor automatically measures & continuously stores glucose readings day and night. You then scan patch to get results.
What are complex blood gas analysers?
- Most common bench-top/complex POCT device
- Arterial, venous or capillary samples
- < 2 mins , 15 - 20 simultaneous analytes
- Gases, electrolytes, metabolites, haemoglobin and derivatives
- Locations: ED, Theatres, ITU, AMU, SCBU
- Adv: Immediate clinical care
What are advantages of portable blood gas instruments?
- Aging population, increasing chronic obstructive pulmonary disease (COPD)
- COPD patients often housebound on O2, socio-economic factors
- Local applications: GP surgeries, patient’s homes
- Adv: Improved patient experience, accessibility, ?O2 bill
What are characterisitis of warfarin monitoring?
- Increasing percentage of population on warfarin therapy
- Large individual variation in metabolism -> monitoring
- Applications: INR outpatient clinics, screening prior to Endoscopic procedure, patient self-testing
- Adv: Improved patient experience and cost saving
What are characterisitics of Urine Screening?
- Screening for new conditions e.g. urinary tract infections
- 5 - 11 analytes on one strip, semi quantitative
- Patients who are ill, procedures, underlying conditions at increased risk
- Manual read vs. machine read
What are characterisitics of HIV Screening?
- 9% of gay men in Manchester are HIV+
- People whose lifestyle puts them at increased risk may be reluctant to attend hospital based services
- Local application: Outreach service
- Adv: Improved patient accessibility and follow-up (public health)
What are characterisitics of Fetal Fibronectin?
- Diagnostic test to assess risk of delivery in preterm labour
- Detectable in vaginal secretions prior to delivery
- Assess risk of delivery in following weeks
- Guide treatment: Steroid administration, Admission, Transfer to tertiary unit
- Adv: Avoid admissions where very low risk and Specialist care for very prem babies
How is Flu testing done?
- Nasopharangeal swab
- Rapid processing time
- Guide treatment, isolation, admission, reduce length of stay
What is the characterisitics of multi-purpose analysers?
- Analyser is a reader; clever technology is in the test cartridge
- Flexible to local needs
- Applications include auxiliary to core laboratory services e.g. ambulatory care unit
- Adv: Varied including economic, patient throughput, bed management
