Point of Care Diagnostic Testing and Screening

Question 1

What is POCT?

Answer 1

RPS: “Any analytical test performed for a patient by a HCP outside the conventional laboratory setting”

AKA: near patient testing/bedside testing/extra-laboratory testing/diesseminated laboratory testing; anything that avoids sending stuff away.

Question 2

Why do pharmacists conduct POCTs?

Answer 2

• Ideally placed in the community due to location and operational hours
• Role in illness prevention, managing long term conditions and health promotion; proactive, not reactive
• We provide support for the self care agenda
• We increasingly provide clinical services requiring monitoring

Question 3

What POCTs do pharmacists do?

Answer 3

• Blood glucose
• Blood pressure
• BMI (height + weight)
• PEFR; peak expiratory flow rate (asthma/COPD)
• INR (fingerprick testing)
• Cholesterol (lipid-measuring)
• Pregnancy testing
• Carbon monoxide levels (smoking cessation)
• Phlebotomy (blood sample taking)
• Urinalysis (UTI/protein/blood/glucose)
• STI screening

Question 4

What should be considered when designing POCT services?

Answer 4

• Purpose
• Delivery
• Training
• Adverstising of service
• Record keeping
• Communication of results
• Audit

Question 5

What are the purposes of POCT?

Answer 5

Beneficence:

• Screening (pre-diagnosis)
• Routine monitoring (post-diagnosis)

Question 6

What needs to be considered with the delivery of POCT?

Answer 6

• How the test is done
• Where the test is done e.g. consultation room?
• Who does the test? e.g. is pharmacist actually required or just competent counter staff etc?
• Limits of the test?
• SOP/indemnity (insurance)

Question 7

What needs to be considered re. training to run a new POCT?

Answer 7

• What training needs are there re. conducting the test, advertising the service, communicating to GP when necessary
• Who should deliver the training; external training provider e.g. diabetic nurses for blood glucose monitoring
• How often should individuals be trained?

Question 8

What needs to be considered with the advertisement of a new POCT?

Answer 8

• To conform to GPhC Standards 1.4; legal, decent, truthful, complies with appropriate advertising code of practice
• Not misleading
• Not abuse the trust/exploit the lack of knowledge of the public

Question 9

What needs to be considered with record keeping in POCT?

Answer 9

What should be recorded?

• Request for test (written consent/legality)
• Result of test
• Referral or advice given
• What has been communicated and to whom

Question 10

What needs to be considered re. communicating the results of POCT?

Answer 10

• Who is competent to interpret the data? (Pharmacist)
• Who do we communicate the result to?
  > Patient (most if not always; dependent on mental capacity otherwise)
  > Patient’s GP (if patient consents/opted in w/routine monitoring via GP; but screening is only for the patient)
  > Relative (if patient consents etc.)

Question 11

Why is it important to #AlwaysAUDIT w/POCT?

Answer 11

• Is the POCT service effective? > Feedback?

- Is it being delivered according to published standards? > SOP

Question 12

What do the 10 RPS Principles of Good Practice entail?

Answer 12

• Staff compentent
• Adequate environment to provide diagnostic/screening service
• Quality assurance program should be in place so reliability of results can be assured
• POCT services should be integrated with other local healthcare services; referral pathways
• Indemnity insurance
• Informed consent before test
• Health & safety measures to protect staff
• Test results given directly to patient unless you have patient’s written authorisation
• Comply with professional standards for advertising
• Carry out a risk assessment before offering the service