F. POINT OF CARE TESTING

Question 1

what is POCT

Answer 1

any analytical test performed for a patient by a HCP outside the conventional laboratory setting

• done on the spot
• immediate results
• not blood tests

Question 2

other terms for POCT

Answer 2

• near-patient testing
• bedside testing
• extra-laboratory testing
• disseminated lab testing

Question 3

why is POCT done at pharmacies

Answer 3

• location and operational hours
• role in illness prevention, managing long term
  conditions and health promotion
• provide support for the self care agenda - diabetics can test their blood glucose themselves
• providing clinical services requiring monitoring eg - minor ailments, CPCS, pharmacy first

Question 4

what POCT can pharmacists do

Answer 4

• glucose monitoring
• cholesterol testing
• INR - how quick blood clots
• peak expiratory flow rate (asthma)
• CO levels (poisoning?)
• BP (manual/automatic machine)
• height, weight (BMI testing)
• STI screening
• lipid profile (do at same time as cholesterol testing)
• oxygen saturation (finger clip)
• urinalysis
• pregnancy
• ketones (do this after if you find high glucose)
• glucose
• protein
• strep A swab
• temperature check
• COVID19 - lateral flow test

*cost-benefit analysis required
*look at local health data profiles ie - high BMIs, COPD etc

Question 5

what 7 things should be considered when designing POCT service

Answer 5

1. purpose of test
2. delivery of test
3. training
4. advertising of the service
5. record keeping
6. communication of results
7. audit

Question 6

what is required from a patient before performing service

Answer 6

consent and capacity to understand what they’re doing and why

Question 7

what is the purpose of the test

Answer 7

Who and why are we testing them?

• screening: trying to find something
• monitoring: concern already established
• diagnosis: something new
• prognosis: QRISK score

consequences of the result?
- confirm presence or absence of something?
- require further tests?
- does it assess severity? (grading of progression)

Question 8

delivery of the test

Answer 8

• how do we do the test? book in or do whilst waiting for prescription
• where do we do the test?
• who will do the test? pharmacist, technicians, HCAs
• what are the limits of the test? referral to another service or we can we manage
• SOP/indemnity - insurance to do the service, good incase something goes wrong

Question 9

training

Answer 9

• conducting the test
• advertising the test
• interagency communication eg - inform GP of patients result
• who should deliver the training?
• how often should individuals be trained?

Question 10

advertising of the service

Answer 10

• must be accurate, truthful and not misleading (ASA - if advertising a service)
• be trustworthy and not abuse the trust or exploit the lack of knowledge of the public
• GPhC standard 3: Pharmacy professionals must communicate effectively
• GPhC standard 6: Pharmacy professionals must behave in a professional manner

Question 11

record keeping

Answer 11

• request for test
• result of test
• any referral of advice given
• what has been communicated and to whom (patient/HC team)
• where is it recorded and how long will it be stored for? - patient’s medical record, data needs to be kept safe and confidential (GDPR)
• how long will it be stored for? documented in SOPs which are set by local CCGs, disposal/storage important

Question 12

communication of results

Answer 12

• who is competent to interpret the test data?
• who do we communicate the result to?
  patients GP?
  patient?
  relative?

*immediate in consultation room or a written letter?

Question 13

audit

Answer 13

• is the service effective? we need feedback: is there the right cohort of patients that your aiming to test, testing for right things in right area, is it having a benefit to patients
• is it being delivered according to published standards?
• SOP: still clinically appropriate, safe procedures and up to date

Question 14

what are the 10 principles of good practice

Answer 14

1. staff competent in the roles
2. adequate environment to provide diagnostic and screening services
3. quality assurance program so that the reliability of results can be assured
4. integrated with other local healthcare services as referral pathways important
5. have the right indemnity insurance
6. informed consent from patients
7. health and safety measures for staff (gloves, face protection, PPE)
8. test results given directly to the patient and no-one else, unless you have the patient’s written authorisation
9. advertising of these services should comply with the professional standards for advertising
10. risk assessment before starting to offer the service

Question 15

what might affect tests

Answer 15

• blood glucose test: what have been eaten
• urine analysis: hydration levels
• co-morbidities
• medications
• look at their holistic well-being