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Analytical methods > POCT > Flashcards

POCT Flashcards

1
Q

What is point of care testing?

A

In-vitro analytical testing performed by a non-laboratory healthcare professional for a patient outisde the conventional lab setting.

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2
Q

What are some advantages to using POCT?

A

Quick turnaround for rapid results
- No transport delays and quick methods

Consequences of reduced turnaround time
- Early treatment and improve patient empowerment

Less invasive

Portability/accessibility

  • Reaching remote places
  • Improved healthcare access
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3
Q

What are some disadvantages to using POCT?

A

Increased risk of adverse incidents and ligation

  • Ease of use -> lead to FN and FP
  • Less sophisticated

Pre-analytical, analytical and post analytical errors
- e.g. capillary shut-down (aka bad blood supply), sample processing errors, documentation

Comparability of methodology

POCT is expensive compared to conventional lab testing

  • Cost of consumables
  • Economics of scales: EQA, ITA, supporting equipment, duplication of equipment
  • Staff resources for patient-facing staff
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4
Q

Where is POCT used?

A 
Across all healthcare services 
Acute services 
- Referral centre 
- general hospitals 
- ambulance services
- Out-patient departments

Community services

  • Intermediate care
  • GP
  • Outreach services

Other POCT venues

  • High street pharmacies
  • Prisons
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5
Q

What are some common POCT?

A
  • Glucose monitoring
  • Complex blood gas analyser
  • Blood gas portable
  • Warfarin monitoring
  • Urine screening
  • HIV screening
  • Fetal fibronectin
  • Flu testing
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6
Q

Describe the following POCT: Glucose analyser

A

Increase frequencies of diabetes means this form of testing is especially important for patients receiving treatments or have illness altering the glycaemic control
- Advantage: improved patient monitoring

Examples:

  • Patients on insulin: need to assess insulin requirements and control
  • Capillary blood glucose
  • Sensor under skin: Automatic measure with storage of results
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7
Q

Describe the following POCT: Complex blood gas analysers

A

Most common benchtop device
- Uses arterial, venous or capillary samples and can examine within 15-20 min

Advantage: immediate clinical care

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8
Q

Describe the following POCT: Blood gas portable

A

This device is especially important for the ageing population where there is an increase in COPD. Easy to travel to homebound patients and test using earlobe sample

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9
Q

Describe the following POCT: Warfarin monitoring

A 
Warfarin therapy (anti-coagulant) is becoming more common, but severity is dependent on metabolism. 
- Commonly used prior to endoscopy

Adv: cost saving and improved patient experience

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10
Q

Describe the following POCT: urine screening

A

Screen for multiple conditions using one sample producing semi-quantitative results.
- Useful in patients with acute disorders, infections, renal function, or underlying conditions

Good screening, but not absolute values are give - can direct further testing

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11
Q

Describe the following POCT: HIV screening

A

Patients with HIV or potentially have it are less likely to visit hospitals so outreach programs are important

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12
Q

Describe the following POCT: Fetal fibronectin

A

Used to determine the risk of delivering pre-term labour. Detectable in vaginal secretions prior to delivery.
- Assess the risk of delivery in following weeks. Guide treatment of steroids, admission or transfer to tertiary units

Adv: avoid admission where very low risks, specialist care for extreme and ability to prematurely discharge patients

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13
Q

Describe the following POCT: Flu testing

A

Nasopharangeal swab. Rapid porcessing time

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14
Q

Describe the following POCT: Multi-purpose analysers

A

This tool is flexible to local needs. Applications include auxiliary to core lab services e.g. ambulance services.
- Advantages are varied

Example, D-dimer, BNP, Cardiac, Tox DS used in the same device

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15
Q

How is POCT developing? with regards to COVID

A

Think about the lateral flow test, antigen or even PCR used to quickly assess possibility of disease to reduce stay in hospital etc.

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16
Q

What is the aim of POCT governance?

A

Provide structure to capitalise on the advantages of the technology while keeping the inherent risks to a minimum

17
Q

What are some general POCT requirements by NHS?

A

POCT is subjected to the same level of public, professional and judicial scrutiny as conventional lab testing
- The assessment by the NHS is mandatory and can include device training, device maintenance, indicents reflection

CareQualityCommission is the body carrying this out

18
Q

What are some examples governance examine?

A 
Clinical and cost effective 
Use valuabel resources most effectively 
Fit for purpose 
Accuracy of results 
Define responsibilities of users/accountability
19
Q

State some specif c POCT guidances.

A
  • MHRA
  • ISO22870: POCT requirement for quality and competence
  • Assessed by UKAS, an organised infrastructure, clinical need/cost benefit analysis, device selection/verification, IQC/EQA
20
Q

What is included in the quality management system?

A

POCT policy, commitee, MDT membership, role, coordinator/team

21
Q

What is POCT policy?

A

Ensures patient safety with respect to POCT

22
Q

What is PCOT committee?

A

Responsible for defining POCT scope

- Representatives from people

23
Q

What is MDT membership?

A

Clinicians/nurses, lab professionals, support services

24
Q

What is the POCT coordinator/team?

A

Deliver the POCT

25
Q

What does the clinical need/cost-benefit analysis investigate?

A

Necessity of the POCT

  • Can current services be modified to meet request. E.g. POCT for creatinine due to CT scan needing contrast (renal function has to be assessed) - patients left waiting for 1h+ which caused delays in system
  • Solution: add urgency label to speed up testing
Impact on patient care
- Specific patient group 
- Benefit of POCT vs lab
Is there a suitable location for devices
Additional staff?
Finance
- Capital: device, connectivity and alterations
- Fixed recurrent: IT , maintenance, EQA
- Varibale: consumbales and staff
26
Q

Once a clinical need has been established how is device selection determined?

A

Analytical quality of devices

  • Comparability with lab results, accuracy, precision and limitaitons and interferences
  • Suitable for screening (less accurate) or monitoring (accuracy needed)

Infection control
- Waste disposal, cleaning

Minimal operator dependent steps

  • Ease of use in correct way
  • Volumes (blood vs urine), timing, reading - Guide implemented

Governance features

  • Password access
  • QC lockout
  • Barcode readers
  • Connectivity
27
Q

Describe the verification process of the selected devices

A

Standard operating procedures (SOPs)

  • Comply with lab standards
  • Non-lab audience (lay language)
  • Accessibility
  • Controlled

Risk assessment: Control of substances hazardous to health (COSHH)

  • Safety of POCT end users
  • Safety

Maintenance:

  • End user/POCT team/lab support
  • Complexity
  • Compliance/recording
28
Q

What is some quality assurance of new devices?

A

Internal quality control

  • Routine accuracy/precision check
  • Frequency dependant on test, e.g. once a day high and low QC is adequate
  • Blood gas iQM, QC is built in and is autonomous

External quality assessment

  • National peer review
  • End users (then reflects better) or lab staff
  • Scheme availability

Training and competency assessment
- Re-assessment interal

29
Q

What is the importance of POCT training?

A

Most POCT errors are operator dependent..so important to train staff to produce accurate readings

POCT operators vary in qualification and training

30
Q

What does the training include?

A
  • Basic principles and theoretical knowledge
  • Sample colletion and handling
  • Quality control/EQA
  • Documentation/reporting results
  • Infection controls
  • Limitations of the systems
  • Responsibilities
31
Q

How is the training content tested?

A

Theoritcal knowledge
Practical observations
E-learning

32
Q

What is the importance of data management?

A

Ensure the qualified individuals are using the POCT, maintenance/calibrations have been made periodically

33
Q

What is audit and what is examined?

A 
Examine full scope of services
Practice
- Cleanliness
- Storage 
- IQC and EQA
- Documentation 
- Trained staff and numbers

Clinical effectiveness

  • Workload
  • Impact of test

Follow up

  • Feedback
  • action plans
34
Q

Describe incident reporting.

A

Root cause analysis

  • ID system failures not placing blame
  • Corrective action/preventative action: systemic improvements, education
  • Follow up

E.g. users sharing unique barcode with each other

Analytical methods (15 decks)

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