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MSC: Analytical Methods > Point of Care Testing > Flashcards

Point of Care Testing Flashcards

1
Q

What is Point of Care Testing?

A

•Working definition: “any in-vitro analytical test performed for a patient by a non-laboratory healthcare professional outside the conventional laboratory setting”

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2
Q

What are advanatages of POCT?

A
  • 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)
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3
Q

Where is POCT used?

A

Acute services:

  • Complex tertiary referral centre
  • District General Hospital
  • Out-patient departments

Community services:

  • Intermediate Care
  • GPs
  • Patient’s Homes
  • Outreach services
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4
Q

What is disadvantages of POCT?

A
  • 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)
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5
Q

What are examples of settings where POCT methods used?

A
  • High Street Pharmacies
  • Prisons
  • Employment screening
  • Sports Teams
  • War zones
  • Natural disasters
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6
Q

What are advantages of glucose meters?

A
  • Improved patient monitoring
  • Sample volume
  • Empowerment
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7
Q

What are types of glucose meters for patient self testing?

A

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.
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8
Q

What are complex blood gas analysers?

A
  • 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
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9
Q

What are advantages of portable blood gas instruments?

A
  • 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
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10
Q

What are characterisitis of warfarin monitoring?

A
  • 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
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11
Q

What are characterisitics of Urine Screening?

A
  • 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
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12
Q

What are characterisitics of HIV Screening?

A
  • 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)
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13
Q

What are characterisitics of Fetal Fibronectin?

A
  • 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
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14
Q

How is Flu testing done?

A
  • Nasopharangeal swab
  • Rapid processing time
  • Guide treatment, isolation, admission, reduce length of stay
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15
Q

What is the characterisitics of multi-purpose analysers?

A
  • 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
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16
Q

What are examples of rapid growth of POCT?

A
  • HbA1c – outpatient clinics, diabetes monitoring
  • CRP – GP surgeries, guide antibiotic prescribing
  • D-dimer – GP surgeries,? DVT, PE – treat, refer for scan
  • Creatinine – prior to emergency contrast radiology
17
Q

What are rationales for introducing POCT?

A
  • Bed management decisions
  • Reconfiguration of lab services
  • Peri/post procedure monitoring
  • Initial assessment
  • Screening for new conditions
  • Monitoring pre-existing conditions
  • Accessing remote places
  • Accessing remote people
18
Q

What is Governance?

A

A system through which an organisation is accountable for quality

19
Q

What is the criteria assessed for governance of POCT?

A
  • Clinical and cost effectiveness
  • Use valuable resources most effectively
  • Fit for purpose
  • Accuracy of results
  • Define responsibilities of users / accountability
20
Q

What is the quality mangement system of POCT?

A

POCT Policy

  • Ensure patient safety with respect to POCT

POCT Committee

  • Responsible for defining the scope of POCT
  • MDT Membership: Clinicians/Nurses, Laboratory professionals, Support services e.g. Procurement, IT, Pharmacy ++
  • Role: Link to Trust organisations / board, Strategic direction; applications for new services, Define the scope of POCT; clinical need, financial implications, technical feasibility, procurement, Review audits/incidents

POCT Coordinator/Team

  • Delivery of POCT
21
Q

How is the Cost-Benefit analysis of POCT done?

A

Is POCT necessary?

  • Can the lab transport/service be modified to meet clinical requirements?

Impact on patient care – patient pathway

  • Context
  • ?Specific patient group
  • Benefit of POCT vs lab?

Suitable location for devices?

Who will perform the test?

Finance

  • Capital: Device, connectivity, alterations
  • Fixed recurrent: IT, maintenance, EQA
  • Variable: Consumables, staff
  • Economies of scale
22
Q

How is device selection for POCT conducted?

A

Test repertoire required?

Analytical quality of devices

  • Comparability with lab results: Accuracy and precision, Limitations, interferences, measuring range
  • Screening or monitoring?

Infection control

  • Waste disposal, cleaning

Minimal operator dependent steps

  • Easier to do the test in the correct way
  • Volumes, timing, reading

Governance features

  • Password access
  • QC lockout
  • Barcode readers – patient ID
  • Connectivity

Size, analysis time, maintenance

Verification prior to implementation

23
Q

What is the standard operating procedures of POCT?

A
  • Comply with lab standards
  • Non-lab audience
  • Accessibility
  • Controlled
24
Q

How is the control of substances hazardous to health important?

A
  • Safety of POCT end-users
  • Safety of patients / visitors
25
Q

Why is maintenance of POCT important?

A
  • End user / POCT Team / lab support
  • Complexity
  • Compliance / recording
26
Q

How quality assurance undertaken in POCT?

A

Internal Quality Control

  • Routine accuracy/precision check
  • Frequency dependant on test
  • Blood gas iQM

External Quality Assessment

  • National peer review
  • End-user or lab staff?: Sample handling/reconstitution
  • Scheme availability

Training and Competency Assessment

  • Re-assessment interval?
27
Q

What is the causes of most POCT errors?

A
  • Most POCT errors are operator dependent: Pre-analytical, analytical, post-analytical
28
Q

What are examples of POCT operators and it usefulness?

A
  • Varied range of HCPs with varied educational background
  • Clinical staff are busy people
  • Company training or in-house
  • POCT Team or cascade trainers / link nurses
29
Q

What is content of training session?

A
  • Basic principles of testing, clinical application
  • Sample collection and handling
  • Reagent storage, preparation
  • Quality control / External quality assessment
  • Procedure for patient testing
  • Documentation / reporting results
  • Infection control
  • Limitations of the systems
  • Responsibilities
  • Further information sources and supporting materials
30
Q

How is competency is training asessed?

A
  • Theoretical knowledge
  • Practical observation
  • E-learning: –On-going learning and –Knowledge/practice gaps
31
Q

How is Data for POCT managed?

A

Records of trained staff

Asset management - device inventory

  • Record all device events e.g. maintenance, faults, service

Mechanism for storing results

  • Standards, medical, medico-legal, patient recall
  • Patient result, person performing test, reagent lots, QC etc
  • Identifiable as POCT results
32
Q

What is stored in a results book?

A
  • Visually read tests / simple non connected devices e.g. HIV, pregnancy testing
  • Results handwritten in patient notes

Advantages: tailor made

Disadvantages: time, transcription errors, legibility, lost books, storage

33
Q

What are the characterisitics of Intermediate devices?

A
  • Results, QC, lot numbers etc stored on the device
  • Print out of results - Stuck into patient notes
  • Manually enter results into the patient record e.g. via the lab IT system

Advantages: results may be recorded in electronic patient record

Disadvantages: Transcription errors, time consuming, limited to low volume tests

34
Q

What are advanatges and disadvanatages of Interfaced Devices?

A

Advantages

  • Remote login to devices: –Add trained users
  • –Review QC data
  • Results automatically added to the electronic patient record
  • Full audit trail of processes

Disadvantages

  • Expensive,
  • IT support required
35
Q

How is an Audit of POCT conducted?

A

Full scope of service

  • Vertical, horizontal and examination
  • Temperature
  • Cascade trainer

Practice

  • Cleanliness
  • Reagent storage
  • IQC and EQA
  • Documentation
  • Trained staff and numbers

Clinical effectiveness

  • Workload
  • Impact of test

Follow-up

  • Feedback to clinical area
  • Action plans
  • Clinical audit department
36
Q

How is Incident reporting conducted in POCT?

A

Reporting system

Root cause analysis

  • Multiple causes?
  • ID system failures not place blame
  • Corrective action / Preventative Action: System improvements, –Education
  • Follow up

Examples:

  • User sharing unique barcode with others
  • Temperature breach in clinic room

MSC: Analytical Methods (13 decks)

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