POINT OF CARE TESTING

Point of Care Testing (POCT) is defined by the International Organisation of Standardisation (ISO) 22870: 2006(E) as ‘testing that is performed near or at the site of a patient with the result leading to possible change in the care of the patient’, (ISO, 2006).

 

The updated Clinical Pathology Accreditation (UK) Ltd (CPA, 2007) now includes a requirement of compliance with ISO 22870:2006. Point-of-care testing (POCT)- Requirements for Quality and competence.

POCT refers to all equipment and processes used outside the laboratory setting to perform analytical testing by healthcare scientists, clinicians, nurses and healthcare workers. To achieve the best possible results from POCT devices it is essential that there is the closest possible liaison with the Pathology services relating to such tests.

 

Traditionally, testing of patient’s body fluids, excreta and tissues are carried out in a Clinical Pathology Accredited (CPA) laboratory. Currently, specific ward based analytical POCT equipment is maintained by the relevant department i.e. Clinical Chemistry, Haematology or Microbiology.  The Pathology Department will advise on/or facilitate the mechanism and methodology of the tests, limitations of the method, troubleshooting, training, support, quality control and quality assurance, risk management, health and safety and infection control issues.

 

The table is a summary of the main issues which need to be addressed in the provision of POCT, the relevant action, level of responsibility and level of evaluation.

 

  Issue

Action by

Responsible for action

Evaluated by

Cost benefit analysis (Business Case)

Directorate/ Pathology

Directorate

Directorate/

Pathology

Health & Safety

Pathology

Health and Safety

Risk Management

Training (Including record of trained staff)

Pathology

Directorate/Pathology

Training and Development/

Directorate/Pathology

Standard Operating Procedures

Pathology

Directorate

CPA (UK) Ltd

Routine Operation

Users

Line Manager (e.g. Ward Sister)/Modern Matron

Pathology

Recording Results

Users

Line Manager

Pathology

Support

Pathology

Pathology

Directorate

Quality Control & EQA

Users

Pathology

Pathology

Budgetary arrangements

Directorate/ Pathology

Directorate

Supplies Dept/

Trust Executive

 

The two most common POCT devices within this Trust are:

1.      Blood Gas Analysers

Laboratory staff perform daily maintenance. Contact 07827 980 537 and if no reply ext 4230 for any problems or queries (in-hours) or ext 4235 (out of hours).

2.      Blood Glucose Meters

Internal Quality control solutions and meters strips are obtained from Pharmacy. Faulty meters are replaced by Clinical Chemistry and may be obtained during normal working hours by contacting ext 4248

External quality assurance of ward based glucose meters and both initial training and up-date training of staff is co-ordinated by Clinical Chemistry.

For any further information, advice or guidance you should contact the Trust Point of Care

Co-ordinator on ext. 4166

 

Other POCT devices and processes currently in use within the Trust are:

·         Coaguchek meter – International Normalised Ratio (INR)

·         HbA1C analysers

·         Pregnancy Testing

·         Urinalysis – Urine dipstick testing using Clinitek Status Device

·         Procalcitonin