Point of Care Testing
Standard AOP.5.1.1: A qualified individual is responsible for the oversight and supervision of the point-of-care testing program.
The College of American Pathologists (CAP) defines POCT as “testing that is performed near or at the site of a patient with the result leading to a possible change in the care of the patient.” POCT is usually performed by non-laboratory trained individuals such as nurses, physicians, nursing assistants, and anesthesia assistants, among others. The primary advantage to POCT is the faster turn-around time for results. An additional advantage is that these tests often require less sample volume than tests performed in the laboratory.
The increased availability and use of POCT is being influenced by many factors, such as; industry trends to move towards patient-centered care and healthcare decentralization, the increasing prevalence of infectious diseases, a growing incidence of lifestyle diseases such as diabetes, heart disease, and hypertension, as well as advances in technologies. The use of POCT can increase efficiency of services and improve outcomes for patients. However, the variability of the testing environment and conditions as well as the competency of staff performing the tests may have an impact on the quality and accuracy of POCT results. To ensure that POCT is performed safely and correctly, hospitals must have a clearly defined and well-structured approach to POCT.
A well-organized POCT program requires thoughtful planning as well as ongoing oversight and supervision. Leadership may be involved in the planning process by identifying and approving the resources dedicated to the POCT program as well as the policies and procedures related to management and oversight of the program. Leadership may also wish to be involved by participating in the decisions regarding the selection of specific tests to be included in the POCT program. Typically, oversight and supervision are provided by the individual responsible for managing laboratory services, however leadership may wish to appoint a designee or allow the laboratory director to appoint a designee.
A majority of the staff who perform POCT are not trained laboratory staff and may not be as knowledgeable about the processes involved in testing, such as patient preparation, sample collection, instrument calibration, instrument maintenance, and quality control. Therefore, it is critical that staff performing POCT have the proper training and competency assessment to ensure test results are accurate and reliable. A staff training program includes the following:
how to use the instruments,
how to perform instrument calibration and maintenance,
where to document results,
the process for reporting critical results,
how to perform quality control for each instrument used, and
what to do when an instrument fails.
Alternatively, laboratory staff may take responsibility, if preferred, for some of the POCT activities, such as managing instrument maintenance and acting on instrument failures. Following initial training and competency, the standards require that staff performing POCT must be re-assessed for competency at regular intervals to ensure the accuracy and reliability of results and the quality and safety of patient care.
Oversight and supervision of POCT also requires management of quality control (QC). Manufacturers generally set guidelines for QC results for each device and staff performing POCT are required to perform QC as recommended. The person responsible for oversight of POCT is responsible for reviewing and evaluating the QC results and taking corrective actions when unacceptable QC results occur.
Finally, a POCT program must be monitored and evaluated to ensure the program is meeting the needs of the patient, the health care practitioner, and staff performing POCT. Like other process in an organization, errors can happen at any phase of POCT. A study by Cantero, et. al. looked at the error rates during all phases of testing in the central laboratory and in performance of POCT. A higher rate of pre-analytical errors was found to be associated with POCT compared to central laboratory testing. The most common error in pre-analytic POCT occurred in relation to patient identification. Staff performing POCT failed to use two patient identifiers in 45% of the POC tests performed.1 Organizations need to identify the risk points in the process where errors in POC testing may occur and take actions to mitigate those risks. Monitoring and evaluation of the POCT program is essential and must be included in the overall hospital quality improvement program.
1. M. Cantero, M. Redondo, E. Martin, G. Callejon, M.L. Hortas. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory. Clin. Chem. Lab. Med. 2015 Feb;53(2):239-247