Final+Chapter+7+revised+2024

Point-of-Care Testing (POCT)

Introduction

  • Authors: Marjorie Schaub Di Lorenzo, Susan King Strasinger

  • Book Title: Blood Collection for Healthcare Professionals

  • Edition: Fourth Edition

  • Publisher: F.A. Davis Company

  • Chapter 7: Point-of-Care Testing

  • Access: Online resources available with a code.

Key Terms

  • Calibration

  • Control

  • Critical value

  • External control

  • Internal control

  • Point-of-care testing (POCT)

  • Proficiency testing

  • Quality control

  • Quality management

  • Reference range

Objective 7.1: Define Point-of-Care Testing (POCT)

  • POCT is defined as tests performed at or near the site of patient care.

  • Also known as:

    • Alternate site testing

    • Near patient testing

    • Decentralized testing

    • Bedside testing

    • Ancillary testing

  • Typically involves portable devices and reagent test kits.

Testing Locations for POCT

  • POCT can be conducted in various settings:

    • Critical or intensive care units including NICU

    • Surgical suites

    • Emergency departments

    • Satellite laboratories

    • Physician offices and clinics

    • Ambulances or helicopters

    • Long-term care facilities

    • Workplace settings

    • Health fairs

    • Dialysis centers

    • Home settings

Points of Care Testers

  • Healthcare professionals involved:

    • Medical laboratory scientists and technicians

    • Laboratory assistants

    • Phlebotomists

  • Non-laboratory trained operators include:

    • Nurses

    • Respiratory therapists

    • Physicians

    • Radiographers

    • Medical and nursing assistants

    • Patient care technicians

    • Patients themselves can conduct tests at home.

Advantages of POCT

  • User-Friendly Instruments:

    • Often small and handheld

    • Provide mobility and ease of use

    • Low maintenance requirements

    • Cost-effective

    • Require decreased specimen volume

    • Lower potential for error

    • Ensure compliance with Clinical Laboratory Improvement Amendments (CLIA)

    • Provide reliable test results

  • Speed and Efficiency:

    • Faster turnaround time (TAT) for results

    • Reduced length of hospital stays

    • Immediate availability of results enhances provider-patient interactions.

Disadvantages of POCT

  • Shortcomings include:

    • Accreditation requirements

    • Challenges in billing mechanisms

    • Documentation of results

    • Quality control issues

    • Intended use compliance

    • Costs associated with implementation

    • Increased number of operators leading to diluted competency.

Commonly Performed POCTs

  • Laboratory Departments and their Tests:

    • Hematology: Hemoglobin, Hematocrit, White Blood Cell Count

    • Chemistry: Basic metabolic panel (BMP), glucose, arterial blood gases (ABG)

    • Serology: HIV, infectious mononucleosis, human chorionic gonadotropin (hCG)

    • Coagulation: Prothrombin time (PT), activated partial thromboplastin time (aPTT).

POCT Instrumentation

  • Important aspects include maintenance, calibration, quality control, and documentation.

  • Types of specimens:

    • Whole blood

    • Urine

    • Direct swabs

    • Saliva

    • Noninvasive technologies (e.g., oximetry, transcutaneous bilirubin).

Phases of Laboratory Testing

  • Preexamination Phase: Test ordering, patient identification, preparation, specimen collection, reagent storage.

  • Examination Phase: Involves testing procedures following manufacturer's instructions and proper specimen application.

  • Postexamination Phase: Interpretation and documentation of results must be accurate and thorough.

Quality Control (QC) in POCT

  • Quality control ensures the reliability of the test system:

    • Precision and accuracy of tests

    • Compliance with regulations

    • Internal, external, and electronic QC performed regularly to ensure test validity.

Common POCT Errors

  • Misidentification of patient results can lead to serious treatment errors.

  • Prevention strategies include:

    • Strong patient identification protocols

    • Accurate specimen collection methods

    • Proper QC and documentation

Safety Protocols

  • Follow standard precautions:

    • Use of Personal Protective Equipment (PPE)

    • Proper hand sanitation

    • Use of appropriate cleaning materials for devices (avoid damage).

Future of POCT

  • Expect advancements in stand-alone devices and enhanced data management

  • Integration with electronic medical records will become the standard, improving overall healthcare efficiency.