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.