preview:• People who are living with diabetes generally use a small handheld device to monitor their blood glucose levels daily and therefore that's a form of point of care testing (POCT).
• Why we have implemented POCT in some particular areas for some particular tests.
• To provide exam...
People who are living with diabetes generally use a small handheld device to monitor their
blood glucose levels daily and therefore that's a form of point of care testing (POCT).
Why we have implemented POCT in some particular areas for some particular tests.
To provide examples and discuss sites where point of care testing plays a key role.
To talk about how we manage it and whether you are obtaining a result within a hospital
laboratory on an analyser or whether you're obtaining a result on a small handheld device
next to the patient’s bedside it's absolutely essential that we monitor and manage the
procedures in place to ensure that we get accurate results.
No particular approach is perfect there are advantages and disadvantages to sending
samples to the laboratory versus the test taking place at the next patient's bedside.
The future of POCT, where we are currently and where we think we're going to go. It is going
to continue to grow due to the increases in technology and the changes that we want to
implement within healthcare.
POCT is testing which takes place outside of the hospital laboratories at the point of care and
so generally near to the patient.
UKAS is the accreditation body that will the accredit hospital laboratories within this country
and are responsible for ensuring that laboratories adhere to set standards therefore they are
providing a high-quality service of which patients can trust him and will obtain results which
are accurate and will inform their diagnosis monitoring and their treatment – all hospital
laboratories have to be accredited by them
The do accredit hospital laboratories an POCT through the ISO, there are two standards
which are important in relation to this this includes ISO standard 15189 which is the
accreditation standard for medical laboratories and ISO standard 22870 which is the
accreditation standard for point of care testing.
Why do you want to have governing bodies regulating diagnostic testing? As a patient you
want to be protected and know that the results that you've obtained are accurate therefore
you can rely on them to influence treatment that you're going to go on and the management
of any conditions and you have or any potential diagnosis that may have.
We have numerous regulatory bodies and standards that will ensure that.
As BMSs the professional body is the IBMS (institute of biomedical science).
It promotes the profession and encourages CPD development amongst other things and as
part of continual professional development as of recently it has developed a new
qualification in conjunction with the University of Ulster in relation to providing a point of
care testing qualification which can be studied by individuals who are either involved
currently in point of care testing or want to be involved in POCT, this qualification supports
career development and advancement.
The IBS also hold an annual congress in Birmingham, it takes places over a few days in the
week where you have different programmes related to different disciplines within BMS and
one new programme is the point of care testing programme, this shows that POCT is a key
feature of the programme of the IBMS annual congress, and it is this growing field and
supported by the IBMS.
, To provide rapid results which can be acted upon to or hopefully improve the clinical
outcomes.
Ideal within urgent situations a good example of that is maybe to the introduction of point
of care testing within A and E department so if patients are presenting with evidence of
having a heart attack, we can actually measure troponins in the A and E ward.
Most point of care tests if they involve blood for example would involve a finger prick test
which you can then put on a strip that is much better than a tourniquet around someone’s
arm, having to swab the area, put a needle in, add the vacutainer to collect the sample,
package that sample within appropriate packaging then send that to the lab.
Easier to analyse urine sample in pot or a few drops of blood than sending it to the
laboratory.
If a patient is complaining of having symptoms of diabetes, they then can be tested within
the GP practise using a handheld device and if it is evident that the patient has elevated
levels of glucose that conversation can be had with a patient there and then rather than
having the patient be bled at the GP surgery to then sent that sample, to then wait for those
results to come back.
It allows urgent clinical decisions to be made, you can act upon those results more
immediately and subsequently can begin treatment.
Outside of hospitals – within police stations for example. They use breathalysers if an
individual is showing signs of drink driving, you could perform a point of care test to look at
drug screening to see if they got any other intoxicants within their body and you can do that
there and then without having to send that sample to the hospital.
The point of care testing device must be easy to use by all members of individuals regarding
using, it makes the training easier, the troubleshooting easier and it makes operating it much
easier.
Examples of that are reagents that maybe last longer have a longshot shelf life and also can
be stored at room temperature, it's no good having reagents that need to be stored at -80
either stored within 4 degrees fridge or can be stored ideally at room temperature. Short
shelf life increases the costs.
Results should be in concordant with the pathology laboratories, that's a key focus of POCT,
it's no good having a test performed in the laboratory and you get one result but if you were
to perform it on a small handheld devise you get a completely different result. You don’t
want any discrepancy,
Should not involve any reagents or any other components of the test to be a risk to the
operator anymore that you want it to be a risk to the patient so obviously you want
everything to be as safe as possible and sometimes reagents may be hazardous, so you have
to have the procedures in place to make sure they are safe to use as long as they are used
properly.
Ultimately POCT is to screen, diagnose and medically mange patients.
29 POCT are currently implemented of care tests.
Blood glucose – can adjust their diet or level of activity if they notice that their blood glucose
levels have changed, do they need to increase their insulin for example.
Cardiac and thrombotic reading – can involve measuring patients using a blood pressure
monitor and we see that within wards, clinics, GP practises and pharmacies.
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