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CRI Lab Quality Advisor

Laboratory Control of POCT

Published May 15, 2014 5:26 PM by Irwin Rothenberg

An ongoing concern among our laboratories is how to ensure that bedside or remote laboratory testing is of the same quality as that performed in-house.

Technological advances have resulted in an explosion in the number of tests that can be performed outside the laboratory setting; locations include the operating room, the nursing station, bedside, and nursing homes to name a few. More than ever, the laboratory must be proactive in monitoring this if quality care is to be maintained. This means that all point-of-care testing (POCT) personnel must be properly trained (with the training documented) and have their competency periodically assessed, even if all of their testing is waived. All instruments involved should be used in accordance with manufacturer’s requirements with quality control, calibration and maintenance records monitored; and test results verified to accuracy and (if the patient has been previously tested) consistent with a patient’s history. Don’t forget to monitor reagent storage and handling as well. Utilization of split sampling and proficiency testing is also recommended for monitoring quality.

Many laboratories, mindful that POCT may be performed by non-laboratory staff, often have a staff tech responsible for monitoring this testing, acting as both a liaison to the laboratory as well as a technical resource for the POCT staff. This is an important responsibility, as feedback from the field to the laboratory is needed to identify potential communication problems, complaints and the needs of both patients and staff.

In this new era of the Affordable Care Act and PCMH, the same standards now apply to POCT as to in-house laboratories: the need for efficient test utilization, the importance of interfacing remote test results with all laboratory testing on that patient and ensuring that all healthcare providers have the same access to these results as they would for in-house testing. New generations of POCT instruments have interfacing capabilities.

There is even talk of using smart phone technology for performing certain tests (such as reading indicator strips) and interfacing these results with the patient database. I can almost see the vision of the original Startrek infirmary where Dr. McCoy diagnosed his patients with the use of a Medical Tricorder.

The bottom line is that there should be no difference in the quality of patient care provided by the laboratory, whether performed within the confines of the laboratory itself or anywhere else. Ultimate responsibility lies with the laboratory administration and staff.

posted by Irwin Rothenberg

2 comments

There is truth in what you say, however, we cannot surrender our standards if we ever hope to achieve sustainable levels of quality. I do agree that the day to day demands on office staff/medical assistants/ Nurses,  and others with multiple and diverse responsibilities make achieving this difficult. But there has to be the commitment before we can see the results.  I have inspected many hundreds of physicians office labs over the last 20 years, and seen exemplary lab work from many individuals who have had to carry out these other responsibilities. I do believe that the goals must be set; realistic strategies for achieving these developed, (including ongoing education and communication about laboratory work from lab professionals, even if they have to be brought in from outside) and follow through.  This principle is true whether we are discussing Nursing, Radiology, Clinical laboratory testing, or Medical Records.  Providing quality patient care must not be compromised in any area of the patient visit.

Irwin Rothenberg, Quality Advisor May 30, 2014 10:05 AM

A laudable goal to be sure.  However, in this era of ever shrinking resources and increasing regulatory demands it is not one that I believe can be achieved.  There is simply no way that someone trained and practicing the art of nursing or nursing assistant can fully incorporate the scope of practice or appreciation for exceptional quality laboratory science.  How does one teach the concept that "just because the machine gives you an answer it may not be the right one" in a twenty minute training session?  Or answer the question "why do we have to do these PT samples again?". And even though staff can perform flawlessly while observed during an observed competency does not necessarily mean they will always do so.  One "staff tech" , really ?,a clinical laboratory scientist is the necessary profession deemed by CMS able to oversee moderately complex testing.  And, yes, we have just one who is also working a bench part of the time, creating competencies, and many other essential tasks who is responsible for managing 600 non-laboratory users of point of care testing.  Feeling a bit stretched, and underappreciated, indeed.

Lori, Clinical Lab Scientist May 30, 2014 8:47 AM

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