Laboratory Control of POCT
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.