poct-introduction-training-final-version-for-southern-docs-(2).ppt

Dr Derek McKillop
Consultant Clinical Scientist
POCT Co-ordinator
Revision 2 August 2019

POCT Definition
 Point Of Care Testing  “… any diagnostic test
performed on a person by
a competent individual,
where a result that can
be interpreted is provided
before the person leaves”
 Alternative names
 Near Patient Testing (NPT)
 Bedside testing
 Extra-laboratory testing

POCT Governance Arrangements
 The governance standards for
POCT are listed within the Trust
POCT Policy.
 The policy can be found in
policy section of the Trust
website or the POCT website
 The policy is based on the
guidance for the Management
ands Use of IVD Point of Care
Devices, published by the
MHRA and endorsed by the NI
Health Estates
 The Key principals are
summarised in the MHRA Top
10 Tips document.

 A question I am frequently asked is “Why do I need to
comply with governance arrangements for POCT
when it is performed at home by unregulated
members of the public ?”
 The answer I give is
 Health service staff will be using POCT in challenging settings
where it could be contra indicated, levels are at the limit of
sensitivity, drug interferences are possible, patient are
unwell/unstable and critical clinical judgement are made based on
results so errors can have tragic consequences.
 To comply with the MHRA guidance
 To comply with professional codes of conduct.

 Governance Objectives
 Protect Patients from harm
 Protect Staff by helping
them to comply with their
professional Code
 Promote continual
improvement.
 incident investigation
 Audit

 POCT limitations
 Although you may not be required to perform POCT you will in
the course of your duties adjust the clinical management of
patients based on results obtained from POCT, therefore:
 You MUST be familiar with the limitations listed in the product insert for the
POCT devices used to generated these results
 Any results which are not in keeping with the clinical presentation MUST be
confirmed by the laboratory.
 The following slides will list the main limitation of core POCT
available within the trust.
 Throughout this presentation we will use case studies to highlight
how the limitations can adversely impact on patient care.

POCT limitations
 Blood Gas
 Not using balanced heparinised syringes will
cause clots and inaccurate electrolyte results
 Air bubbles will result in inaccurate blood
gas results
 Failure to mix will cause clots and falsely low
haemoglobin results
 Unlabelled syringes result in patient mix up
 Ionised calcium results are different from
Total calcium reported by the laboratory
 Potassium can be falsely elevated by masked
haemolysis in whole blood samples
 Dilution from line fluid, please note Sodium
chloride 0.9% should be the only solution
used for arterial line infusion and flushing

POCT limitations
 Glucometers/ketone meters
 Result may be unreliable if peripheral circulation is
impaired. Examples include:
 Severe Dehydration due to Diabetic
Ketoacidosis
 Hypotension
 Shock
 Hyperosmolar, Hyper glycaemic State (known
previously as H.O.N.K )
 Decompensated heart failure NHYA Class IV
 If peripheral circulation is impaired send a sample
to the laboratory or use a venous sample.
 Only heparinised samples can be used - other
anticoagulants will result in misleading results
 Continued glycolysis will adversely effect results if
not analysed immediately
 Any sample glucose reading below 2.8 mmol/L
or above 20 mmol/L, or which is not in keeping
with the clinical picture, should be verified by
sending a venous specimen of blood to the
laboratory.

Management & Organisation
 POCT is managed in partnership between the POCT
Committee, the POCT Coordinator and Stake holders
Dr P Sharpe
Chair POCT Committee
(list of members available on POCT website)
Dr D McKillop
POCT Co-ordinator
Link Nurses
Ward Managers
Pharmacy
Supplier
Laboratory
EQA Providers
Clinicians
Users POCT BMS
Ciara Arthur
POCT MLA
Gareth Prideaux,
Governance

Procurement & Laboratory Support
 Procurement stages
 Stage 1- prepare for approval a business case to secure funding for
the new POCT service and support services
 Stage 2- Discuss with the POCT coordinator who will advise on the
completion and submission of the POCT application form for
approval by the POCT committee.
 Stage 3- approved equipment should NEVER be purchased as a non
stock item. The trust is the legal entity in relation to procurement.
To ensure compliance with procurement rules the advice of the POCT
coordinator and the procurement department should be sought. The
following must be taken into consideration
 Is there a Regional contract?
 Is there a Local contract?
 Is NHS supply chain a viable option?
 Any tender must allow for future growth for the service from other
departments.

Training & Competency
Assessment
 Training
 Only staff whose training and competence has been established and
documented can perform POCT.
 The training program is designed to ensure staff have the
knowledge to use the device safely and avoid patient harm.
 POCT training is provided by either:
 The supplier
 Online training package with observational competency assessment
 At formal training sessions organised by the laboratory
 Local cascade training by a Link Nurse
 All link nurse trainers MUST have completed the company's train
the trainer training and signed up to the Cascade trainer model of
good practise

Training & Competency
Assessment
 On going competency assessment
 The competency of all trained POCT users MUST be evaluated at
least every 3 years.
 This should be noted as part of the KSF exercise and added to the PDP at least 6
months before competency is due to expire.
 Line manager should inform their designated POCT link nurse of staff that
requires competency assessment within the next 6 months.
 Or
 If the member of staff has not been rotated or routinely worked in a section for a
period of at least 6 months.
 Following return from maternity leave.
 Following return from extensive sick leave.
 Secondment to a new role.

Document Management
 All POCT related documents are
controlled and regularly
reviewed within the Q-Pulse
document management system
 All controlled documents are
hosted on the POCT website:
http://vsrintranet/SHSCT/Labs/
webhb/poct/home.htm
 Printing documents is
discouraged as they are only
controlled on the day of
printing.
 As a regularly used site we
would recommend placing
a link on your desktop by
opening the page, right
click, create short cut/
select yes.

Record keeping
 It is imperative to keep
accurate records which
must include:
 testing info- date; device
type; batch numbers; result;
operator identity; patient
identity.
 Stock control
 Temperature monitoring (if
required)
 Ensure records are stored
so as to protect patient
confidentiality

Maintenance
 Maintenance and appropriate storage of consumables
is essential for the safe and effective use of POCT
devices
 Planned preventative maintenance should follow the
manufacturer’s guidance,
 A maintenance contract should be in place to cover
 Preventative maintenance
 Out of hours call out
 Follow the weekly and monthly maintenance checks as
stated in the SOP and manual
 All devices must be decontaminated as per the SOP
prior to maintenance

Adverse Incident Reporting
 An adverse incident is an event that causes, or has the
potential to cause, unexpected or unwanted effects
involving the safety of device users including patients
or other persons.
 All incidents should be reported using the IR1
procedure.
 To ensure thorough investigation it is essential that
where possible the reporter:
 Contacts the POCT coordinator at the time of the incident
 Retains the sample and quarantines implicated test strips.
 Retest using alternative device/strip lot and confirm with lab
result

Adverse Incident Reporting
 An adverse incident is an event that causes, or has the
potential to cause, unexpected or unwanted effects
involving the safety of device users including patients
or other persons.
 If the root cause identifies an issue with the device
then the incident must be escalated to NIAC
 Please complete the NIAIC form available on the trust
share point and return to the risk manager
Nigel.McClelland@southerntrust.hscni.net
(http://sharepoint/pr/ess/grm/Policies%20and%20Proc
edures/Forms/AllItems.aspx)

Conclusion
 POCT is a risky aspect of your role
 Working with the POCT team we
can minimise those risks, both for
the patient and for you
 You must now complete a short
test based on the information
you have been given
 To access the e-learning platform to
complete your test email
elearning.support@southerntrust.hsc
ni.net or Tel: 02837564162
 When you have completed the introduction module and passed the test, you must
now complete the POCT device specific training modules as per your job role
requirements. POCT online courses can be located at
http://www3.hscni.net/stlabs/webhb/poct/training.htm
 Doctors must complete the e-declaration on southern Docs to verify
completion of the introductory module.
Thank you for completing this module Revision 2 August 2019

poct-introduction-training-final-version-for-southern-docs-(2).ppt

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