DIAGNOSTICS
T Getting straight to the point
here are many situations in the day to day running of the NHS where clinicians
are forced to act quickly in order to deliver the best patient care. This is where point-of-care testing becomes an extremely useful tool.
POCT is used in a variety of settings and according to Dr Danielle Freedman, vice president of the Royal College of Pathologists, its real utility comes when clinicians need to make a quick decision.
“For example, in an acute setting we would use it to check a patient’s blood gas levels, if they are using a ventilator in the intensive care unit.
“Using POCT means that you get a response immediately, as opposed to sending samples down to the laboratory, which could take anything up to a few hours, depending on what tests are being carried out.”
The speed and convenience which POCT offers means that it used in many areas of acute care such as the accident and emergency department, intensive therapy unit and neo- natal intensive care units.
However, despite its diagnostic speed making it perfect for an acute setting, GPs are also using POCT in primary care settings as well.
“GPs use it for anticoagulant monitoring and test patients to assess adequacy of warfarin dosage, along with checking the glucose levels in diabetic
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the internet, which involve you sending them a capsule of your blood through the post. They will even send you a little kit to bleed yourself with, again, for a large fee.
“This is why I think that POCT needs proper clinical governance arrangements.”
Dr Danielle Freedman
patients and also cholesterol checks. Given its success so far, I believe that its use in primary care will continue to grow.”
High street chemists are already offering point-of-care testing for certain conditions, with some also considering entering into agreements with primary care trusts to offer point-of-care testing more widely to patients.
Despite the good work being carried out by many high street chemists with POCT, there are some who look to exploit it to make money out of a wary public.
“There is also a problem with some outlets which are offering supposed tests to the public. For example, there is what looks like a converted burger van set up in one town centre which offers ‘a test’ for prostate cancer, for a fee of course. These are not run by any NHS organisation.”
The growth of the internet has also fuelled the amount of ‘tests’ which are available online, some of which are rather questionable.
“There are even some companies which offer ‘allergy tests’ on
Dr Freedman is one of a team of professionals who recently contributed to guidance on the use of POCT (‘Management and use of IVD point of care devices: DB 2010 (02)) published by the Medicines & Healthcare Products Regulatory Agency.
“One message which must get to anybody considering the use of point-of-care-testing is that they must follow this MHRA guidance, as it is applicable to both primary and secondary care, along with the private sector as well as the NHS.”
This guidance covers many areas, one being the role and importance of the hospital laboratory, which Dr Freedman explained using her own trust as an example of best practice.
“We have a POCT committee which assess the need for any kind of point-of-care testing equipment and is accountable to the risk management committee. A recent example was that of our respiratory physicians who wanted a gas machine to measure gas levels in patients with chronic obstructive pulmonary disease.
“To do this they had to put together a proper business case for the procurement of
Point-of-care testing offers clinicians a fast and convenient way to carry out a variety of tests and is set to increase in the future, reports Richard Mackillican
the equipment which was then put before the committee. This business case had to cover the clinical need for it together with a recognition of the cost involved and reassurances on how they would maintain quality assurance.
“The laboratory plays a big role in this quality assurance, including the training of the user or testing their competency. This means that I know that anyone using POCT in the hospital has the right experience to do so properly so that clinicians can be sure that the results they are given are correct and, more importantly, ensuring patient safety.”
Due to the advance of
technology, it is also possible for the laboratory team to monitor POCT remotely.
“Through the use of information technology it is possible for me to monitor, for example, someone’s blood glucose levels measured by POCT, in a ward at the other side of the building.”
Dr Freedman and her team also maintain good links with their colleagues working in primary care to ensure that they also work to a good governance model.
“We work very closely with them to make sure that they are complying with the guidance set out by the MHRA. This should also be the case in private laboratories from the independent sector.”
Due to its increasing significance in modern healthcare, POCT is
Jul/Aug 10
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