CONTINUING EDUCATION :: POCT
records electronically, reducing printing costs and increasing efficiency. Again, verifying the performance of the device aids in ensuring accurate patient results.
A quality POCT program will also include the performance of proficiency testing (PT). Proficiency samples are run at the device and downloaded to the data manager. The results can be reviewed and stored electronically in the data management system. The POCC can mark the proficiency results as reviewed and indicate whether the testing was successful or unsuccessful once the assessment is received from the proficiency testing provider. The POCC uses the proficiency samples to monitor device performance and that the operator is handling samples correctly and performing testing correctly. A device may need to be taken out of service or an operator retrained in the event of failed proficiency. Reviewing and storing the proficiency results in a data management system eliminates printing and storage of paper documents and reduces the risk of lost or misplaced information.
Harnessing the management of manual or lateral flow-type test results, such as pregnancy, rapid strep, and fecal occult blood, has always been problematic. In the past, results were often manually written in the patient’s chart, with no documentation of passed internal QC, kit lot numbers, or who performed the test. The results were easily lost or overlooked when they were handwritten “somewhere” in the chart. A data management system that utilizes a manual test entry (MTE) feature allows the POCC to not only configure the result entry fields but also to track operators who are trained and certified to perform manual tests. The certified operator enters the patient result, internal QC
result, and if set up to do so, the kit lot numbers. Once entered, those results are evaluated by the system and if all information is entered correctly, the manual test result is sent to the patient electronic medical record (EMR). If the internal QC is invalid, the POCC can hold those results in the data manager so that the patient result is not sent to the EMR. The benefit of having all the documentation for the manual test and the result in the EMR far outweighs the minimal amount of training for the operator to use the MTE feature.
Using connectivity to manage test materials at the point of care The POCC can enter all test materials, including strip/reagent/ kit lot numbers, QC lots, linearity lots, and proficiency sample IDs in the data manager. The POCC can enter the test materi- als with manufacturer’s expiration date, along with acceptable ranges for QC and linearity. For devices that have bidirectional communication, the test materials are sent to the device, and the operators are not allowed to use materials that have not been entered in the system. The acceptable ranges are also sent to the device allowing the operator to be alerted by the device if QC or linearity results are out of range. The data management system should also provide inventory
tracking so that the POCC can plan ahead, making sure test materials are ordered in a timely manner. For unidirectional devices and manual tests, the system can be set up to flag results performed using new test materials that are not yet validated, and those results can be held or sent to the patient record. In this case, the POCC would be alerted and can in- vestigate why the materials were used or can validate them and put them into use. Being able to track all lot numbers and inventory in the data management system eliminates the need for paper logs and ensures test materials are validated prior to use.
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Reports manage key performance indicators A POCT data management system will provide the ability for the POCC to generate various reports, which can be used as part of the laboratory’s key performance indicators. The POCC can also send reports to the various nursing unit managers or device operators as needed. Example reports may be ‘Criti- cal values for a given time period’ or ‘Operator certifications expiring soon.’ The system should have a wide range of report- ing capabilities that a POCC can use for quality assurance purposes and for communicating to testing personnel and unit managers. The reports can give insight into the overall health of the POCT program — what is going well and what areas may need improvement.
Additional features of a data management system at the point of care
Managing compliance and competency A data management system may provide the POCC with the ability to create quizzes and assign them to the operators as part of their competency assessment. The successful completion of the quiz can be used as criteria for auto-recertification. The data manager may also be able to interface with an external learning management system (LMS) through a direct inter- face or through a file-based data import. Like the integrated quiz, the successful completion of the LMS course can be documented in the POCT data manager and used as criteria for recertification.5
Managing access to the data management system Another feature of a data management system would be per- mission-based access to the system. A POCT program might not have 24-hour, 365-day coverage and the permission-based access allows the POCC to give access to the data manage- ment system to those who can assist with daily operations. For example, the program may have nurse educators who help train new personnel on the use of a glucose meter. The POCC can give system access to nurse educators to enter new operators and give glucose certifications in the system. The educators will have access to only the operator management function. Having additional staff resources access the system as needed for certain functions creates efficiency and uninterrupted service to the testing locations.
Using other programs to enhance the use of the data manager Lightweight Directory Access Protocol (LDAP) or Active Directory is a great feature that can be used with the data management system. Manually entering new operators is very time consuming, especially with the current staffing issues found nationwide. This feature provides a means for the operators to be automatically added, edited, or removed from the data manager. The Active Directory that may already exist at an institution can be set to sync with the POCT data manager to add new operators to the system based on specific criteria. The sync can also remove operators who no longer work in the facility or network (such as travel or temporary staff) from the system, adding another layer of security to the program.
Conclusion The pandemic has accelerated the use of POCT. Many clinicians who had not performed lab testing began performing COVID-19 and other types of tests. A data management system can ensure
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