Once interest in a POC Test has been identified by a clinical area, the next step is contact with the local POCT co-ordinator.
The POCT team will offer help and advice on the appropriate POCT device to fit the clinical need, taking into account many considerations such as technical limitations, clinical diagnostic performance and comparison with local laboratory test results, where relevant, and IT connectivity.
Local and national procurement frameworks and preferred supplier lists also exist in POCT for a number of devices, underpinned by agreed quality specifications.
The POCT co-ordinator will be able to provide capital expenditure pricing and highlight ongoing costs to support the business case.
The POCT team is able to specify the learning outcomes for staff training and prepare the competency assessments needed in order to use the POCT device effectively, covering the following areas:
Several all-Wales training documents have been developed by POCT co-ordinators for tests including blood gases, coagulation, blood glucose and ketones, glycated haemoglobin, lipids, pregnancy testing and urinalysis
POCT device manufacturers may offer training.
The POCT team can facilitate the delivery of this training and they will maintain a record of trained operators and monitor device access using result log sheets or restrict access using POCT software systems.
The expanding repertoire of POCT devices offered by manufacturers and the growth in POCT activity in terms of test workload, number of operators and uptake in new clinical locations requires a scalable and open unified POCT data management system.
In response to this need funding was sought via the Welsh Government Healthcare Technology and Telehealth Fund to implement an All Wales Point of Care Testing solution (WPOCT). This software interfaces all connectable POCT devices within secondary care. Connected POCT device test results are viewable in Welsh Clinical Portal (WCP). The procured solution is also designed to enable connection of POCT devices in the community in the future.
The project involves engagement with the existing POCT community and partnership with the Health Boards and Digital Health and Care Wales (DHCW) and the data management system supplier to specify, select, implement and support WPOCT.
Quality assurance in POCT includes all the measures taken to ensure investigations are reliable and safe. Selecting the most suitable device, facilitating operator training and putting in place robust IT systems are all critical elements that support quality assurance.
On an ongoing basis it is important to review internal quality control measurements and external quality assurance result performance and determine the appropriate follow-up actions, conduct environmental monitoring such as temperature checks, and carry out audits. Resource should be identified for this support. Typically this is incorporated into a Service Level Agreement (SLA) between service users and the POCT department which defines the scope of the service provided and the responsibilities of both parties.
Prudent healthcare places great emphasis on patient outcomes and the aim of creating a patient-centred healthcare system. Appropriate outcome measures such as ‘has this intervention resulted in improved patient experience or reduced overall care delivery costs?’ requires gathering data from many sources. WPOCT can generate reports from standardised templates to facilitate effective audit.