Physicians Office Resource Volume 12 Issue 6 | Page 35

• Glucose monitoring ; Hemoglobin A1C
• Hematology
• Infectious diseases ( such as Influenza and Rapid Strep )
• Pregnancy and fertility
• Tumor / cancer markers
• Urinalysis testing
• Other Chemistries ( Magnesium , Lactate , Micro-albumin , Creatinine )
• D-dimer for thromboembolism
Challenges inherent in managing point of care testing : In the core lab , errors occur most frequently in the pre- and post-analytic phases , however , POCT errors occur primarily in the analytic phase of testing . This is related to a lack of understanding or training of non-laboratory staff who are involved in POCT . In addition , there are possible test limitations and misuse in a particular environment . This often raises concern over the reliability of test results .
More than ever , the laboratory must be proactive in monitoring all aspects of POCT , if quality care is to be maintained . These actions include :
• All Point of Care ( POC ) testing personnel must be properly trained , and have their competency periodically assessed , even if all their testing is waived
• All instruments involved should be used in accordance with manufacturer ’ s requirements with quality control , calibration , and maintenance records monitored ;
• Test results must be verified as to accuracy and ( if previously patient tested ) consistent with a patient ’ s history
• Reagent storage and handling must be monitored
• Utilization of split sampling and proficiency testing is recommended for monitoring quality .
Managing POCT : the Laboratory Liaison Mindful that POC testing may be performed by non-laboratory staff , laboratories often have a staff tech responsible for monitoring this testing , acting as both a liaison , as well as a technical resource for the POC testing 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 .
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 .
An alternative model : POCT Management Teams Interdisciplinary POC management teams that include the laboratory , physicians , and nurses are considered as the most effective way to ensure the best oversight . This model increases the probability of inter-departmental cooperation and buyin by non-lab staff of all the procedures required to assure quality POCT . They would be responsible for :
• Determining the test menu
• Selecting methodologies
• Establishing policies and procedures
• Confirming proper training and competency assessment
• Overseeing regulatory compliance
• Documenting corrective action where necessary
• Providing advisory assistance to the

“ The Bottom line , there should be no difference in the quality of patient care , whether performed within the confines of the lab , or anywhere else . Ultimate responsibility lies with the lab administration and staff .”

Ralph Taylor , CEO , Sysmex America , Inc .
users of POC technologies
However , regulatory standards hold the Laboratory Director ultimately responsible for managing and supervising POCT
Compliance strategies in the digital age : The Use of Data Management Systems Technology has now enabled us to monitor all aspects of POCT remotely , from test requests to test results ; from QC to maintenance records to documentation of competency to operate instruments . When possible , use digitalized monitoring to ensure quality work . Here is a sampling of the capabilities of remote monitoring :
Training & Competency Assessments
• Documentation of the initial training , as required by CLIA and Accreditation organizations , prior to POC testing , followed by documented competency assessments at specific intervals .
Quality and Compliance
• QC limits and frequency intervals can be configured on the test instrument or managed remotely through a data management system ...
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