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1. Point-of-Care testingin home and hospital 22nd Biomedical Instrumentation conference
Provides an alternative
to laboratory testing
That is easy, portable,
Allows for testing either
by physician or patient
4. Cost-effective for many disease ,such as diabetes, acute coronary syndrome
Results can be shared instantaneously with all members of the medical team through software interface enhancing communication by decreasing turn around time
5. bedside analysis, near-patient analysis
decentralized analysis, and off-sit analysis
7. Where it all began 20 years ago?
8. Advantages of POCT Reduce TAT
Smaller sample size(microliters vs. milliliters)
9. POCT: Advantages Faster stabilisation of life-threatening crises (drug overdose, electrolyte disturbance)
Closer therapeutic management (eg. diabetes)
Better patient compliance with therapy (diabetes, anticoagulation, hyperlipidaemia)
repeat clinic/practice visits
length of stay in hospital
complications (intra- & postoperative)
use of blood products (surgery)
10. POCT: Advantages Reduces the risk of preanalytical errors
the transportation of samples
No need laboratorian staff. ???
11. POCT: DISADVANTAGES Analytical performance can be inferior to lab (eg. glucose meters), so need lab backup
Risk of poor operator competence
Risk of poor quality patient information
Risk of poor equipment maintenance
12. POCT: DISADVANTAGES Cost per test (>>lab), so look at clinical & economic OUTCOMES of patient episode
All depend on the way equipment is selected and used
Lack of adequate documentation
results may get mishandled or misplaced
have an affect on potential reimbursement issues.
13. What were some of
the most important ?tools?
that you used when you
first got involved
14. POCT Informatic Tools Early to mid 1990?s
Touch screen PCs
Results sent to centrallaboratory for analysis
15. What?s Driving POC Informatics? Hospital POC growth rate
Decentralized patient testing
Reducing overall healthcare costs
16. The Information Revolution? As POCT evolves, needs will include:
Getting more data to the EMR
Continuous glucose testing and monitoring
Open IT standards
RF and web-based communication and connectivity
17. Emerging Trends inPoint-of-Care and theirImpact on Data Management?
18. Trends? 1. It?s not just glucose anymore?
19. POCT is Not Just for Glucose! ??
20. Trends? It?s not just glucose anymore?
Goodbye Paper?Hello e-Patient
21. Goodbye Paper?Hello e-Patient! It?s a ?Paperless? World!
EMRs reduce overhead andimprove efficiency
EMRs increase patient care
22. Goodbye Paper?Hello e-Patient! Download stations must always down load
Servers must always be on the network
Connections to host systems (LIS/ HIS) never lost
24. Trends? It?s not just glucose anymore?
Goodbye Paper? Hello e-Patient
Zero Tolerance for Errors!
25. Zero Tolerance of Medical Errors The Need for Data Management
Total control of POCT Programfrom device to operator topatient to test order
Federal initiative launched to reducemedical errors and improve patient safety
26. In the Future?. Look for more patient outcome data
Statistics to validate quality
New reports to allow users to sort data on various criteria such as nursing unit, patient, result, etc.
POCT as a separate laboratory department
27. Trends? It?s not just glucose anymore?
Goodbye Paper? Hello e-Patient
Zero Tolerance for Errors!
Where have all the Med Techs gone??
28. Who does POCT?
Doctors Nurses Ambulance paramedics
Patients Careers Retail & Leisure centre staff
ICUs Operating theatres
A&E Delivery Suites
General wards Ambulances
GP surgeries Pharmacies
Field hospitals Retail & leisure centers
Monitoring chronic disease (or acute disease in ICUs)
Diagnosis, risk stratification
30. EXAMPLES OF POC TESTS ? Blood gases: pH,
? Na, K, Ca, Cl-
? Urea, Creatinine
? Cholesterol, TGs
? Troponin, CK-MB,
33. Amperometric method Glucoseoxidase
35. Photometric Glucoseoxidase,Peroxidase
39. POCT Closer to Home? 2 million+ on Anti-Coagulation therapy
Warfarin - 22nd most common drug
1,100 Clinics growing at 20% a year
Heart Valve replacement
40. The Use of Portable Coag Devices? Bedside testing enables:
Home health providers to make immediate changes in coagulation therapy if necessary
Frequent testing = Fewer complications
Home testing with data communication= improved patient management
41. Management of POCT
42. The multidisciplinary POCT group Laboratory professional (Chair)
Information Technology Manager
Medical Equipment Manager
Risk / Safety Officer
44. POCT Policy
45. POCT Management Procedure Must setting and monitoring whatever about Quality system , should be stock or plan number of tests used in a year ( same lot No.) ,
Reference range of Quality control , Frequency of calibration, Must setting and monitoring whatever about Quality system , should be stock or plan number of tests used in a year ( same lot No.) ,
Reference range of Quality control , Frequency of calibration,
46. Procedures and instructions
47. Providing the evidence Application for POCT device
Certificate of competence
Maintenance log form
48. Training Who is trained?
Who does the training?
What is the content?
National/International Occupational Standards
49. Certification Assessment of competence
Multiple choice questionnaire
50. POCT accreditation standards
51. Data Management at Home Provides direct oversight by the care provider
Eliminates patient transcription errors
Allows for timely medication adjustment
Improves patient satisfaction
52. 1. Where are POCT diagnostics currently being used?
2. What are their benefits over lab based clinical
Depends on clinical context, circumstances & quality of
local POCT management
3. What are their current limitations?
Cost, IT networking capability, ?wireless, ease of use,
insufficiently ?idiot-proof? and robust, range of tests
available. Need more non-invasive systems (eg bilirubin)
Little currently on the market for continuous minimally
invasive monitoring (eg for diabetes).
53. 4.What features could be improved?
Simplicity of use, miniaturisation, robustness (device &
consumables), costs, IT connectivity, remote lockout for
unaccredited users, decision support software, inclusion of
quality materials within costs, training support. Suppliers to
encourage ?whole system? approach to implementation as
part of local diagnostic support.
5. Do they provide clinically useful information? Are they what clinicians want?
Very dependent on appropriate implementation and
consideration of outcomes. Clinicians want ease of use,
reliability, low cost. Managers want improved capacity &
throughput, reduction of beds and staff costs.
54. 6. Do the current POCT diagnostics provide the
required sensitivity and accuracy?
Requirements differ depending on circumstances; quality of
results dependent also on competent use
7. Will POCT diagnostics replace lab based
diagnostics or will it be the other way round?
NEITHER: both are an essential & integral part of
diagnostic provision and will continue to be in the
Major changes in profiles of healthcare provision, IT
developments, analytical technology, requirements of
Clinical Governance and risk management --> blending of
deliveries and need for increasing flexibility of systems.
56. Thank you for your attention