Point-of-Care testing in home and hospital

Point-of-Care testing in home and hospital

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Point-of-Care testing in home and hospital

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1. Point-of-Care testing in home and hospital 22nd Biomedical Instrumentation conference

3. Introduction Point-of?Care-Testing (POCT) Provides an alternative to laboratory testing That is easy, portable, and accurate 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 Reduce errors Reduce paper 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) Reduce: 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 handling the labeling 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 with POCT?

14. POCT Informatic Tools Early to mid 1990?s Bench-top analyzers Touch screen PCs Results sent to central laboratory 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: Instant information Getting more data to the EMR Continuous glucose testing and monitoring Open IT standards RF and web-based communication and connectivity Optimum security

17. Emerging Trends in Point-of-Care and their Impact 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 and improve 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 Program from device to operator to patient to test order Federal initiative launched to reduce medical 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 Pharmacists Patients Careers Retail & Leisure centre staff Where? ICUs Operating theatres A&E Delivery Suites General wards Ambulances GP surgeries Pharmacies Field hospitals Retail & leisure centers

29. Purpose? Monitoring chronic disease (or acute disease in ICUs) Diagnosis, risk stratification Screening

30. EXAMPLES OF POC TESTS ? Blood gases: pH, pCO2 pO2 ? Na, K, Ca, Cl- ? Lactate ? Glucose ? HbA1c ? Urea, Creatinine ? Cholesterol, TGs ? BNP ? Troponin, CK-MB, Myoglobin


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 Indications Atrial fibrillation Heart Valve replacement Stroke

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) POCT Co-ordinator(s) Nurse Clinicians Information Technology Manager Medical Equipment Manager Accountant Pharmacist Risk / Safety Officer

43. Documentation

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 Electronic logs QC records

48. Training Who is trained? Nurses/Doctors Medical assistants Who does the training? Laboratory staff What is the content? Knowledge Practical skills National/International Occupational Standards

49. Certification Assessment of competence Written test Multiple choice questionnaire Direct observation Update training EQA Updates Self assessment Training records Certificates Central record

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 diagnostics? 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 foreseeable future. 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

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