The Management of POCT Competencies from a Nursing Perspective

Point-of-Care Testing (POCT) relates to an alternative to core laboratory testing. It is an option for conducting laboratory testing closer to the patients – such as an emergency room, IC unit, operating room, physician’s office, or an ambulatory care clinic.

The popularity of POCT continues to increase, and the options for methods and devices continue to expand. Employing POCT has several advantages that aid in increasing the efficiency of services. POCT offers results within minutes as opposed to hours, and at the same time can improve patient outcomes.

These tests do more with less sample volume than tests performed in the laboratory. The devices used are more compact, require less blood, and have electronic information management. 

Challenges with the use of POCT

Variations in the testing environment and conditions, however, affect the validity of laboratory testing outside the laboratory.

Another challenge is that the technical and operational factors will always be a major contributor to the quality and accuracy of POCT analysis. In other words, the competency of the nurses performing the tests can influence the validity of the results.

A great number of these nurses and other staff who perform POCT do not have essential training as laboratory staff. They also possibly have little knowledge about the required processes involved in testing. These processes include patient preparation, collecting and retrieving samples, calibration and maintenance of instruments, quality assurance, interpretation of results and documentation for the patient’s distinct context.

These nurses and staff need to be regularly trained and gain adequate experience to ensure test results are accurate and reliable. 

Adverse Effects and Competencies of POCT

Since POCT offers quicker results, there is the possibility of inaccuracy and difficulty performing/documenting controls and calibrations. This is because the technical training of the nurses may not be comparable to traditional laboratory staff in a central laboratory.

While point-of-care testing presents the possibility for improved care, realizing beneficial results depend on the balance of quality and clinical need. Both of these are centered on the nurses’ competence. The convenience of POCT too often results in poor quality and over-utilization that raise the cost of care.

Point of care testing as a remote expansion of the laboratory produces medical information that leads to clinical action. When the device is used inappropriately, incorrect results are produced. Further diagnostic intervention can result in increased healthcare costs and risks to the patient.

Management of Point-of-Care Testing

Managing the state of POCT requires an interdisciplinary team approach. Since the testing is performed on the medical unit by the nurses with immediate interpretation, the laboratory must ensure test quality through the clinicians.

The potential of point-of-care testing for faster test results does not fundamentally assure improved patient outcomes. Only through the participation of the laboratory on interdisciplinary management teams can the utilization of POCT be optimized for patient benefit.

A major function of the interdisciplinary committee will be to choose appropriate POCT technologies that will match the needs of various patient populations. While the use of a single device may be the easiest means of managing POCT, technical limitations may exclude a given method from wide adoption.

Many formal and professionally based standards and guidelines for POCT abound. They outline the best way to implement, manage, check and maintain the performance quality of POCT. Most professionally based guidelines follow a similar approach and provide similar information. This usually includes specific references to staff training and competency assessment.

What constitutes competency and its assessment are critical when discussing POCT, as those definitions will be gathered from the agencies auditing a POCT program. The founding of a POCT quality assurance program requires an appreciation of clinical need, and expertise in the technical aspects of POCT devices. Above all, it requires the willingness work on an interdisciplinary healthcare team. 

The Management of POCT Competencies

For POCT, nurses’ performances are dependent on motivation, technical competency, and the complexity of the testing device. The Quality assurance of POCT considers both analytical effects on the device and ensures that the nurses consistently interact with the devices.

Initial training should be standardized so that the same information is delivered identically. This can be accomplished through the use of training checklists, written procedures, demonstrations, electronic tools, and even videotapes.  Nothing, however, compares to a validation of the actual performance of the nurse both before initial use and at frequent ongoing intervals. This is to ensure the same level of performance over time.

Also, agencies such as the Joint Commission ensure that documented procedures for POCT exist, appropriate quality control is performed, and the nurses have specific training on the devices. They also check that the ongoing nurses’ competency is documented. Additionally, a result trail can be built linking the test result to the nurse (and their training) and the device (and quality control performed on that device).

More guidelines for more complex POCT require on-site laboratory guidance, validation of devices, daily sign-off of patient results, and inclusion in institutional policies. This is for performance improvement, leadership, human resources, and management of information.

In summary, Point-of-care testing allows the potential for instant test results and corrective action. However, simply offering POCT on a medical unit does not assure a beneficial patient outcome. Delays in physician acknowledgment, over-utilization of POCT, and inconsistencies in quality can increase healthcare costs and risks to the patient.

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