Setting up a POC testing workflow and Guidelines - Nisarat Opartkiattikul

In this informative webinar for the Roche Point of Care Academy, Prof. Nisarat shares her own experience of implementing a new POCT workflow and how her hospital’s journey to ISO22870 accreditation has influenced Thailand’s national guidelines. 

It started with an emergency

At the beginning of the webinar, Prof. Nisarat recounts a patient case from 2005. A 60-year-old male was admitted to the emergency room at Siriraj Hospital in a coma. According to the non-connected blood glucose meter, he was within the normal range.and was sent to get a CT scan. However, the blood sample results from the central lab revealed that his blood glucose levels were too low, indicating hypoglycaemia. The patient was then treated and regained consciousness.

Prof. Nisarat shares this story to highlight the motivation behind introducing a new POCT workflow. The reason for the big discrepancy was that the ER had been using expired strips. At the time the Clinical Chemistry department was not involved in the glucose testing done at the patient bedside.

Ten steps to making significant changes

From 2007-2019, the POCT processes at the hospital underwent a transformation, one that led to improved internal quality control and increased patient, nurse and doctor satisfaction. It’s a process that Prof. Nisarat consolidates into ten steps, which she explains in more detail in the webinar:

1. Situation analysis
2. Studying international standards (CAP/JCI regulations)
3. Performing a pilot
4. Establishing a POCT committee
5. Setting up policy & criteria for selection
6. Purchasing
7. Appointing POCT multidisciplinary team
8. Implementation 
9. Evaluation / Opportunities for improvement
10. ISO 22870 accreditation
    
     

Obtaining ISO 22870 accreditation

Siriraj Hospital received ISO 22870 accreditation in 2009. It was the first hospital in Southeast Asia to do so. This standard specifically refers to competency and quality in POCT and is intended to be used alongside ISO 15189 (the medical laboratories standard). You can find out more about the details of ISO 22870 here.

Beyond blood glucose monitoring

Today, if other departments want to set up POCT, there is a process that involves key stakeholders, a review of the benefits and a process for instrument selection. Once approved, there is a POCT office to manage instructions and training, plus a requirement for the department to submit annual reports.

Creating Thailand’s National POCT guidelines

After the transformation at Siriraj Hospital, Prof. Nisarat was invited, along with 17 other experts, to create the guidelines for Point of Care Testing in Thailand. 

Prof. Nisarat acknowledges that meeting the standards of ISO 22870 accreditation may be out of reach for many of the hospitals in Thailand. Therefore, the guidelines have been created to support all hospitals so that it is possible to improve and standardise POCT operations at a national level. You can learn more about the resulting guidelines towards the end of the webinar.