POC implementation: Do’s and dont’s report from Latin America by Guzmán and Gutiérrez

In this webinar delivered for the Roche Point of Care Academy, Dra. Karla Gutiérrez González and Dra. Lic. Anel Guzmán discuss how their hospitals implemented Point of Care Testing (POCT) for glucose monitoring and what they learned from the experience.

We hope it is a useful resource as you consider introducing POCT within your own clinical setting.

Point of Care Testing (POCT) within a hospital setting refers to ‘the procedures of laboratory medicine in the immediate vicinity of the patient/bedside’. POCT can be used for a faster turnaround of test results to support clinical decision-making and is usually performed by non-laboratory trained individuals.

In a webinar delivered for the Roche Point of Care Academy, Dra. Karla Gutiérrez González and Dra. Lic. Anel Guzmán outline how they implemented POCT at their respective hospitals and the lessons learned from the experience. We have summarized their key points below.

Clinica Biblica Hospital is a private hospital with 75 beds. Its laboratory covers both inpatient and outpatient testing. The hospital needed to improve Point of Care Testing for glucose because the current process wasn’t traceable.

The aims of the project:

• Meet the JCI standard (6th edition) and ISO22870
• Platform needed to correlate with the one installed in the lab
• Platform needed to be monitored by the lab
• Data needed to be digitized

Results:

The lab now has a data system that can follow up on all the results from patients. It also has more control over each instrument (how it is performing) and who is doing the testing.

Insights and lessons learned:

• Appoint a POCT committee and set up a protocol: You need to know how you’re going to proceed and who is going to do it.
• Proceed with a verification process that adapts to your needs: You need to be assured that the measurements taken at the bedside are the same as in the lab. The verification process used in this hospital was as follows:
  - Precision and veracity (EP15-A2 user verification of performance for precision and trueness, CLSI)
  - Linearity (Accu-Chek Linearity Test Kit®, Roche Diagnostics)
  - Correlation with the reference method (Cobas c501)
• Nurse department must be committed to the project: In this hospital, the nurses were used to using a smaller instrument. They also didn’t like the lab having more control over the testing itself. The hospital needed to demonstrate that the nurses were integral to the process and that it was for the benefit of the hospital.
• Communication between your IT department and the provider: So that the management of the data system works well. Without this, it’s like having a hole in the middle of the process.

HGPS is a private hospital with a non-profit board. It is a tertiary-level care hospital with approximately 300 beds. It has electronic health records, which is an advantage for patient management, as the hospital laboratory and radiology information systems are connected.

However, the following issues needed to be addressed:

• Medical staff ordered glucose monitoring in the patient’s electronic health record (on an evaluation form, rather than a laboratory entry form)
• Nurses had to check patient records because there was no alert system
• Materials for each test had to be drawn from the hospital’s pharmacy unit
• Results were manually registered by nurses using paper charting
  

Results:

Doctors can now order glucose monitoring and desired frequency as a lab test order entry in the patient EMR and nurses have a specific work view where every entry pops up and is organized by ward. The hospital enjoys bidirectional connectivity between POCT data management software and the laboratory information system/hospital information system.

Insights and lessons learned:

• Choose one test (or one device) to implement at a time: There is a wide POCT menu, which includes blood glucose, cardiac markers, blood gases, coagulation and infections – but it’s best to focus on one at a time.
• Tech specifications: Make sure you evaluate every specification of the device/software you are implementing. IT and healthcare teams often have their own language, so take the IT personnel "out of the computer" and into the field with you. Express your needs clearly, using non-technical language, and try out what they are suggesting before approving.
• Cost-effectiveness analysis: POCT can be more expensive than testing in a central laboratory and so a cost-effectiveness analysis must be completed.
• Set objective goals and implement a time/goal chart:
  - Identify key users and train them (in this hospital, they designated new positions – a lab POCT coordinator and nurse POCT coordinator)
  - Verify that everyone has IT access and what the workflow is
  - Try not to train personnel until everything is ready (otherwise, users will be trained on the wrong version)
  - Make sure things work, e.g., a verification test of the complete workflow with dummy patients
  - Make sure users have the contacts they need in case they encounter issues during implementation
  
• Constant monitoring in phase 1:
  - Make sure visual rapid guidelines for device uses are available
  - Ask coordinators to constantly monitor device status and use through the software
  - Ask coordinators to do rounds and generate weekly reports
  - Use the control options available in the device
• Constant monitoring in phase 2:
  - Develop a continuous training program with a minimum year-round frequency (so new personnel receive a minimum training program). You may wish to add this to your new personnel induction programs.
  - Ask key users to actively identify improvements.

Dra. Lic. Anel Guzmán concluded her presentation with these final considerations:

• POCT requires significant support from the laboratory to ensure the quality testing requirements
• Buy-in and support from top management is key
• Programs are most successful with multidisciplinary involvement and extensive, coordinated clinician education
• Take it to its maximum potential but follow your personnel/institution’s rhythm
• Take the experience and apply it to other POCT implementations