Setting up a POC testing workflow and Guidelines - Nisarat Opartkiattikul

Prof. Nisarat Opartkiattikul
Implementing a Point of Care Testing (POCT) workflow in Thailand

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.

The views and opinions expressed in this webinar are those of the speakers and do not necessarily reflect the views or positions of Roche or any other sponsors.


Prof. Nisarat is Chairperson of the Siriraj Institutional Review Board and was formerly Head of the Department of Clinical Pathology at Siriraj Hospital. She has held various positions as chairperson for national and international committees in pathology, with an interest in point of care. She has published over 90 national and international papers in clinical pathology and lab quality improvement.

Key points
  • Implementing a POCT workflow under supervision of the laboratory has the potential to save time and costly diagnostic tools (for example the CT scan)
  • It is important to fully understand the existing issues before trying to implement a new workflow and this includes being aware of international standards
  • Training is crucial and has a significant impact on results
  • Devices should be compared for precision and accuracy, and support connection to IT
  • Key success factors: Good standards, good technology, good personnel, good communication and collaboration
Further reading