Given that many medical tests are nowadays rapidly performed at the patient’s bedside compared with tests that required sending samples to a laboratory and waiting for results, last month’s special issue of Point of Care: The Journal of Near-Patient Testing & Technology reveals that as more of these point-of-care testing (POCT) technologies are integrated into patient care, careful attention is required to protect patient safety and avoid medical errors.
The special issue contains invited editorials, research studies, and case reports that offer a broad overview of strategies professionals use in order to ensure the safe use of POCT.
The introductory article by James H. Nichols, PhD, Professor of pathology at Tufts University School of Medicine in Boston and medical director of clinical chemistry for Baystate Health in Springfield, Mass. states:
“While the theme is patient safety, each article is different and the authors were not constrained to one format or question, but free to express their concerns and perceptions around the theme of patient safety and medical errors.”
Point-of-care tests are more advanced and are gaining increasing popularity in wide spread use, as they allow health professionals to rapidly obtain common lab results either at or near patient’s bedside, or in their office. Laboratory managers, ‘POC coordinators” as well as other front line professionals who work to ensure a safe integration of POCT into clinical care have all contributed in this month’s special issue, which also contains descriptions of several articles on new technical advances in POCT, such as built-in quality controls and security measures to avoid likely sources of error. Even though at present only few formal guidelines exist, new technical standards are being developed and the U.S. Food and Drug Administration assess increasing numbers of POCT devices.
The special issue contains a wide range of key issues regarding the safe use of POCT, and also describes pitfalls that could potentially lead to medical errors. The report’s contributions point out the need for systematic approaches in terms of patient safety, patient identification, operator training, timely results and system alerts.
The special issue contains several articles with informative examples of errors that occurred as the implementation of POCT technology has become more widespread. One article describes that problems arose at one hospital unit with the introduction of a new test that used different values for abnormal results than the test used previously. Another case describes that generated reports indicated a system malfunction when it was in fact a busy technician who skipped routine control checks on POCT equipment.
Several of the articles refer to the importance of following quality control steps, and whilst some POCT units include built-in quality checks, others need to be done prior to testing each patient sample. However, despite of quality checks, errors potentially persist. According to one article POCT displayed a rate of almost 2% inaccurate patient identification on a routine point-of-care blood test, whilst another article points out the likelihood for “errors of omission” in cases when a health care professional is unavailable to make necessary care decisions in cases of abnormality POCT results.
Dr. Nichols calls for a risk management perspective on POCT in his editorial. In light of these tests being more susceptible to certain types of errors compared with traditional medical tests, he underlines the need for special attention in terms of quality control issues, operator training, as well as other steps to ensure that point-of-care tests are used appropriately and focus on safeguarding patient safety.
The editors of Point of Care aim to provide professionals with a valuable and thought-provoking resource when working to realize the benefits of POCT while protecting patient safety. According to Dr. Nichols:
“The collection is a testament to the many problems and risks that are managed by POCT programs each day, as well as the ingenious processes that manufacturers are developing to control risk.”
Written by Petra Rattue