Many medical tests that once required sending samples to a laboratory and waiting for results can now be rapidly performed at the patient's bedside. As these point-of-care testing (POCT) technologies are increasingly integrated into patient care, careful attention is needed to protect patient safety and avoid medical errors, according to this month's special issue of Point of Care: The Journal of Near-Patient Testing & Technology. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Consisting of invited editorials, research studies, and case reports, the special issue of Point of Care provides a broad-ranging overview of how professionals are working to ensure the safe use of POCT. "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," according to an 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.

As POCT Becomes Routine, Special Attention Needed to Patient Safety

Point-of-care tests allowing common lab results to be rapidly obtained at or near the bedside or in the doctor's office are becoming increasingly sophisticated and widely used. The special issue presents contributions from laboratory managers, "POC coordinators," and other professionals on the front lines who are working to ensure that POCT is safely integrated into clinical care.

Several articles describe new technical advances in POCT, including built-in quality controls and safeguards to avoid potential sources of error. Although there are currently few formal guidelines, new technical standards are being developed and POCT devices are drawing increased scrutiny from the U.S. Food and Drug Administration.

The special issue addresses a wide range of key issues in the safe use of POCT, including pitfalls with the potential to lead to medical errors. Contributions highlight the need for systematic approaches to patient safety, including patient identification, timely results, system alerts, and operator training.

Several articles provide informative examples of errors that have arisen with widespread implementation of POCT technology. For example, at one hospital unit, problems arose when a new test was introduced that used different values for abnormal results than the previously used test.

In another case, a busy technician was omitting routine control checks on POCT equipment thus generating reports suggesting a system malfunction. Several of the articles highlight the importance of following quality control steps. Some POCT units include built-in quality checks, in some cases run before each patient sample is tested.

And yet, the potential for errors persists. One article finds nearly a two percent rate of inaccurate patient identification on a routine point-of-care blood test. Another highlights the potential for "errors of omission" when a health care professional isn't available to make necessary care decisions in case of abnormality POCT results.

In his editorial, Dr Nichols calls for a risk management perspective on POCT. Since these tests are more prone to certain types of errors than traditional medical tests, he emphasizes the need for special attention to quality control, operator training, and other steps to ensure that point-of-care tests are used appropriately, with a focus on safeguarding patient safety.