Dear Dave

The sentence of mine you quote is a little out of context and does seem to me
to suggest I was rather hostile to the CPA. That certainly isn't the case. It
would be a little ungracious (particularly since the CPA has just awarded our
lab accreditation, albeit of a conditional nature). Keep up the good work!

The other implication of your reply was of some confusion on my part, i.e. not
reading your e-mail properly. That was not the case either. You original message
contained:
"But I have been just asked what is CPA's position regarding 'stick' testing
that is not associated with instrumentation."
I was merely trying to make clear (perhaps clumsily), as one of the earlier
respondents and particularly to our non-UK colleagues, that I was not myself
replying on behalf of the CPA.

That said, if you were speaking on behalf of the CPA why didn't you say so? If
people identify that they are speaking in a certain capacity rather than as
individuals,  I imagine it can only help those, particularly overseas, who are
less familiar with the somewhat parochial status of UK participants and their
organisations. (It could also just occasionally avoid the rest of us upsetting
someone really very important!)

As far as your eliciting views of participants, I think my brief note attempted
to give a view, identifying the roles of clinical governance and audit. These
points have been expanded on more fully and eloquently by others, so hopefully
you have found it a useful exercise so far.

If I can humbly express one more opinion, in light of others' comments that
generally I agree with. We are in a bit of a "chicken and egg" situation here.
Doug Hirst hit the nail on the head by asking whether there are any standards
for this area. To date as far as I know no one has replied to cite any. Apart
from cases of trying to rectify glaring misuse, as described by Phil, we
strictly speaking need standards of good practice first. We can then use these
to audit local practice and then introduce guidelines to try to influence
practice as appropriate.

The CPA recommendations, rightly or wrongly, act as de facto standards in this
country. One has only to consider the history of POC blood glucose monitoring,
as was also pointed out.  As soon as CPA made QA schemes a recommendation, and
by implication a condition of accreditation, those in laboratories who
previously didn't want to know suddenly appeared very enthusiastic about our
involvement. To be fair the ACB and sister organisations also  issued guidelines
at about that time.

We are now in the same situation regarding urine strip testing. We need
standards either from the CPA or from our professional bodies, or both. (For all
I know this may be already in progress or even in existence, if so sorry,
sorry!). The standards will then enable us  to convince through audit those who
control hospital purse strings and other doubters that setting up QA is not too
boring, irrelevant and costly. If CPA is waiting for ordinary professionals to
tell them what guidelines CPA should issue, it seems to me we will get in a
vicious circle and will have a long wait, since we don't yet have the standards
ourselves to advise CPA about (unless the ACB and/or sister organizations take
the lead instead of CPA).

I am surprised that you seem to imply that CPA has yet to formulate a firm view
on our role with regard to urine strip testing. After all, urine strip testing
pre-dates near patient monitoring for blood glucose and probably ward based
blood gas analysis (unless anyone has any memories to the contrary), and you do
police those areas effectively.  I fear that by not explicitly stipulating that
action by labs is necessary regarding urine strip testing, CPA is signaling
that we should not be active in this area at present. That being the case, pilot
studies are likely to remain damp squibs for the moment.

Regards

Steve

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David Williams wrote:

> Dear Stephen (and others),
>
> Many thanks for your reply(s). You say that "CPA will wish to speak for
> itself".
>
> Perhaps I didn't make it clear that the question was asked by me on behalf
> of CPA.  CPA sometimes has to make decisions from scratch and therefore
> needs advice from the profession to get some idea of the views around.  This
> was the point of the request for advice.  We need to develop our policy on
> point of care testing and one of the suggestions that has been made to us is
> that of ensuring that in hospitals urine stick testing is treated in the
> same way as, for instance, blood gas analysers in the intensive care unit.
>
> Is it a responsibility that laboratory departments can take on?  Is it
> something that is valuable to do?  Do Hospitals recognise the activity as
> one which if uncontrolled may cause clinical errors?  and if so are they
> willing to fund a mechanism for making it accreditable?  These are the
> issues that my CPA committee must discuss before we decide one way or
> another whether to include these "analyses" in the spectrum of near-patient
> testing activities that we ask our inspectors to investigate..
>
> Cheers,
>
> David.