I think that while CPA does support labs' efforts to maintain high
standards in hospital POCT, they could help more by giving us more
leverage (via Trust Clinical Governance and Risk Management systems) for
use in those areas where compliance is poor.
The problem is that while the MDA/MHRA and the JWG Guidelines are
excellent, they are advice/guidance only and have no "teeth".
Compliance with good practice has to be achieved by education of
clinical users and managers plus a Trust Policy, since there is no
regulation by any national directives - the UK has less POCT regulation
than most other countries and seems unlikely to get any as long as the
DoH continues to back off issuing central directives and instead
promoting "local" initiatives.
I was going to refer to Graham Beastall's article in the RCPath
Bulletin, but I see he's just joined the discussion himself. Wayne's
reference to the CPA meeting indicated the concern of many there who
felt that there is inadequate regulation of quality in POCT; for
example, while there are many excellent pharmacist POCT schemes, there
are others which are far from excellent, hence fears that there are
disasters waiting to happen. Their professional advice is quite good,
but there is no obligation to comply - especially when, for example, the
purpose of QC and EQA is rarely understood (and hence they're often not
used).
CPA should certainly be involved (but not solely) in any accreditation
of POCT, but I'm sure that's a long way off. Ian is right - we need to
keep pushing our case. Many users still need convincing that POCT
operators need training and that the additional costs of QC and EQA are
worth incurring, let alone accreditation - which means that a lot more
education (and our time) is needed.
Dr MJ Pearson
Department of Clinical Biochemistry & Immunology
Old Medical School
Leeds General Infirmary (Leeds Teaching Hospitals NHS Trust)
LEEDS LS1 3EX
UK
tel (44)-113-392-3945
fax (44)-113 392-3453.
http://www.leedsteachinghospitals.com
>>> IAN WATSON <[log in to unmask]> 16/09/2005 14:22 >>>
Don't agree that CPA has not influenced hospital based POCT, in my
experience it has along with the MRHA guidance.
To cover POCT outwith the central lab, we need to accept that networks
should include the disseminated aspect of analysis and interpretation
and that we as professionals in this area are best place to deliver
this. There is no logical reason why patients should be exposed to
more
risk by ineptitude [a common POCT problem], but unless we push our
case............
Ian Watson
>>> "Taylor, Richard" <[log in to unmask]> 09/16/05 2:09 pm >>>
You got predictable answers, Wayne.
So, we have our labs regulated to the hilt internally, with nobody but
us
really interested or understanding the complexities, but as a
profession we
are failing to regulate, or 'build a service responsive to patients'
for
POCT in our own hospitals in clinical areas, where there is far less
regulation and consistency of practice, but a clear need.
The existing lab-centred CPA system has not even been a useful lever
to
influence POCT practice in our own hospitals. It could have been a
useful
adjunct to the leverage available through developments in Clinical
Governance. The present CPA scheme is not specific on POCT
requirements,
(with the implication that it is not important), which diminishes our
authority to change practice or argue for resources in our
organisations.
In response to Jonathan's question, a separate CPA scheme for
regulating
POCT on our hospital sites, community hospitals, DTCs and GP surgeries
would
be valuable step forward. It may as well be separate because the
practicalities are different from procedures within a laboratory. It
should
cover all POCT sites within and beyond the hospital, because the
practicalities are common between them. Maybe it should also provide
for
Clinical Biochemistry to have influence over the 'POCT that isn't
related to
Biochemistry'.
If we had such a CPA in operation, we would have a clear set of
criteria for
acceptable standards for POCT. It would be easier to introduce and
manage
better ways of doing POCT. As Jonathan points out, this would
obviously
involve working in partnership with nurses and other clinicians. We
would
have a higher profile, a clear, shared agenda with primary care
colleagues
and hopefully some more like-minded allies in primary care. We would
then be
in a better position to shape agendas for POCT in the high street.
Richard Taylor
Dr Richard Taylor
Consultant Clinical Scientist
Dept of Clinical Biochemistry
John Radcliffe Hospital
Oxford
OX3 9DU
tel 01865 220477
fax 01865 220348
> ----------
> From: Clinical biochemistry discussion list on behalf of
Wayne
> Bradbury
> Reply To: Wayne Bradbury
> Sent: Thursday, September 15, 2005 15:05 PM
> To: [log in to unmask]
> Subject: Re: PoCT EQA & CPA
>
> I asked the panel at the last CPA conference this very question.
>
> At the moment PoCT is usually linked to Biochemistry accreditation
> although much
> PoCT isn't related to Biochemistry.
> I made the point that there is a no incentive to tick the box on
their
> application
> form saying you are following the JWP guidelines on PoCT. If the
> inspectors find
> your PoCT is not up to scratch you could lose accreditation for the
> laboratory.
>
> At the moment CPA don't publish the number of labs which have
applied
> for
> PoCT accreditation. I suspect many labs like my own don't apply.
>
> Enrolment for laboratory accreditation is mandatory; but illogically
is
> not for PoCT.
>
> The CPA panel were unenthusiastic about a separate scheme - I
suspect
> because
> they are struggling to cope with the workload for just the
> laboratories.
>
> Wayne Bradbury
>
>
>
> Mr. W.H. Bradbury
> Consultant Biochemist
> Cumberland Infirmary
> CARLISLE
> CA2 7HY
>
> Telephone: 01228 814521
> Facsimilie: 01228 814831
> E-mail: [log in to unmask]
>
>
> >>> Jonathan Kay <[log in to unmask]> 15/09/05 12:02:57 >>>
> What are the arguments for and against a new CPA scheme that
assesses
>
> PoCT across an organisation such as a hospital or primary care
> organisation (not a laboratory)?
>
> I think it would be much better to have a specific scheme shaped
that
>
> way, rather than being laboratory-based, because
> 1 So many of the issues are about operators (who are mostly nurses)
> 2 Organisational ownership is often the factor which limits quality
> 3 Many of the issues are common across PoCT, but don't match
> traditional laboratory disciplines
>
> Jonathan
>
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