Doris, MHRA are quite correct in their assumption.I and many others actively try to avoid anything that requires any sort of timing by the user, as they rarely stick to the times quoted.(The current strictures on infection control mean many nurses no longer wear a watch anyway and timers are non existent or go missing in record time.) Urine sticks are either read far too early, or the nurse goes off and comes back 10 minutes later and still reads the strip.I now have urine strip readers on every ward to get round this problem, and that of individual perception of colour on the pads.This of course, can only solve the problem if the nurse doesn't dip the urine then have a chat before placing it on the instrument table.The same applies to pregnancy tests, and I have now changed methods so that they are read on the instument too.
Drugs of abuse kits are open to similar abuse in timing, usually left sitting about for a while before reading. Despite training we still get the odd individual who has a "senior moment" and misreads them like pregnancy tests where the line is present for a positive, whereas drug kits tend to have an absence of a line as a positive.
Any kits requiring more complex timing, say of a two step process where they add the sample to tube A, and 5 minutes later add that to tube B, are a total recipe for disaster, and simply best avoided.A single step process is always the preferred method.Pipetting is also something that does not come naturally to nursing staff, and forgetting to put the tip on a pipette and filling the pipette with blood is not unknown.
With regards to training of medical staff - this is a huge problem. Ours are mainly on four month contracts so the logistics of training for them are immense - that's if they turn up when you have arranged training anyway.Password protection is another issue as they pass them around or stick barcodes on the underside of shelves and all use that to gain access to an analyser they have no training to use.
Training by companies does emphasise the need for correct timing, but then people will still think that an extra minute or two can't matter, can it?
Best wishes
Jan
Mrs. J. Still,
POCT Manager,
Biochemistry Dept,
Watford General Hospital. 01923-217998.
The views expressed in this message are personal and do not reflect West Herts NHS Hospitals Trust policy.
--- On Wed, 9/9/09, Doris-Ann Williams <[log in to unmask]> wrote:
> From: Doris-Ann Williams <[log in to unmask]>
> Subject: Timing of point of care tests
> To: [log in to unmask]
> Date: Wednesday, 9 September, 2009, 1:48 PM
>
>
>
>
>
> The MHRA have raised
> an issue with BIVDA relating to the timing by nurses of
> manual point of care
> tests such as dipsticks and lateral flow devices. It is
> believed that there is
> insufficient information in the instructions around the
> tolerance of the timing
> and this, combined with the nurses being busy, could
> lead to incorrect
> timings and potentially incorrect results. BIVDA is raising
> this with member
> companies as a potential issue but we also feel there
> should be awareness made
> in training of medical staff who do these tests around
> hospitals so am
> addressing this in particular to Point of Care
> Co-Ordinators. I'd also be keen
> to hear from anyone who has seen an issue of this
> type.
>
> Regards
> Doris-Ann
> Williams
> BIVDA
>
>
>
> ------ACB discussion List Information--------
> This is an open discussion list for the academic and
> clinical
> community working in clinical biochemistry.
> Please note, archived messages are public and can be viewed
> via the internet. Views expressed are those of the
> individual and
> they are responsible for all message content.
> ACB Web Site
> http://www.acb.org.uk
> List Archives
> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
> List Instructions (How to leave etc.)
> http://www.jiscmail.ac.uk/
>
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|