Apologies for delay in posting this - responses came in for quite a
while, so I waited, then found that the amount of information was very
complex to analyse!
There were 29 responses (including Leeds) - many thanks. Not everyone
responded to every question, and the variety of staffing arrangements
(every one different) makes it very difficult to draw general
conclusions, but I'll try, and anyone who would like more detail about
anything should let me know and I'll attempt to extract it.
(NB: Annette Thomas is preparing a POCT questionnaire which will be
much more comprehensive than mine, and undoubtedly better thought out,
so more POCT information will be on the way from that).
* POCT Group/Committee?:
YES: 22, NO (but tried): 1, IN PROGRESS: 3, QUESTION NOT ANSWERED:
3
* POCT Coordinator/Manager?:
YES: 23, NO 2. Others are writing business cases to appoint one, or
gave no specific reply
Of the YESes, many were part-time, with other departmental
responsibilities.
12 were A4C band 7, but those actively involved in managing POCT may
also be 8a, b or c (mainly clinical scientists, and mainly in large
multi-site hospitals. These mostly have other responsibilities, being
up to 0.9 wte in POCT).
3 large or fragmented sites mentioned having >1 coordinator, but not
all of these were full time.
* Dedicated POCT staff (other than coordinator.manager)?
10 mentioned these, every one different, with most being part-time
(other departmental responsibilities). These staff could be senior
clinical biochemists, BMS 1& 2, MTOs, or MLAs (bands 3-7).
One respondent mentioned that clinical engineers looked after the blood
gas analysers.
* POCT staff who rotate OUT or other lab staff rotating IN
7 mentioned this - very variable, from band 2 to band 7 and mostly with
notional part-time allocation which may not happen because of pressure
elsewhere. The question is probably not applicable to most people, as
it is clear that much support is not only highly variable, but is
provided out of goodwill and a concern for POCT quality, which rarely
get much interest from the Trust in terms of resources provided/posts
approved. There were some comments that some lab staff are keen to be
more involved in POCT.
* Line management
I asked this only as a supplementary question. Line management may by
via BMSs or clinical scientists, usually within Biochemistry, but one
respondent's line management arrangements were to the Pathology
Directorate, which makes sense when there is increasing haematology and
microbiology POCT.
* Trainee biochemists in POCT?
9 said YES, with variable involvement, 1 is about to start involving
them, 3 said NO, with 1 commenting that it was a good idea. Several
others do not have trainees.
* Equipment managed
One respondent commented on the continuing difficulties of getting any
interest from clinical areas in lab involvement in POCT
Glucose meters were unsurprisingly the main system supported, varying
from 30 to 450 meters - many systems networked
Blood gas analysers were also almost universally supported, 2 - 28 per
organisation. Some mentioned that Medical Physics/Biomed engineering
(etc) supported their blood gas analysers.
One respondent mentioned 55 i-STATs, supported by clinical engineering,
implying that there were no conventional blood gas analysers.
Mentioned by most:
Urine meters: 2 to 60
Mentioned by some:
HbA1c: 1 - 6 per organisation
bilirubin meters: 1 - 3
i-STATs: 1 - 5 (in addition to those mentioned above)
urine pregnancy testing, up to 16
2 respondents each:
DOA screening, Co-oximetry
1 respondent each:
FOB (31), O2 sat (1), Intraoperative PTH (1), TnT/myoglobin (4), urine
osm (1), cholesterol (1), breath alcohol (1)
Haematology tests (mentioned by several):
ACT, FBC, TEG, Hb, INR. (Hemocue also mentioned by several, but this
could also be for glucose)
Microbiology (1 site):
HIV, RSV, Influenza A & B
* Duties/ responsibilities
I didn't specifically ask for these, but some respondents have detailed
job descriptions for POCT Coordinators/Managers. The range of duties
will be of no surprise to anyone - equipment maintenance,
troubleshooting, managing EQA schemes and user training being the main
things mentioned. Several mentioned involvement with community POCT -
GP practices, directly or via PCT, plus one respondent mentioning
pharmacies, prison, dentists, nursing homes (I'm sure Jan won't mind me
mentioning that this is her impressively comprehensive service, in its
enterprise, if not vast numbers).
My main conclusions are
* that POCT management is being provided remarkably comprehensively by
many biochemistry departments (and a small number by pathology as a
whole) despite great difficulties with staffing. Of course staffing
pressures exist across the whole laboratory service, but since POCT is
being done very visibly around our hospitals and in the community, we
might reasonably expect more understanding by Trusts of the importance
of managing it properly, and therefore resourcing it.
* that as a result, the way POCT support is staffed is highly variable
* that more support should be provided for haematology and microbiology
POCT. Only a minority of Trusts provide as comprehensive support for
these as for biochemistry systems
Annette Thomas' presentation on Accreditation and POCT (ACB Regional
Meeting, Harrogate) last week indicated that ISO 22870:2006 and ISO
15189 mean that the governing body of the organisation is ultimately
responsible for ensuring that measures are in place to monitor the
accuracy and quality of POCT conducted within the organisation.
This sounds like good news. Perhaps we should all push our Trusts to
work towards CPA accreditation of POCT, or must we rely on the implied
threat of litigation to push this for us? Some of us already use POCT
"Horror Stories" to great effect in our user training!
Many thanks again to all who replied.
Joan
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)-[0]113-392-3945
fax (44)-[0]113 392-3453.
http://www.leedsth.nhs.uk
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