>David Williams wrote:
>"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.."
We introduced a policy for Dipstick urinalysis in 1996 testing following a
trust-wide Audit in 1995 (presented in part at one of the Grasmere
meetings). We had introduced a general NPT policy in 1994 but there was some
scepticism in Clinical Policy Group as to whether similar rigour was
required in urine dipstick testing procedure (how could it possibly go
wrong?). We suggested an audit and came up with the following standards: 1.
Reagent strips are used correctly (such that performance meets the
manufacturer's stated recommendations) in 95% of cases. 2. Documentation is
adequate to ensure accurate reporting of results and to provide material
suitable for Clinical Audit. 3. Health and Safety Regulations are followed
during the performance of routine testing in 100% of cases. 4. Positive
steps are taken to ensure appropriate follow-up of abnormal test results in
95% of cases. The audit included testing site visits and observation of
practice, collection and laboratory retesting of samples from outpatients, a
case note audit and clinician questionnaire.
The resulting document was of the SHOCK, HORROR, PROBE! variety. I won't
go into details for fear of being boiled in my own lard by the men in grey
suits, save to say that none of the standards were met (not ever close!) and
our proposal of Dipstick urinalysis policy was unanimously accepted by our
Clinical Policy Group. One problem particularly worthy of mention was the
wide variety of different strips in use, many with far too many worthless
pads, which contributed to strips being read incorrectly of before full
colour development (false negative rates of up to 54% in one high volume OPD
location). Note that dipstick urinalysis is frequently undertaken by the
most junior nursing assistants. We have now standardised on a single 4-pad
strip which is distributed exclusively by the laboratory. As a result of the
policy being adopted we have had Trust-wide training, certification and
retraining, standardised documentation and a laboratory run QA scheme
(distributed monthly) for the past 4 years, across 61 testing sites hospital
sites (+23 in the community) all supervised by our NPT Co-ordinator (an
MLSO3).
Yes to all of David Williams concluding questions.
*************************************
Dr RDG Neely
Department of Clinical Biochemistry
North Durham Healthcare NHS Trust
Dryburn Hospital
Durham DH1 5TW
Tel. 0191 3332440 Fax. 0191 3332679
*************************************
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|