We also banned visual reading in this Trust many years ago following the attached Audit and insist on meter reading. The Multistsix which we use are more susceptible to visual reading errors than the Roche ones as they are more time critical. The audit was done many years ago, and one of the things I remember when speaking to the staff was that the nurses doing the test said they did not bother too much as the Doctors took no notice of the results and the Doctors said they did not take any notice of the results as the nurses did not do them properly!
I also observed that they visually read the strips in the sluice took a mental note of the results, walked back to the patients notes then wrote down what they had remembered, this was for 8 parameters!
I also got quite a lot of resistance to the meters as they read all the results at 60 seconds and they thought it took too long, although they should have been allowing 120 seconds for visual reading of the leucocytes.
For anyone who does not have a POCT manager/coordinator, try an audit of visual reading and see if anyone is needed to improve the situation and reduce the waste of resources in producing suspect results.
Tim.
Tim Hogan
Laboratory Manager
Clinical Biochemistry
Basildon and Thurrock University Hospitals
NHS Foundation Trust
0845 155 3111 Ext 3036
[log in to unmask]
www.basildonandthurrock.nhs.uk
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of IAN WATSON
Sent: 10 September 2009 12:56
To: [log in to unmask]
Subject: Re: Timing of point of care tests
Doris, I agree with Jan. There are significant governance issues in POCT and manually read devices. Not only should strips be read on meters, but for preference these should be linked to the a computer system e.g. LIMS, PAS etc for continuity of records and audit trails.
Ian
Dr Ian D Watson
Consultant Biochemist & Toxicologist
Dept Clinical Biochemistry
University Hospital Aintree
Lower Lane
Liverpool
L9 7AL
Tel +44 151 529 3575
Fax +44 151 529 3310
Fundamentals of Analytical Toxicology recently published:
http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470319356.html
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Janice Still
Sent: 10 September 2009 10:39
To: [log in to unmask]
Subject: Re: Timing of point of care tests
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
>
>
>
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