An interactive two-step training and management model of point-of-care glucose testing in northern Finland

What We Should Consider in Point of Care Blood Glucose Test; Current Quality Management Status of a Single Institution

Background and Objectives: Point of care test (POCT) is generally performed by non-laboratory staff who often lack an understanding on the quality control and quality assurance programs. The purpose of this study was to understand the current status of quality management of point of care (POC) blood glucose testing in a single institution where non-laboratory staff perform the tests. Materials and Methods: From July to August 2020, management status of glucometer, test strips, quality control (QC) materials, quality assurance program, and operators’ response to processing of displayed results was monitored in all Soonchunhyang University Bucheon hospital departments that performed POC blood glucose test. Results of the POC blood glucose test conducted from January 2019 to May 2020 were analyzed retrospectively. Results: A total 124 glucometers were monitored in 47 departments. Insufficient management of approximately 50% of blood sugar, test strips, and QC materials was observed. Although daily QC was conducted by 95.7% of the departments, the QC records were inaccurate. The method of recording test results varied with departments and operators. Various judgments and troubleshooting were performed on the unexpected or out of measurable range results, including some inappropriate processes. In POC blood glucose test results review, 4568 atypical results were identified from a total of 572,207 results. Conclusions: Sufficient training of the non-laboratory staff and ongoing assessment of competency through recertification is needed to maintain acceptable levels of POCT quality. In this study, various problems were identified in glucometer and reagent management, QC and post-analytic phase. We believe that these results provide meaningful basal information for planning effective operators’ training and competency evaluation, and the development of an efficient POCT quality management system.

Development and evaluation of point-of-care testing recertification with e-learning

One of the main requirements in point-of-care testing (POCT) is efficient operator training to avoid diagnostic errors. Considering a variety of users and time-independent learning, e-learning is preferred. However, in our experience, e-learning is not always accepted by employees. After using a commercial e-learning program with little success, we developed a specific e-learning offer to achieve a better acceptance of online-based training. Herein our goal was to identify the most relevant aspects for better acceptance. The new e-learning modules were implemented with the learning management system ILIAS and dealt with typical sources of error. The implementation was accompanied by an anonymous online questionnaire within the POCT operators examining differences between the acceptance of the commercial e-learning and the hospital-specific. The results show higher acceptance for clinic-specific e-learning whereby online training of the POCT operators could successfully established. Most relevant aspects are the relevance of contents for the personal work and the working processes within the clinic as well as processing time. Thereby, the recertification of the POCT operators based on the successful completion of the learning modules was fully integrated in the POCT process. In respect to the need for regular recertification of POCT operators, our study shows that the acceptance of e-learning could be improved by adapting e-learning modules to the specific workflows in the hospital.

Point-of-care glucose testing: on-site competency assessment

PURPOSE

The purpose of this pilot paper is to use on-site assessment to determine common non-compliance in point-of-care (POC) glucose testing, deficiencies that should be improved by the POC team or emphasized in further training.

DESIGN/METHODOLOGY/APPROACH

Assessment forms for POC site and staff competency were developed and used for direct observation in four POC sites. Nurses were sampled in these sites.

FINDINGS

The on-site assessment demonstrated that initial operator training was insufficient. Only three of 15 nurses achieved a satisfactory score on the first assessment. In all nine participants who had been assessed at least twice improved their performance. In total, 16 (30 percent) of 53 competency items were not achieved, so these should be addressed during refresher training. Improved compliance with the checklist was observed in two of four POC sites.

RESEARCH LIMITATIONS/IMPLICATIONS

Medical students and residents also perform the test, so more representative samples are needed.

PRACTICAL IMPLICATIONS

The assessment of staff performance in the workplace with constructive input and POC site inspections to identify common deficiencies are recommended. Refresher trainings should be focussed on the deficiencies identified.

SOCIAL IMPLICATIONS

Assessing staff performance in the workplace with constructive input and POC site inspections to identify common deficiencies are recommended. Refresher trainings should focus on deficiencies.

ORIGINALITY/VALUE

This study involved directly observing POC site staff during glucose testing. The assessment forms were based on ISO 22870:2006 technical requirements.