POINT OF CARE TESTING (POCTS): THE IMPORTANCE OF CRITICAL PROBLEMS REPORTING

BACKGROUND: POCTs encompass a range of testing and most hospitals use POCTs to deliver results in a timely manner allowing quick clinical decisions and, potentially, a better clinical outcome. Consequently, POCTs demand the need for robust governance and quality assurance procedures are required to guarantee the reliability of POCTs results. METHODS: The Laboratory records all information about critical problems (ICP) notified by clinical wards and identified from data transmitted in real time by middleware. In this work we counted all ICP collected in March and November, from 2009 to 2013, and we reported the average of two months. The aim of this work is to analyse the collected data and verify if corrective actions undertaken have been effective. RESULTS: The number of POCT instruments increased from 126 (2009) to 168 (2013). The ICP typology concerns: in- strumentations failures (INS), 25%; non conformities (NC), 25%; failures in Internal Quality Control performances (IQC- F), 39%; calibration problems, 7%; others, 4%. 70% of ICP concerns 168 Blood gas analyzers (BG), 27% from 309 glucose meters (GM) and 3% from 236 coagulometers (CM). The ICP number related to BG decreased from 44 (2010) to 21.5 (2013): IQC-F, 53%; NC, 20%; INS, 17%; others, 10%. The main problem of IQC-F concerns a continuous decreasing of concentrations of lactate at a low level (87%). Nevertheless, the ICP number is decreased: from 15 (2010) to 4.5 (2013). The number of ICP related to GM highlights a variable trend over time: 12 (2009); 17 (2010); 23 (2011); 6 (2012); 11 (2013). The main problems are INS (37%) and NC (34%) that showed an increasing from 2009 to 2011, followed by a decreasing in the last two years (from 11.5 and 15, in 2011, to 0.5 and 6, in 2013 respectively). CM data are not reported for the low percentage. CONCLUSIONS: The results demonstrate an improvement of POCTs management and the effectiveness of implemented corrective actions. The main implemented actions suggested by laboratory have been the BG electrode replacement, when the performance of IQC starts to decline, and the change of GM with new and more efficient analyzers (after 2011). The continuous monitoring of POCTs problems is an efficient tool for directing the laboratory interventions to the critical issues.