Opinion

Emergency nurses can learn from trust’s implementation of point of care testing

Empowering healthcare staff to use point of care testing (POCT) is beneficial to staff and patients alike, and nurses could be involved in its delivery and implementation

Empowering healthcare staff to use point of care testing (POCT) is beneficial to staff and patients alike, and nurses could be involved in its delivery and implementation


Picture: Radiometer

Point of care testing (POCT) typically involves blood samples, with or near the patient, to provide the consulting clinician with rapid diagnostic capability.

In 2017-18, POCT for D-dimer was introduced to the ambulatory care unit (ACU) at Great Western Hospitals NHS Foundation Trust (GWH) in south west England to assess patients presenting with suspected deep vein thrombosis (DVT).

The community DVT service was closed with short notice and transferred to the ACU. The unit had no POCT D-dimer capability, so the service was developed by unit staff to meet the requirements of increased patient flow in an already busy unit.

The successful implementation was the catalyst for further POCT development in the unit and three main lessons were learned regarding effective POCT integration and implementation:

  • User engagement.
  • Collaboration. 
  • Use of a clinical pathway.

Effectiveness of point of care testing for urgent treatment centres

The NHS recognises the effectiveness of POCT and standard 12 of its Urgent Treatment Centres – Principles and Standards states all urgent treatment centres should have access to POCT which could include glucose, haemoglobin, D-dimer, electrolytes and troponin.

Emergency nurses may be involved with delivering POCT and could benefit from the lessons learned from implementing the practice at GWH.

User ownership of POCT for D-dimer and an open culture of team working contributed to the impact of the new POCT capability.

An intent-based leadership strategy (Marquet 2015) helped staff to feel valued and clearly understand the aims of the initial trial, empowering them to contribute to successful implementation. The King's Fund recognised the importance of an empowered workforce and control and decision-making were handed down to staff at all levels.

Staff were encouraged to take ownership of the POCT D-dimer kit, were trained to use it and were able to pass on skills to others. They were also involved in developing the clinical pathway for POCT.

Close collaborative working between ACU staff and the pathology team was important to the project’s success and the implementation of the new technology. Pathology staff worked with clinicians to develop their competence and confidence in using and maintaining the equipment.

Integrating POCT with clinical pathways

It is important that POCT for D-dimer has a specific aim in the pathway. Evidence-based clinical pathways, applied to a structured approach to care, have been found to decrease patient length of stay and costs, improve patient outcomes and provide a good level of patient experience and satisfaction.

If the POCT for D-dimer is used outside of a clinical pathway the result may not contribute to the overall clinical picture and it can be an expensive method of obtaining a result. In the pathway, it has a clear objective and acts as a decision-making tool.

The D-dimer test result does not change management of the patient but allows a clinician to make rapid and accurate decisions on treatment when used with the pathway. 

Nurses considering developing POCT services should focus on user engagement, collaboration with the pathology team and integration of a clinical pathway, the combination of which has enabled successful implementation at GWH.

References


Neal AplinNeal Aplin is advanced nurse practitioner in ambulatory care at Great Western Hospitals NHS Foundation Trust, Swindon

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