The quality of any point-of-care (POC) testing service depends on the abilities of the individual in charge, and choosing the correct person for the position of POC coordinator is a challenging but crucial venture. The first challenge is to convince administrators—of a hospital or hospital system, for example—that there is a real need to have a dedicated employee in this role.
Selling to the suits
Tallying the time that is “wasted” in the course of coordinating POC activities can be difficult, because it occurs in a few minutes here and a few minutes there, and when there is no single POC leader, it can be divided among several people, as a sort of unmeasured and unacknowledged drain. For example, time lost when staff goes to a unit to meet a nurse manager who “was around a moment ago,” or was pulled into another meeting can slowly add up. Site visits can also eat up a lot of time; driving to the sites, parking, walking, and waiting are all components that should be taken into account when figuring out the true workload that POC involves and implementing effective quality assurance in a POC testing service. Corrective actions for failed proficiency tests that involve tracking down the nurse/respiratory care practitioner or other healthcare worker who performed the test but who may be working on a different unit or shift can be time-consuming and require persistence and focus. Communicating with technical support is another activity that uses time that is often not accounted for.
Organizations that have a dedicated person in the position of POC coordinator are better able to keep on top of all these issues and to identify time drains and develop strategies to combat them. That is an important point to make when proposing to hospital administration that such a person be hired, either on a full or part-time basis, depending on the size of the facility and available funds.
Finding the right person
Once the need for a coordinator who will have regulatory and clinical oversight of the POC program has been demonstrated and approval has been granted, however, a possibly greater challenge remains. Candidates with the correct qualifications can be found; clinical laboratory professionals are usually the candidates of choice, as they have the academic qualifications and appropriate laboratory testing experience. But not all of them will be right for this job. Selecting a candidate with the correct personality and aptitude is crucial, and those are qualities that can be more difficult to gauge. Candidates need to have the “people-skills” that are vital to this position.
Because POC testing is generally CLIA-waived, it can be performed by a wide variety of staff, some of whom may have limited laboratory experience. Some POC testers need to be educated with regard to errors that can occur in the pre-analytical, analytical, and post-analytical stages of the testing process. Some need to be taught the rudiments of quality control. The ability to teach such things to a variety of staff is therefore an essential part of a POC coordinator’s job, as part of his or her responsibility is to ensure that POC testing is done correctly. The ability to tactfully correct workers is essential. Accessibility and face-to-face meetings (for example, as a follow-up to e-mails that are sent to the charge nurse or individual staff member) are important in ensuring continued compliance.
Another indispensable attribute of an effective POC coordinator is the ability to prioritize and problem-solve. This mindset is invaluable because problems come in many forms, and the POC coordinator has to effectively prioritize and then solve them almost daily.
For example, the middleware used with POC instruments to connect them to laboratory information systems not only facilitate the transfer of results electronically but have useful data management tools. If personnel do not know how to use them to their full potential, that can create the potential for noncompliance issues. Thus the POC coordinator must learn these new areas of informatics via a request to a vendor or appropriate departments for training. A person who cannot prioritize might leave this important aspect of the job to the last minute, which is never a good practice.
Other examples of problem-solving include working with both vendor information technology (IT) and hospital IT in resolving connectivity issues; researching scientific literature regarding a particular test requested by a clinician; identifying what needs to be done from a regulatory perspective to verify a new test and keep the POC testing service in compliance with regulatory laws; troubleshooting inconsistent quality controls; working with other departments to put processes in place to ensure compliance with written protocols; and re-evaluating protocols to ensure significance—among many others.
POC coordinators work in an environment where they control their own time. They need to be responsible and self-motivating, and to be up to the requirements of all of their tasks. Checking and comparing lot numbers on kits and controls with the numbers written in quality control logs, for instance, can be tedious, but it is necessary. Good coordinators have the “whatever it takes” mindset.
POC testing is a rapidly changing and expanding field. As technology improves and costs decline, it is not difficult to imagine a future in which routine tests are performed at the point of care and only esoteric tests are performed in the central core laboratory. POC coordinators are at the interface of the laboratory and the rest of the healthcare system, and their unique and important role may become even more central to healthcare delivery in coming years.
Adil I. Khan, MSc, PhD, is an Assistant Professor in the Department of Pathology and Laboratory Medicine, Temple University Lewis Katz School of Medicine. He also serves as Director, Point of Care Testing and Clinical Chemistry, Temple University Health System.