PATIENT SAFETY

Plan for Quality to Improve Patient Safety at the Point of Care

Plan for Quality to Improve Patient Safety at the Point of Care

Introduction

Every day our lives are bombarded with "things happening." Most-volcanoes, earthquakes, hurricanes, fires-are acts of nature and beyond our control. "Things happen" in healthcare as well. In 2000, the U.S. Institute of Medicine reported that as many as 98,000 people die in UnitedStates hospitals every year as a consequence of avoidable remedial mistakes. This report alerted the public and the medical community and focused attention on ways to improve quality and eliminate medical errors to ensure patient safety. In spite of efforts to do away with these errors, errors are still widespread. More recent studies report that as much as 45 percent of every dollar spent on U.S. health care is related to medical mistakes and that some kind of mistake or adverse event occurs in one-third of all hospital admissions. The key phrases in these reports are "mistakes" and "preventable medical errors," which means solutions can be found and implemented.

Point-of-care testing (POCT)

Point of care testing (POCT) is defined as any testing that is conducted outside the central clinical laboratory and near the patient. The popularity of POCT keeps increasing and is based on the supposition that experiment outputs on hand in a incredibly little timeframe help caregivers with instant verdicts and/or medical interference to advantage patient outcomes. Errors can occur anywhere in the entire POCT process, from deciding to order a test (pre-pre-analytical), to ordering and collecting a patient sample, through the analytical process, to reporting and finally acting appropriately on the result (post-post-analytical). Patient safety potentially can be compromised whenever there is a disruption in achieving all of the necessary "correct" quality criteria throughout the process-correct test order, correct patient, and correct specimen collected at the correct time, correct test result, correct patient record, and correct clinical interpretation leading to the correct and timely clinical response (Kohn, 2000).

Plebani et al and others described the frequency of errors in the three phases of the total testing process. The most cited POCT deficiencies impacting the analytical phase include failure to perform and document quality control, follow the procedure and manufacturers' directions, perform and document personnel training and ongoing capability, acquire suitable remedial actions, verify accuracy of analytes tested, and document results in the patient record (Plebani 1997, 1348). Meier and Jones, in their seminal papers, identified three basic sources of POCT error-operator incompetence, not following protocols and uncontrolled reagents and equipment, and also suggested that wherever POCT errors occur, the effects of these errors are amplified by incoherent or no regulation, the availability of rapid test results often reported without appropriate quality checks, and immediate therapeutic decisions and treatment based on these rapid results. "Amplifiers" as used by these authors are factors, which increase both the frequency and magnitude of the errors. Numerous articles that include extensive references enumerate examples of POCT errors (Downer 2005, 1).

Planning for Quality

POCT is an ever increasing and significant component ...