Plymouth Hospitals NHS Trust is among the first sites in the UK to achieve Clinical Pathology Accreditation (CPA) for Point of Care Testing (POCT). The accreditation covers both connected and non-connected elements of the POCT service at the main Derriford Hospital site in Plymouth and, for the first time, it also includes community hospitals, hospital clinics and external clinics served by the Trust.
The POCT service for Plymouth Hospitals NHS Trust has been in development since 2006. The POCT team currently includes a combination of biomedical scientists, associate practitioners and assistant technical officers dedicated to POCT and EQA. They provide a very supportive service that aims to help users achieve their care goals and with communication at the heart of everything they do.
Importance of CPA
CPA for POCT is an important indicator of quality, as Tony Cambridge, Section Lead for POCT and EQA at Plymouth Hospitals NHS Trust, explains. “The POCT service should provide the same quality of service as the clinical laboratory,” he says. “CPA is regarded as the benchmark for quality, giving users confidence in the service they are procuring. It also ensures that patient safety is optimised.”
“We felt it was essential to be in the first wave of NHS organisations to be accredited for POCT as this helped us to expand the POCT service into areas which previously had little or no governance, such as external sites (GPs, Primary Care Hospitals, Minor Injury Units, Health Centres),” Tony continues. “CPA is not mandatory but it has the potential to become essential in the future. It is hoped that the cost of the accreditation process will be offset against new POCT contracts that are gained through having the CPA stamp of approval.”
Scope of accreditation
The scope of the CPA for POCT at Plymouth Hospitals includes:
• blood glucose testing, using both connected (Roche Accu-Chek® Inform II) and non-connected (Roche Accu-Chek® Performa) meters
• urinalysis, including both automated/connected (Roche Urisys 1100®) and visual/non-connected (Roche Combur 7 test strips) reading of results
• urine pregnancy testing
• blood gas testing
• haemoglobin testing.
“We decided to include everything in the scope for accreditation, even the non-connected elements,” comments Tony. “I also believe we are the first accredited site to include POCT at outlying sites, both within the Trust and within Primary Care. Our success proves that accreditation is possible to achieve, providing there is sufficient governance and control around the entire service. It is important for the POCT team to engage with all users and to provide adequate training for them, whether they are based on-site or off-site.”
“A large part of our POCT service is connected,” he continues. “We have 40 Roche Accu-Chek Inform II meters which are wireless-enabled and connected to the Roche POCT data management software, cobas® IT 1000. It is hoped that, in the future, all POCT equipment from different manufacturers will be managed through one open access system such as cobas IT 1000.”
The accreditation process
The CPA process for POCT begins with a pre-assessment visit. This is a crucial stage to determine what work is still required.
“The pre-assessment is essential in providing a gap analysis prior to the full assessment,“ Tony explains. “Without key elements being present, such as an effective quality management system, CPA will not recommend the full assessment. The gap analysis provided a framework for us to work with, allowing us to concentrate on elements of the service that needed tweaking or further development.”
For the full assessment, the CPA assessing team visited various sites within the application, including the Royal Eye Infirmary, a community hospital ward and a minor injury unit. They audited both high and low usage areas to ensure that the same high quality of service was provided irrespective of demand.
The POCT team at Plymouth Hospitals received an excellent report from the CPA assessors, whose many positive comments included, “There is a dedicated POCT team who work with real enthusiasm and commitment. They have a good presence on the wards and have been very effective in gaining compliance from the staff of the Trust and remote sites. Their approach has been very supportive and they provide a fast, efficient troubleshooting service. There is an outstanding training and competency system for staff operating POCT equipment. The staff operating equipment in wards and clinics assessed demonstrated a good understanding of what was required in order to gain a valid result. ”
A major achievement
The Trust board at Plymouth Hospitals NHS Trust is delighted with the success of the POCT team in gaining CPA accreditation. One of the long term goals of the Trust is to promote their POCT services further afield; to engage more GPs and to demonstrate the importance of having a fully audited service.
"This is a major achievement for us,” says Tony. “These were new standards and for our POCT team to have performed so well is a credit to the whole team. The POCT team has always been a motivated workforce, genuinely enjoying their work, but having the CPA assessment to focus on gave us new drive to come up with inventive ways of working. Achieving accreditation has validated the hard work that they put in day to day.”
“This will be one of the first CPA accreditation successes for POCT in the UK, and the only one in the South,” he adds. “It is expected that this stamp of approval will ensure that we remain at the forefront of point of care provision within the South West Peninsula and beyond.”
“The main thing I would advise others,” Tony concludes, “is to have a dedicated POCT team based on the size of the service they want to provide. Many hospitals share POCT staff with other pathology areas. Ensure that management is in full support of POCT and develop a long term plan with them. This will ensure they remain engaged with the process. I would advise that a quality management system (QMS) is in place before applying for a pre-assessment. A full audit programme is essential and an effective Governance Group needs to be active to address any failures. If this is not in place CPA are unlikely to recommend the full assessment.”