Peer Evaluation Assessment and PowerPoint Presentation

Running head: THESIS DRAFT 0

Thesis Draft

Katelyn B. Rhodes

D40375299

DeVry University

Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).

Historic Timeline

In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.

Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more portable and laptops were used to collect test data for the instrument (Valorz, n.d.).

Since the late 1990’s, point-of-care testing technology has grown even more portable and has a greater ease-of-use. The testing instruments are still hand-held, but now do not require the addition of a separate computing system to collect results. Patient medical records are now predominantly electronic and laboratories use sophisticated laboratory information system (LIS) software to record, manage, and store data. Test information for a given patient can now go directly from the testing device to their electronic file (Henricks, 2012).

As time goes on, it is expected that point-of-care testing devices will utilize more sophisticated testing methods to expand the range of tests available. Furthermore, the mobility and expanding test menu will make it possible to bring the clinical diagnostic laboratory to those in developing countries.

Cultural

Global changes in the economic and social environments are creating a strong need for changes in health care delivery worldwide. Point-of-care testing has the potential to make clinical diagnostic testing more accessible to a large population, including those in developing countries. The laboratory infrastructure in developing countries has been neglected, so patients are not able to get critical services and care. Furthermore, in the United States there is a high demand for healthcare to be more economical. Point-of-care testing has the potential to fulfill the need of economical benefit by using less reagents, permitting more tests to be performed in a given duration of time, and allowing for earlier diagnosis for patients. The analyzers are also portable, use smaller sample volumes, and have fewer requirements for use. However, there are still many hurdles to overcome to make point-of-care testing the best method for the patient (Huckle, 2008).

Political

In 2016, the Centers for Medicaid Services (CMS) published a memo that established how educational requirements for laboratory testing is to be interpreted. CMS determined that nursing degrees are considered biological science degrees and as such, nurses can perform non-waived, high-complexity laboratory testing. Many point-of-care tests are viewed by governing agencies as simple “recipes.” However, in reality these tests still require critical thinking skills, not just motor skills, and are best performed by trained laboratorians. Allowing nurses to perform clinical diagnostic testing is widely viewed as being detrimental to patients. As such, there has been a great deal of effort to overturn this interpretation of the educational requirements for point-of-care testing (McDaniel, 2017).

Economic

In evaluating the economic benefits of point-of-care testing, the faster turnaround times must also be considered. There is an elevated cost per test for point-of-care testing, but the overall gain in expedited patient flow counterbalances this, especially in high-volume departments such as the emergency room (Rooney & Ulf, 2014). In a fairly recent study, it was determined that point-of-care testing would have limited economical benefits unless care pathway processes change. However, if the process of care is dramatically changed, point-of-care testing could result in savings through the utilization of resources, such as reduced emergency admissions, reduced hospitalizations, reduced length of stay, and increased patients who can receive home care (John & Price, 2013).

Point-of-care testing has the potential to make a positive impact worldwide. However, with this relatively new technology, numerous aspects of health care need to evolve as well. Care pathway processes, management, the training of testing personnel, quality control and proficiency testing must be re-worked in order for point-of-care testing to be beneficial to health care facilities and patients.

Ethical Considerations

Point of care testing has the potential to improve patient care globally. It can decrease turn-around-times for common tests, allowing for earlier diagnosis and bringing clinical laboratory testing to those in developing countries.

Clinical laboratory scientists follow a deantological code that binds them to their duties. For example, the Code of Ethics set by the American Society of Clinical Laboratory Science (ASCLS) includes a duty to the patient, duty to colleagues and the profession, and a duty to society (Code of Ethics, n.d.). For this reason, many laboratorians have rallied against the decision by the Centers for Medicare and Medicaid Services (CMS) to allow nurses to perform high-complexity laboratory testing. Furthermore, this decision permits Advanced Practice Registered Nurses (APRNs) to supervise laboratory testing. Nurses and clinical laboratory scientists have vastly different scopes of practice. While it is agreed upon that nurses are highly valued, the education and training they obtain does not delve into the depths of the scientific concepts that clinical laboratory testing is based upon.

Support of this decision by the CMS goes against clinical laboratory scientist’s duty to the patient as well as to the profession, as it poses a serious risk to public health. It is important to ensure that every patient receives the highest quality of care and that the laboratory services are safe and effective (McDaniel, 2016).

Clinical laboratory scientists also adhere to utilitarianism ethics from time to time, as they must consider which testing method would benefit the most people. Point-of-care testing often supports this ethical principle in that the developed tests are those commonly performed and would benefit patients by having the ability to perform them outside of the laboratory. Point-of-care testing also decreases turn-around times so that results can be generated quicker. Additionally, there is a great need to make health care more economical so that more people may benefit from it worldwide. Point-or-care testing can potentially aid in that effort, as they provide a shorter turn around time that permits high-volume setting to conduct more testing (John & Price, 2013).

Laboratorians follow a strict set of ethical standards to ensure that they are fulfilling their duty to patients, colleagues, society and the clinical laboratory science profession as a whole. It is important to place the needs of the patient above personal needs and to be accountable and take pride in the quality and integrity of laboratory services provided. Laboratorians also fulfill their duty to society by choosing analytical methods that provide the greatest benefit to the greatest number of patients.

Sources

Code of Ethics. (n.d.). Retrieved June 1, 2017, from http://www.ascls.org/about-us/code-of-ethics

Henricks, W. H. (2012, October 09). LIS Basics: CP and AP LIS Design and Operations. Retrieved May 18, 2017, from http://www.pathinformatics.pitt.edu/sites/default/files/2012 Powerpoints/01HenricksTues.pdf

Huckle, D. (2008). Point-of-care Diagnostics: An Advancing Sector With Nontechnical Issues. Retrieved May 26, 2017, from http://www.medscape.com/viewarticle/584399_7

John, A. S., & Price, C. P. (2013, August). Economic Evidence and Point-of-Care Testing. Retrieved May 26, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799220/

McDaniel, G. (2016, July 31). CMS Says Nurses Can Perform High Complexity Tests. Retrieved June 01, 2017, from http://community.advanceweb.com/blogs/mt_2/archive/2016/07/31/cms-says-nurses-can-perform-high-complexity-tests.aspx

Rooney, Kevin D., and Ulf Martin Schilling. "Point-of-care testing in the overcrowded emergency department – can it make a difference?" Critical Care. BioMed Central, 08 Dec. 2014. Web. 27 May 2017.

Valorz, S. (n.d.). Point-of-Care Informatics: Past, Present and Future. Retrieved May 18, 2017, from https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fwww.pointof care.net%2FBaltimore%2FOctober%25202004%2520Images%2FPoint_of_Care_Informatics_Past_Present_and_Future_100804_Final.ppt