Establishing an Effective POCT TeamEstablishing an Effective POCT Team

Tony CambridgePOCT Co-Ordinator

Lead BMSPlymouth Hospitals NHS Trust

What Makes An Effective POCT Team?What Makes An Effective POCT Team?

ListenActReviewLearn

Engage

Quality, Safety and Governance

A Bit of BackgroundA Bit of Background

2000- POCT section was part of the Chemistry Special Investigations section

2006- POCT section created with a section lead (BMS3), deputy (BMS2), BMS and ATO staff with rotation of BMS staff through the laboratory

2008- Rotation of staff through the POCT team removed

2009- Workforce redesign. Reduction of state registered staff in favour of associate practitioners

2011- Further changes to the team including addition of an ATO

2012- (January) CPA Pre-Assessment visit(July) CPA 2 day Assessment (3 assessors)

2012- (November) Received 3 certificates of accreditation

The ServiceThe Service

16 Blood Gas Analysers 230 Glucose meters (50 Inform

II) 70+ Urinalysis sites 6 Hemocues 20 Urine Pregnancy sites 30 INR meters 15 Blood Ketone meters Some ESR sites (inc GPs)

Activity-Training and CompetencyAuditQuality AssuranceDocumentationMaintenance and TroubleshootingNon-conformanceCorrective action

Bragging rights- How big is your POCT Bragging rights- How big is your POCT team?team?

1 person? 3 people? Hundreds of staff?What constitutes a POCT team? Where does the

‘team’ begin and end?We can’t fund a team! It’s too expensive.

Derriford POCT team – 4.5 wte – how was this set up?

Hospital staff >6000 + external site staff?How can we govern the service?

Integrated Team Approach?Integrated Team Approach?

POCT team

Users

Should they be treated as separate?What can the user do to aid the service?

Who else should be involved?

Who to include?Who to include?

POCT teamMDLP and cascade

trainersBlood Transfusion

Nursing TeamDiabetes TeamBlood Gas TechniciansNICU technician

Critical Care TeamSupplier TrainersMedical Equipment

Management Service (MEMS)

Training and Development Team

Procurement (PPSA)Peninsula POCT

network

Governance StructureGovernance Structure

Safety and Quality Committee

Quality Governance and

Improvement Group

POCT Governance Group Medical Devices Strategy Group

POCT Team

EscalationReport

Communication LinksCommunication Links

Absolutely essential

1. Good Clinical and Managerial Support and Engagement2. Belief and Trust3. Clear Plan4. Transparency5. Accountability

POCT Governance Group (2 months) POCT management/clinical team meetings (regularly) MDSG (2 months) MDLP meetings (2 months) NICU Equipment Meeting Peninsula POCT meetings (2-3 per year)

Communication AidsCommunication Aids

Dedicated Inbox Trust Daily Email Vital Signs- Weekly trust email POCT Newsletter- every quarter Questionnaire Staffnet POCT page Trust website Pathology POCT page eLearning system GP Leaflet

Work with your suppliersWork with your suppliers

We have learned to:Tap into their experience with:

◦Communication aids◦Marketing - CLABS◦Promotion – publications◦Service design◦Optimising connectivity◦Word of mouth ◦Sharing best practice

Utilising the Existing InfrastructureUtilising the Existing Infrastructure

Time consuming tasks-◦Training◦Competency Assessment◦Audit◦Maintenance◦EQA and IQC◦Non-conformance follow up

TrainingTraining

Daily training performed by POCT staff

Clinical education days across the trust

Blood Transfusion Nurses

MDLP and cascade trainers train regularly and send completed training sheet to POCT

Supplier training days, monthly

CompetencyCompetency

Competency assessed through eLearning for POCT tests which reduces man hours required

Competency as part of initial training but also EQA results

Appointed staff can also assess competency

All records held on trust training database (OLM)

AuditAudit

POCT team has an audit calendar in our QMS (Qpulse)

Internal/External

6 monthly audits by suppliers

Self audit tools sent out

Findings held in QMS as per CPA requirements

Datix incidents

MaintenanceMaintenance

Some sites have ‘super users’ who are trained by POCT to perform some remedial tasks and troubleshooting

Connectivity software reduces man hours – looking at next generation data manager software

Modern equipment requires less intervention

MEMS

Currently looking at cartridge based BGAs

EQA and IQCEQA and IQC

Insist on nominated leads for POCT at each site

Use them to co-ordinate quality assurance

Better compliance

More chance of resolving issues

Essential link between staff and POCT team

Non-conformance follow upNon-conformance follow up

NCWs raised in QMS against offending site

Details sent to nominated individual for action

Corrective action taken by users of the service

POCT team monitors future performance

Actions also generated at POCT Governance Group to be addressed by group members, not POCT team

Reviewing EffectivenessReviewing Effectiveness

We perform a periodic review of the POCT service ( every 3 months)

Annual Management Review

Trends in Non-Conformance

Action Plans

Root Cause Analysis

All held in the QMS

Is the Service Effective?Is the Service Effective?

Clinical EffectivenessCost Effectiveness

Example-

WEQAS set 80% return rate, we set 90% KPI

Email: tony.cambridge@nhs.net