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Study, strategy lift up POC critical value practices

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Ann Griswold, PhD

February 2015—Too many point-of-care glucose test results in the critical high and low ranges may be nonreproducible and therefore should be repeated. That was the finding of a study published last year that said POC glucose results in the critical ranges should be considered to have a relatively high probability of signaling a potential preanalytic error.

The retrospective analysis of POC glucose testing in routine patient care settings found that as many as half of all critically high or low test results, when repeated, were not so critical after all (Schifman RB, et al. Arch Pathol Lab Med. 2014;138:962–966).

Dr. Schifman

Dr. Schifman

“The lesson we learned is that you need a strategy for confirming, verifying, and reporting critical point-of-care blood glucose values,” says lead author Ron B. Schifman, MD, chief of diagnostics for the Southern Arizona VA Healthcare System, Tucson, and vice chair of the CAP Quality Practices Committee. He hopes such studies will help others become aware that critical values must be addressed in the point-of-care setting just as they are in the laboratory setting.

Over time, Dr. Schifman and colleagues implemented policies, processes, and training that have now nearly eliminated POC glucose critical value test result errors.

“The study made it clear we needed to develop processes to make the critical value verification, documentation, and reporting easier for our test operators,” he says.

A large percentage of hospitals have policies for repeat testing of POC critical value results, but Dr. Schifman worries that many of those institutions have not yet implemented useful criteria for interpreting repeat test results.

“Ultimately, there are no guidelines out there to help us,” he says. “Every lab director or program director is pretty much on their own in terms of how they want to design or develop their guidelines for repeat tests, and how to interpret them.”

How quickly should a POC glucose test result in the critical range be repeated? Should it be repeated with capillary blood using a handheld meter or with venous blood specimens on a chemistry analyzer in the core lab?

“These questions have been left unanswered,” Dr. Schifman says. “No experts have reviewed the literature and developed best practices associated with critical values in the point-of-care setting.”

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