Critical Care Nurses' Views and Experiences of Preanalytical Factors Influencing Point-of-Care Testing

Abstract

The main users of point of care testing devices placed outside the central laboratory are clinicians, predominantly nurses. Understanding the factors influencing sample accuracy is important to ensure appropriate clinical decision making. Previous studies focus on the analysis process, however, errors can also occur during the pre-analytical phase, linked to user knowledge, skills and other factors associated with the wider context of care. This study explored adult critical care nurses' views about point of care testing, the challenges they experience and their suggestions on how the pre-analytic phase might be improved. Using a qualitative design, four focus group discussions took place with 60 critical care nurses studying at two London based Universities between April and July 2019. Anonymized and verbatim-transcribed focus group data were uploaded into NVivo11 and underwent a standard process of inductive thematic analysis. Findings suggest that nurses' concerns focus on three key areas: Training and competence; Sample frequency and volume; and impacts on patients, relatives and staff. Critical care nurses view POCT as a necessary task, which aids timely patient management. However, the process can detract nurses from performing other care duties. Being able to draw less blood was identified as an important way to increase patient comfort and to reduce risks. Collaborative working is key to ensure that improvements made to the pre-analytical process reflect users' needs. Ensuring best use of nurses' time by streamlining preanalytical processes and ensuring equipment is readily available for use is important to ensure other clinical priorities can be achieved.

Nurses' perceptions of point of care testing in critical care: A cross‐sectional survey

“…Informed by the findings of our qualitative study 8 and following best practice guidance, 10,11 an online questionnaire was designed by a single researcher (SB) in collaboration with a clinical nurse specialist (SL).…”

“…1,5,6 Nurses frequently undertake POCT testing in critical care units, most commonly for arterial blood gas analysis. 7,8 This staff group, therefore, plays a key role in avoiding errors. However, the limited research published to date suggests that the added workload associated with POCT may increase the risk of error.…”

“…However, the limited research published to date suggests that the added workload associated with POCT may increase the risk of error. 5,[7][8][9] Performing POCT also detracts nurses from other care duties potentially increasing the risk of adverse incidents such as pressure ulcer formation, and reducing the time available for psychological support and timely recognition of deterioration amongst other things. 5,[7][8][9] A United Kingdom (UK) focus group study with nurses working in intensive care units (ICUs) and emergency departments also highlighted significant frustrations around equipment availability, and challenges with maintaining training and competence requirements.…”

“…5,[7][8][9] Performing POCT also detracts nurses from other care duties potentially increasing the risk of adverse incidents such as pressure ulcer formation, and reducing the time available for psychological support and timely recognition of deterioration amongst other things. 5,[7][8][9] A United Kingdom (UK) focus group study with nurses working in intensive care units (ICUs) and emergency departments also highlighted significant frustrations around equipment availability, and challenges with maintaining training and competence requirements. 8 Further research investigating nurses' perspectives of POCT more widely is required to better understand its impact on the nursing role and patient care and to explore how best the value of POCT can be optimized.…”

“…5,[7][8][9] A United Kingdom (UK) focus group study with nurses working in intensive care units (ICUs) and emergency departments also highlighted significant frustrations around equipment availability, and challenges with maintaining training and competence requirements. 8 Further research investigating nurses' perspectives of POCT more widely is required to better understand its impact on the nursing role and patient care and to explore how best the value of POCT can be optimized.…”