The role of POCT in Diagnostics Annette Thomas

The role of POCT in Diagnostics Annette Thomas Consultant Clinical Scientist POCT Clinical Lead Cardiff and Vale University Health Board

What is POCT? http: //nww. poctmatters. wales. nhs. uk

What’s the governance structure in Wales? All Wales POCT Committee - Informal network of POCT Healthcare Scientist and Practitioners from each HB. Responsible for oversight of the acquisition, implementation and monitoring of POCT services to National standards. http: //nww. poctmatters. wales. nhs. uk/who-we-are

What’s our Vision Building on the success of the informal network to create a structured network within Wales to deliver a Po. CT service with appropriate resource and capacity to meet current and future needs of the population that is a nationally co-ordinated, sustainable service, delivered at national, regional and local levels. CAVUHB PHB ABHB National Strategy BCUHB HDHB SBUHB CTUHB

The Vision A “one Wales” Po. CT service that is patient focused that: • Delivers a “diagnostics anywhere” approach to healthcare; providing diagnostic testing where it is needed. • Reduces inappropriate variation using evidence based practices consistently and transparently. • Works in partnership with academia for opportunities, making best use of innovation with disruptive and transformational technology. • Embraces multidisciplinary working, a workforce that is flexible that can work across geographical boundaries breaking down the barriers between Health Boards and the “silo” specialities. • Ensures workforce models are sustainable; that standardised training programmes are developed at all levels at the right level for the clinical need. • Makes effective use of resource, establish efficiencies of scale for equipment and consumables through managed service contracts on an All Wales basis. • Builds on the IT Strategy for future needs, making best use of business intelligence.

Role of Point-of-Care Testing in Diagnostics Screening and diagnosis: • diabetes • heart failure • DVT • STIs Referral triage Manage discharges Post operative care local hospital community treatment centre regional/specialist hospital primary care centre Disease management: • • diabetes heart failure PATIENT warfarin COPD home e. ICU Day case surgery Intra-operative monitoring Acknowledgement - Professor Christopher P Price, Oxford

What we do in Wales Current repertoire – secondary care • • • Referral triage in ED Screening Diagnosis Monitoring Optimising treatment Pre operative assessment Post operative care Manage discharges glucose, ketones, Hb. A 1 c, urinalysis, microalbumin local hospital INR, ACT, TEG, TEM haemoglobin, FBC & 5 part diff h. CG, e. ICU fetal fibronectin, Actim Partus, Actim Prom Day case surgery Intra-operative monitoring HIV, Influenza regional/specialist hospital blood gases and co-oximetry, i-calcium, electrolytes, urea and creatinine lactate drugs of abuse, D-dimer. Over 3000 POCT devices used in secondary care in Wales Over 1, 000 POCT test sets undertaken annually in Cardiff & Vale UHB Over 4, 000 POCT tests undertaken annually in Cardiff & Vale UHB

What we do primary care and community nursing Current repertoire – Primary and Community care • • • Chronic Disease management: Glucose • Diabetes • Anticoagulation management Urinalysis Anticoagulation – rolled out as part of DES • Respiratory infection CRP - Already implemented in 75 practices in Wales Pregnancy testing in Family Planning Clinics Pharmacy led strep A group testing • Some practices undertaking wider repertoire inc. ECG

What we do home Current repertoire – patient self management Chronic Disease management: • glucose • diabetes • Warfarin • INR • COPD District nurse teams, diabetes monitoring – glucose in home care setting Anticoagulation nurses – INR in home care setting Respiratory nurses, home ventilation service, Oxygen service - blood gases

What we do community treatment centre Assessment Monitoring during transit Optimising treatment Transit / Ambulance Community pharmacist Health Checks Antibiotic Stewardship local hospital Referral triage in ED Screening Diagnosis Monitoring Optimising treatment Pre operative assessment Post operative care Manage discharges Governance / Training/ Patient safety/ QA / Data capture / BI regional/specialist hospital primary & Community care Chronic Disease management: • diabetes • warfarin Pregnancy testing Respiratory infection ECG PATIENT home e. ICU Intra-operative monitoring Chronic Disease management: • diabetes • Warfarin • COPD

Our Strategic Plan Priorities Brief description of planned activities and goal Outcomes and Deliverables. Leadership Research and Innovation for service improvement Provide leadership in delivering a National POCT integrated Service. Horizon scanning for new technology esp. in relation to AMR agenda / Community Diagnostics / chronic disease management/ pre-hospitalisation. Primary and Community care connectivity. All POCT regardless of where tested and by whom to be connected to WPOCT and results available in WCP National POCT Network – 18 months. Accreditation to ISO 22870 for POCT services. All POCT Departments accredited in 2 year. Training and Competency documents completed – Q 1 2020 Organise POCT Health Fairs and patient engagement sessions – 12 months Value based healthcare Quality and safety Model for Community diagnostics - 12 months Full connectivity in secondary care completed by June 2019 and primary care June 2020. Working with Shared services to develop Managed service contracts which are Managed service framework for POCT underpinned by VBH principles. – 12 months Define better cost models and models of service with provider that will provide outcome metrics. Integration of data into Business Intelligence system to collect metrics such as hospital admission, length of stay, time to treatment, time in therapeutic range, customer satisfaction, and school/work days lost. Development of Core framework for POCT training. Accessing and championing Health Science Greater publicity and engagement to promote POCT services. The need for improved engagement is increasing, as patients will be undertaking more of their own testing.

Where are we ? The right infrastructure - WPOCT A system which supports shared decision making providing the infrastructure to enable full connectivity of all approved Point Of Care Testing devices across Wales in all suitable locations. INR pilot to start shortly. Live in 3 HBs, 1 Trust, Over 3000 devices will be connected by August 2019. INR pilot to start shortly. Home ventilation & diabetes monitoring service to pilot Patients, users clearly identified Quality checks on user/ device/ reagents - safer testing Safer data exchange Data collected to support audit and outcome measurement Facilitates Sharing of information

Where are we ? The right technology - Value based Procurement Working together for a National solution: INR monitoring in primary care including patient self management - completed Professional blood glucose managed service for acute care – completed National formulary for patient self testing devices for diabetes – in process

Where are we ? The right staff - Harmonised Training & Competency Making the most effective use of all skills and resources. All Wales Generic documents produced for: • Blood Glucose • Urinalysis • Blood Gases • INR testing • Pregnancy testing • Drugs of Abuse • Hb. A 1 c • Ketones • Cholesterol Training credits