Improving Safety in Point-of-Care Testing
Marcy A. Metzgar
Point-of-care testing (POCT) is performed close to the patient, permitting swift delivery of test results for diagnosis and treatment. It can play a major part in diagnosing illness because results can be ready in 30 minutes or less.1 More advantages of POCT include its portability, absence of storage requirements, small sample volumes, availability of various tests, minimal processing requirements, and usability in the clinical workflow.2
However, if POCT isn’t conducted correctly or it’s used for purposes other than its intended ones, then ambiguous results may lead to more testing, which may cost more and put the patient at risk.3 Compared to a clinical laboratory setting, POCT may yield results that are not as precise, accurate, specific, or sensitive.4
In addition to the possibility of ambiguous or unclear results, safety concerns regarding POCT devices — including insufficient staff knowledge, inadequate training, poor compliance with quality control (QC) measures, limitations in technology, and environmental conditions — may occur at any stage of the process.5
Like testing in a clinical laboratory, many mistakes in POCT occur during the pre-analytical stage, and the person or system interpreting the results may not be able to easily identify them.6 These mistakes involve healthcare employees incorrectly identifying patients, improperly collecting specimens, or not testing at the best site on the patient’s body, as well as the presence of air bubbles, hemolysis, and interfering substances.7
Another safety concern is that nurses and patient care technicians usually perform POCT, but they have minimal laboratory skills and experience.8 They may be unfamiliar with adhering to test procedures, device maintenance and calibration, or QC processes, which may heighten the chance of errors in the analytical phase of testing.9 Therefore, it is imperative to provide training and continuous education for them.
In addition to robust training, healthcare organizations need to bolster the safety of POCT by implementing structured protocols and strict QC measures that align with established standards and focus on regulatory compliance and patient safety.10 These efforts will hopefully lead to more efficient and accurate diagnoses that will enhance positive clinical outcomes.
More recommendations to prevent mistakes and increase safety in POCT include the following:
- If the POC device has a barcode scanner, use it to prevent patient identification errors. Also make sure to scan the armband that is physically on the patient to ensure proper identification.
- Before cleaning a puncture site with alcohol, ensure it is completely dry. Avoid sites that have been punctured, and thoroughly clean the area prior to specimen collection.
- Choose a lancet of sufficient size for the volume of blood necessary for testing. Warm the collection site before puncturing to allow blood to flow and to avoid milking, which occurs when a puncture site is squeezed or massaged too much to get the blood flowing.
- Avoid air bubbles in blood gas samples by collecting the first drop of blood in one fluid motion. Blood gas samples and cuvettes must be collected free of air bubbles for accurate test results.
- Train individuals who perform POCT how to properly label and handle specimens.
- Educate patients and healthcare employees about endogenous and exogenous substances that can interfere with POCT and produce inaccurate results.11
More information can be found at the Centers for Medicare & Medicaid Services’ (CMS’) Clinical Laboratory Improvement Amendments (CLIA) webpage. CMS regulates all laboratory testing, and the CLIA program maintains testing standards for and grants certification to clinical laboratories.
Endnotes
1 Gallagher, A. (2023, June 9). Point-of-care testing shows promise in future, concerns about sensitivity accuracy. Pharmacy Times. Retrieved from www.pharmacytimes.com/view/point-of-care-testing-shows-promise-in-future-concerns-about-sensitivity-accuracy
2 Jenkins, J. (2023, July 1). What can go wrong with point-of-care testing? Association for Diagnostics & Laboratory Medicine. Retrieved from https://myadlm.org/cln/articles/2023/julaug/what-can-go-wrong-with-point-of-care-testing; Khan, A. R., Hussain, W. L., Shum, H. C., & Hassan, S. U. (2024, May 12). Point-of-care testing: A critical analysis of the market and future trends. Lab Chip Technologies, 3. Retrieved from www.frontiersin.org/journals/lab-on-a-chip-technologies/articles/10.3389/frlct.2024.1394752/full
3 Jenkins, J., What can go wrong with point-of-care testing?
4 American Society for Clinical Laboratory Science. (n.d.). Laboratory patient safety tips: Point of care testing use and limitations. Retrieved from https://ascls.org/wp-content/uploads/2012/11/Brochure_POCT_Use_Limitations_Providers_2019.pdf
5 Satheesh, S. S., & Mourya, GV. P. (2025, March 12). Risk evaluation of point-of-care testing (POCT) devices: Insights from a tertiary care hospital. Cureus, 17(3), e80499. doi:10.7759/cureus.80499. Retrieved from https://www.cureus.com/articles/340261-risk-evaluation-of-point-of-care-testing-poct-devices-insights-from-a-tertiary-care-hospital#!/; Khan, A. R., et al., Point-of-care testing: A critical analysis of the market and future trends.
6 Jenkins, J., What can go wrong with point-of-care testing?
7 Ibid.
8 Njoroge, S., & Nichols, J. H. (2014, July 1). Managing risk at the point of care. Clinical Laboratory News. Retrieved from https://myadlm.org/cln/articles/2014/july/managing-risk-at-the-point-of-care
9 Ibid.; American Society for Clinical Laboratory Science, Laboratory patient safety tips: Point of care testing use and limitations.
10 Satheesh, et al., Risk evaluation of point-of-care testing (POCT) devices: Insights from a tertiary care hospital.
11 Jenkins, J., What can go wrong with point-of-care testing?
