A Multicenter Evaluation of the Quality Management Practices for Point-of-Care Testing in Nigeria

Abstract

Introduction The need for timely patient management has led to the proliferation of point-of-care testing (POCT) within health care facilities. However, POCT is often implemented without supervision by laboratory personnel, which raises concern about the quality of its results. The aim of this study was to determine the quality management practices for POCT in several Nigerian tertiary hospitals. Materials and Method This was a descriptive study of 61 POCT sites at 5 tertiary hospitals across Nigeria. Research laboratories and self-monitoring POCT were excluded. Data were collected using interviewer-administered questionnaires, as well as visual inspection of records and facilities. Results were presented as counts and percentages. Results The predominant POCT was the glucometer (65%). Cost of testing was majorly 0 to 500 naira (<2 US dollars; 78%). Point-of-care testing sites were majorly operated by physicians 40%, and only 26% of the sites had documentation of training on the POCT before use. Method validation was not performed in 81% of the sites. Internal quality control and external quality assessment were performed at 26% and 10% of the sites, respectively. There was no traceability of results on the device to the patients tested at 78% of the sites. Troubleshooting a faulty device was performed by nonlaboratorians at 77% of the sites. Most sites did not involve the laboratory in device procurement (74%), validation (77%), maintenance (78%), troubleshooting (64%), or monitoring the accuracy of the results (74%). None of the hospitals had a POCT committee. Discussion The practice of quality management for POCT in tertiary hospitals was poor because of inadequately trained operators and noninvolvement of the laboratory. Laboratory staff should provide guidance and a framework for POCT implementation to ensure quality results and patient safety.