POC Testing in the ED

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I'm trying to determine what is common practice for POC testing in the ED. Specifically in relation to testing that is not automated (i.e. Urine dips, hemacults, pregnancy tests, etc.)

Does your site allow nurses to perform them on the unit or do you have to send them to the lab? If you do run them on the unit, is it a nursing order or a lab order that is placed in the HIS? How do you record the lab results, directly into your HIS or via your LIS? Also are your QC logs documented on the HIS, LIS, or on paper?

I appreciate your responses and thank you for your time.

classicdame, MSN, EdD

2 Articles; 7,255 Posts

Specializes in Hospital Education Coordinator.

our nursing staff in ER are trained as certified users for POC by the lab. The nurses result the tests in ER and post results on computer.

The same is true for L&D nurses who have special testing needing immediate results.

robinzkj

29 Posts

Specializes in Emergency Department.

In our ED we are able to do POC troponin, influenza swabs, rapid streps, ua dips and urine HCG. All are kept in individual logs with pt info, result, lot # and exp date of test and RN initials date and time. We then put the results in the computer with our computerized charting. Troponins have to get faxed to the lab and they place the result in with the labwork for the DR to see.

brysmit

6 Posts

Thanks, classicdame & robinzkj. I appreciate the feedback.

Larry77, RN

1,158 Posts

Specializes in Trauma/ED. Has 10 years experience.

Our urine dips and HCG's are charted manually by staff and our Glucometer and Troponin/BNP/CK-MB sync automatically to the in-house lab computer system. The printouts of the Troponins are brought to the charge nurses and are passed on accordingly to the docs. Lab does the 3hr lab draw and gives the blood to either the RN or EDT (usually pt's are not still there, so this isn't common). Our hospital is almost all electronic...only thing left is the actual physician order sheets...they are afraid of CPOE.

MikeyBSN

439 Posts

Specializes in ED. Has 7 years experience.

We're allowed to do POC testing in the ED, but I wish were weren't. Although some amount of POC testing is useful, I think that it is needlessly ordered. It takes me a good 10-15 minutes to do a POC urine. First I have to get the urine, then bring it to the testing room. I have glove up and find some urine strips (we never seem to have any where they should be). I have to dip the thing and give it crude reading. Then I need to clean it up and fill out the form, noting all results. It's a pain in the arse. I could see if this was a fast track patient and we were just waiting on a urine, but the docs order the POC all the time. If I'm going to wait an hour for blood work to come back, I don't see why I can't just send the urine to the lab. It would be more accurate and take about 30 seconds of my time.

cjcsoon2bnp, MSN, RN, NP

8 Articles; 1,156 Posts

Specializes in Emergency Nursing.

In my ER we do the following: Urine Dips (if positive we will send the urine off for a UA and/or Urine Culture), Accuchecks, Rapid Strep (we send off flu swabs) and all blood work and UPREG are sent off to the lab (most labs are completed within 1 - 2 hours and UPREG in 20 minutes.) Urine Dips and Accuchecks are done by Techs or Nurses (if its really busy) and the Rapid Strep is done by the Docs. We do need a doctors order for all of it but they usually put them in right away so its not an issue. I will say that if a doctor asks me to do a urine dip even if they haven't ordered it yet then I will and if its positive then I will prep the urine for a UA and possible Urine Culture and ask the doctor or nurse to put in the order for me. I think we would do UPregs in the ER as POC but since were a Peds. ER we don't do them a lot (usually only on Females 13+ with abdominal pain or general weakness who is sexually active.)

!Chris :specs:

brysmit

6 Posts

Thanks for the responses everyone, I appreciate it.

Virgo_RN, BSN, RN

3,543 Posts

Specializes in Cardiac Telemetry, ED.

We do urine dips, urine HCG, and fingersticks. Our urine machine prints out a sticker with the results, which we place in the chart. CBGs are hand written in the patient care record.

Everything else is sent to the lab, and the results appear in the EMR.

Larry77, RN

1,158 Posts

Specializes in Trauma/ED. Has 10 years experience.

I sent you an email about the facility you asked about Bryan...

canoehead, BSN, RN

6,841 Posts

Specializes in ER. Has 30 years experience.

If we ever get POC testing for pregnancy I think people that come just for a pregnancy test should be told it takes an hour to come back. True or not, make them wait.

Specializes in ED only. Has 25 years experience.

We run POC on urine pregnancy, hemoccult, urine dip and rapid strep screens. Orders are placed by secretary so they can be charged. We fill out a carbon copy form with the results, original goes on chart (plus documented in nursing notes) and carbon goes to lab because they get the revenue off this testing because it is a "lab test" and it is billed as a "lab test".