Relevant Quality Assurance of Point-of-Care Testing in Emergency Home Health Nursing: An analysis of factors affecting Clinical Practice

Chronic kidney disease (CKD) is a growing public health challenge with substantial morbidity, mortality, and cost. Early detection is critical, yet abnormal kidney function results in primary care are often lacking timely follow-up.

Purpose: The study aims to identify factors affecting clinical practice related to QA for POCT analyses in EEH nursing services. This is to support collaboration between EHH nursing services and BLS’s located at hospital-based clinical laboratories, in designing relevant and functional QA programs for POCT performed in the EHH nursing service.

Material and Methods: EHH nursing services from four Danish districts participated in the project. The findings of this project are based on participant observations and interviews. Participant observation among EHH nurses in all four districts served as the foundation for a moderator guide, which was used for two focus group interviews among the nurses. Finally, the findings were refined through an interview formalized with two hospital-based BLS’s responsible for POCT QA. All three interviews were transcribed and processed through thematic analysis.

Outcomes/discussion: The EHH nursing services participating in this project all have a collaboration with a hospital-based BLS for their POCT QA. However, they all have experience with QA strategies, which have proven ineffi­cient. The results showed that the following themes influence the EHH nurses’ involvement in QA for POCT analyses: Management, Organization of QA, Approach to QA and Skills in QA. All the themes have factors that affect QA for POCT but also affect the EHH nurses’ quality of work life and/or professional values.

Conclusion: The findings indicate that an incentive to participate in QA programs for POCT must be established before collaboration between the management of EHH nursing service and the clinical laboratories is plausible. But if a collaboration has been established, key factors for QA-BLS include establishing collaboration with relevant districts management; organizing QA programs with attention to local structures and workflows; and encouraging strong relationships between QA-BLS and the EHH nurses to ensure correct training and follow-up among the EHH nurses.