Critical Care Nurses' Views and Experiences of Preanalytical Factors Influencing Point-of-Care Testing

A Qualitative Study

Abstract

The main users of point-of-care testing devices placed outside the central laboratory are clinicians, predominantly nurses. Understanding the factors influencing sample accuracy is important to ensure appropriate clinical decision making. Previous studies focus on the analysis process; however, errors can also occur during the preanalytical phase, linked to user knowledge, skills, and other factors associated with the wider context of care.

This study explored adult critical care nurses' views about point-of-care testing, the challenges they experience, and their suggestions on how the preanalytical phase might be improved. Using a qualitative design, 4 focus group discussions took place with 60 critical care nurses studying at 2 London-based universities between April and July 2019. Anonymized and verbatim-transcribed focus group data were uploaded into NVivo₁₁ and underwent a standard process of inductive thematic analysis.

Findings suggest that nurses' concerns focus on 3 key areas: training and competence; sample frequency and volume; and impacts on patients, relatives, and staff. Critical care nurses view point-of-care testing as a necessary task, which aids timely patient management. However, the process can detract nurses from performing other care duties. Being able to draw less blood was identified as an important way to increase patient comfort and to reduce risks.

Collaborative working is key to ensure that improvements made to the preanalytical process reflect users' needs. Ensuring best use of nurses' time by streamlining preanalytical processes and ensuring equipment is readily available for use are important to ensure other clinical priorities can be achieved.