Community pharmacy POV: Point-of-care testing
By Ronnie Baggett, PharmD
Baggett Pharmacy, started by my father, has served the community of Kingston, Tenn., since 1972. Whether filling prescriptions, offering product recommendations, or delivering on-site clinical services, our guiding philosophy has always been to treat patients as we wish to be treated—like family.
Over the years, when adding new services such as drug compounding and durable medical equipment, we did so by nurturing trust in our community. When the COVID-19 pandemic hit, we recognized that point-of-care testing (POCT) would help the community during a turbulent time. We knew that being able to quickly test and deliver results at our store would remove barriers to treatment since patients wouldn't need to visit their doctor and then make a second trip to a lab location to learn their status.
Nonetheless, any new venture brings elements of uncertainty. What's more, every owner's situation is different. So, you may be wondering, why would my pharmacy offer POCT and what does it take to get started?
Let me run you through what you need to know.
Getting started with POCT
POCT uses diagnostic tests to produce rapid and reliable results to help identify or manage acute infections and chronic diseases. At Baggett Pharmacy, we offer COVID-19 rapid testing and antibody testing, as well as rapid testing for influenza and strep throat, and we're getting into travel testing. Other community pharmacies around the country have implemented POCT to screen for HIV and hepatitis C, and for chronic disease management (e.g., monitoring for blood sugar levels and blood clotting time).
Community pharmacies have federal authority to perform POCT through waiver of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). You'll be providing CLIA-waived tests, which means they've been cleared by the Food and Drug Administration for home use. These tests present results with negligible likelihood of error and pose no reasonable risk of patient harm if performed incorrectly.
Note that although CLIA-waived testing is federally approved, state legislation or regulation varies considerably. For example, some states explicitly follow federal CLIA regulations while others have limitations on tests that can be performed in a community pharmacy. Further, some states only allow pharmacists to perform CLIA-waived testing through collaborative practice agreements (CPAs) with physicians. Check with your state board of pharmacy or state pharmacy association for guidance on whether your store may implement CLIA-waived testing and if CPA language limits how you would administer the tests.
Regarding testing equipment, current rapid detection kits available from your wholesaler enable you to test for flu strains A and B, as well as COVID-19, from a single patient sample. The kit we use at Baggett Pharmacy comes with a complementary analyzer that returns results in minutes.
You'll also need to consider training and certification. Pharmacies must complete OSHA Bloodborne Pathogen Training, which is available from GNPUniversity or the Red Cross. Additionally, the National Alliance of State Pharmacy Associations offers an optional 20-hour certification program (recognized by the Accreditation Council for Pharmacy Education) covering the skills and background information necessary for developing a POCT program. In my experience, completing certification heightens confidence in performing point-of-care tests. I also built self-assurance by conducting “practice" tests on myself and volunteer staff members before performing them on patients.
Putting POCT into everyday workflow
Integrating a new service into current pharmacy workflow can be a challenge. I'm fortunate at Baggett Pharmacy to have trusted staff who think ahead and have a knack for putting actions in sensible order. My staff also realized that POCT would have a valuable impact on the community. They committed to the effort with an overriding message of “we're here to help you."
Staff members created flowsheets and placed them next to each phone in the pharmacy to capture relevant information when patients called in with questions about COVID-19 testing or vaccinations. They shared that information with our pharmacists, who evaluated whether the patient needed to immediately go to the doctor or wait a few days until symptoms appeared or exposure was confirmed. By managing information flow from the outset of patient calls, staff helped our pharmacists make decisions in a less-stressful manner.
We also planned for action by creating POCT-specific intake and assessment forms, which were loaded into our pharmacy computer system for on-demand printing (pre-populated with patient name). In this way, we prepared POCT paperwork prior to testing.
As for the testing itself, we integrated it into our workflow with vaccines. For example, we vaccinated 10 patients every 30 mins with COVID-19 shots, and scheduled and tested 30 patients per day for COVID-19 without disrupting our normal in-store workflow.
Patient intake includes measuring oxygen level, heart rate and body temperature, and we pass that information on to the patient's physician along with a complete assessment that covers drug interactions and disease issues. We've found that doctors and nurses greatly appreciate that information, especially when the patient is being tested for COVID-19 and Paxlovid is the recommended treatment. For example, if the patient is taking rivaroxaban or apixaban, dosages may need to be adjusted if the patient is to start on Paxlovid.
The bottom line with POCT is to set standards for sharing information among in-store staff and providers in the community while cultivating processes that help you manage your time most efficiently so that you can see all patients in need.
Are you looking to offer point-of-care testing in your store, but aren't sure where to start? Good Neighbor Pharmacy Premier members get access to our full POCT curriculum at no additional cost. You also get 100+ courses, including ACPE accredited CEs, through Good Neighbor Pharmacy University. Enhance your pharmacy's patient care services today.
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