Point-of-Care Testing and Patient Education

This is Unit Eighteen of Medical Assistant Prep. Unit Seventeen collected specimens to send to the laboratory. This unit covers the tests done right in the office, called point-of-care tests, and then the teaching that helps patients carry the provider's plan home. Carry one idea through this lecture. A test result is only as good as the technique, and teaching is only as good as what the patient can explain back. A constructed visit at the end shows both halves with one patient. By the end you will be able to explain what makes a test waived. To run the common waived tests by the manufacturer's instructions. To record and report each result. And to teach, check understanding, and adapt to each patient.

Four entries on the rules: what makes a test waived, the certificate, complexity levels, and the instructions.

What waived means.

MAS 426 What Makes a Test Waived

Under federal laboratory rules, a waived test is a simple laboratory test that meets at least one of three criteria. It is cleared for home use, or so simple and accurate that errors are unlikely, or harmless to the patient if done incorrectly. Simple does not mean careless. A waived test still has to be done exactly right.

Following the manufacturer.

MAS 427 The Certificate of Waiver

A practice that performs only waived tests operates under a federal certificate of waiver. To hold that certificate, the practice must follow the manufacturer's instructions for performing each test and meet the program's other requirements. Skipping the manufacturer's steps puts the practice's certificate, and patients, at risk.

Three levels.

MAS 428 Three Levels of Test Complexity

Laboratory tests are categorized by complexity: waived, moderate complexity and high complexity. The categorizing is done after a test is cleared or approved; a test that has not yet been categorized is treated as high complexity until it is. Perform only the waived tests your practice is certified for and you are trained to do.

The procedure itself.

MAS 429 Follow the Instructions Exactly

For every waived test, the manufacturer's instructions are the procedure. They set the specimen type, the timing, how to read the result, and when quality checks are run. Keep the instructions with the test, and follow them every time rather than from memory, even for a test you run daily.

Six entries on tests run in the office: capillary glucose, quality checks, dipsticks, pregnancy, rapid strep and occult blood.

A drop from a fingertip.

MAS 430 Capillary Blood Glucose Testing

A capillary glucose test uses a drop from a fingertip and a calibrated meter. Confirm the order, identify the patient and gather the meter, lancet, strip, alcohol swab and gauze. Check that the meter was calibrated as policy requires. Clean your hands and glove, clean the site with alcohol if required, and let it dry fully. Puncture the side of the fingertip in one quick motion. Wipe away the first drop and apply the second to the strip. Hold gauze on the site, read the result and record it with the time. Never squeeze or milk the finger, because extra tissue fluid dilutes the sample and makes the reading unreliable.

Calibration and checks.

MAS 431 Calibration and Quality Checks

Point-of-care equipment must be checked to show that it reads accurately. Meters are calibrated as the practice's policy and the manufacturer require; the glucose kit includes calibration drops for this purpose. If a quality check fails, do not test patients on that equipment; report it.

Pads that change color.

MAS 432 Urine Dipstick Tests

A urine dipstick is a strip with test pads that change color in response to substances in urine. Some dipstick tests check for signs of urinary tract infection, such as nitrites and white blood cells; others check for glucose or protein. Read each pad at the time the instructions specify, and record exactly what you see.

One hormone.

MAS 433 Urine Pregnancy Tests

A urine pregnancy test detects a hormone called human chorionic gonadotropin, or hCG. The test stick or strip reacts to the hormone in urine; morning urine usually contains more of it than urine later in the day. Record the result as read, and let the provider discuss it with the patient.

Rapid, then culture.

MAS 434 The Rapid Strep Test

A rapid strep test checks a throat swab for strep A antigens and gives results in about ten to twenty minutes. If the rapid test is negative but the provider still suspects strep, a throat culture may be ordered, which takes a day or two but is more accurate. Collect the swab the same careful way for either test.

Screening, not diagnosis.

MAS 435 Fecal Occult Blood Test

A fecal occult blood test checks stool for hidden blood that cannot be seen. A small sample is placed on a special card or in a tube; blood in the stool may be a sign of colorectal cancer or other problems. A result is a screening finding for the provider to act on, not a diagnosis.

Five entries on results and teaching: recording, teach-back, self-exams, and nutrition.

Exactly as read.

MAS 436 Recording and Reporting Test Results

Record each point-of-care result exactly as read, with the time, and report it to the provider. Note the test, the result, any control or quality check, and your name, as the practice's procedure requires. Interpreting a result for the patient belongs to the provider, even when the result seems obvious.

In the patient's words.

MAS 437 The Teach-Back Method

The teach-back method checks understanding by asking patients to explain, in their own words, what they need to know or do. After reviewing instructions, ask, "To be sure I explained it well, can you tell me how you will do this at home?" If the explanation is off, re-teach and check again; the gap is in the teaching, not the patient.

Knowing what is normal.

MAS 438 Breast Self-Exams

A breast self-exam is a way for a person to check their own breasts by feeling for lumps or other changes. It helps a person learn how their breasts normally look and feel, so they notice changes; alone it is not adequate screening, and research shows it does not lower the risk of death. Reinforce the provider's teaching and screening plan.

Report any change.

MAS 439 Testicular Self-Exams

Testicular cancer is most often first found by men themselves, by chance or during a self-exam. No studies have shown whether self-exams, or other screening in men without symptoms, lower the risk of death from the disease. Encourage patients to report any change to the provider promptly.

A divided plate.

MAS 440 Nutrition Basics With MyPlate

Federal dietary guidelines describe healthy eating through an image called MyPlate, which divides a plate by food group. Nutrient-dense foods, such as fruits and vegetables, offer a high proportion of nutrition for their calories. Reinforce the provider's nutrition advice; special diets come from the provider or a dietitian.

Five entries on adapting the visit: hearing loss, vision loss, older adults, disability, and a constructed visit.

Aids in.

MAS 441 Patients With Hearing Loss

Patients with hearing loss need communication adapted to them. Ask whether they use hearing aids, make sure the aids are in, and adapt how you communicate to what the patient needs. Document hearing aids and other devices, so every team member knows to check for them and use them at each visit.

Light and paths.

MAS 442 Patients With Vision Loss

People with sensory impairments are at higher risk of falls and injury. Provide good lighting and clear walkways, and make sure the patient has their glasses with them. Document glasses and other aids, so every team member knows to keep them with the patient throughout the visit.

Extra time, baseline.

MAS 443 Older Adults

Older adults are at higher risk for chronic conditions such as diabetes, osteoporosis and Alzheimer's disease. They are also more likely to be hospitalized for infections such as pneumonia, and many draw on long life experience to manage new health conditions. Allow extra time and speak plainly; compare what you observe with the patient's usual baseline, and report changes.

Ask, do not assume.

MAS 444 Patients With Disabilities

Disability is one of the characteristics linked to health disparities, so care must adapt to each patient's needs. Ask patients what help they need for moving, communicating or understanding, rather than assuming, and adapt the visit to their answer. Record the help the patient needs, so every team member can provide it at the next visit.

A fingerstick and a teach-back.

MAS 445 A Glucose Check and a Teach-Back

A constructed visit pays off the opening idea. An older man with type two diabetes needs an ordered fingerstick. The assistant confirms the meter's calibration check. Seeing him turn his head to hear, she asks about hearing aids; they are in his pocket, so she waits while he puts them in and moves to a quieter corner. She cleans and dries his fingertip, punctures it in one motion, wipes the first drop and uses the second without squeezing, then records and reports the result. Asked to reinforce his new home meter, she reviews the provider's steps and asks him to show her. He forgets to wipe the first drop, so she explains it again and he gets it right. Noticing his hearing first and checking understanding after made both halves of the visit work.

Look at what you can now do. You can explain what makes a test waived, why the practice needs a certificate, and why the instructions are the procedure. You can run a fingerstick glucose and the common urine, strep and occult blood tests, with quality checks first. You can record and report each result exactly as read, and use teach-back to reinforce self-exams and nutrition. And you can adapt the visit for hearing loss, vision loss, older age and disability. Unit Nineteen begins phlebotomy: the patient, the preparation, the tubes and their order.