Training activity information
Details
Perform under supervision point of care testing for ketones (ketometers/dipsticks), glucose (glucometers) and blood gas instruments
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to accurately performing point-of-care (POC) testing for blood gas and ketones and understanding the practical application and limitations of these devices
- Consider how the learning outcomes apply, specifically in relation to applying an appropriate testing strategy for acute presenting disorders relevant to inborn errors of metabolism.
- Discuss with your training officer to gain clarity of what is expected of you in relation to adhering to SOPs/manufacturer instructions, performing quality control checks, and recognising the limitations of POC results compared to laboratory methods.
What is your prior experience of this activity?
- Think about what you already know about performing QC procedures and POC devices.
- Consider possible challenges you might face during the activity, such as obtaining suitable fingerpick samples from paediatric patients, performing the test accurately under clinical pressure, or understanding the appropriate paediatric clinical decision points for results.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you are unsure when POC testing is the appropriate strategy versus when laboratory analysis is required or if a device fails quality control checks.
- Acknowledge how you feel about performing tests that inform immediate clinical decisions in managing acute paediatric metabolic issues.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as gaining practical experience in performing POC glucose and ketone tests.
- Identify the specific insights you hope to gain into the accuracy, reliability, and limitations of point-of-care devices in a clinical setting and how POC results are used to inform immediate clinical decisions in paediatric management.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of using clinical devices or performing tasks under pressure.
- Identify important information you need to consider before embarking on the activity, such as reviewing the manufacturer instructions and QC procedures for the specific meters, reading about the clinical use of these tests in acute paediatric presentations (e.g., ketoacidosis), and preparing for potential difficulties in sample acquisition.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing point of care testing under supervision?
- Are you encountering situations such as:
- Issues related to obtaining the sample from a paediatric patient?
- Instrument performance problems?
- Results that don’t align with the clinical picture or expected ranges for children?
- Unexpected issues when comparing this experience with previous experiences of similar activities, such as performing point of care testing on adult patients.
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Did you adapt or change your approach to performing the test?
- Consider the steps you are taking in the moment, such as:
- Checking the instrument calibration
- Checking patient sampling technique
- Seeking supervisor guidance
- How are you feeling in that moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence? Did you feel positive you could reach a successful conclusion?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice while performing the point of care test. For example, are you successfully performing the QC and test according to manufacturer instructions? Or are you needing support because the device fails quality control checks despite troubleshooting?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the practical aspects and potential issues with point of care devices in a paediatric context?
On action
What happened?
- Begin by summarising the key steps you took when performing point of care testing (POCT) for ketones and/or blood gases under supervision.
- Consider specific events, actions, or interactions which felt important, such as the procedure you followed, including sample collection and analysis using the POCT device or how you managed quality control checks for the glucometer.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking supervisor advice when faced with a POCT result that did not align with the expected clinical presentation.
- How did you feel during this experience, e.g., did you feel confident in performing the POCT procedure or stressed by the pressure of obtaining results for an acute metabolic issue?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the practical aspects and limitations of POCT for ketones n a paediatric setting. What strengths did you demonstrate, e.g., adherence to quality control procedures for the POCT device?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with appropriate testing strategies for paediatric clinical scenarios like metabolic acidosis?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in understanding when POCT is the appropriate clinical strategy?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding when to recommend laboratory analysis over POCT for a critical measurement, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to specific considerations to keep in mind when performing or advising on POCT in the future.
- What will you do differently next time you approach POC testing for ketones, for instance, by proactively reviewing the paediatric clinical decision points for results?
- Do you need to practise any aspect of the activity further, such as quality control troubleshooting for POCT devices or key learning outcomes related to applying appropriate testing strategies for paediatric clinical scenarios.
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of laboratory quality control processes or managing acute metabolic disorders since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent learning on acute paediatric conditions (e.g., DKA management) forced you to re-evaluate the criticality of strict QC and adherence to manufacturer instructions during your first attempt at performing POCT for ketones/blood gases
- Considering what you understand about POCT governance, potential user error, and the balance between speed and accuracy in acute care now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your POCT oversight or verification checks based on further learning and experiences? For example, how you proactively reviewed and integrated knowledge of factors affecting POCT accuracy (e.g., haematocrit) when interpreting results or communicating with clinicians.
- Has discussing POCT device reliability or the governance requirements for decentralised testing with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a POCT result disagreement requiring definitive laboratory verification refined your understanding of the critical nature of system quality and limitations.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent quality management and acute care experiences, contributed to your overall confidence and ability in assessing the utility and limitations of rapid diagnostic tools, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in performing POCT accurately and adhering to QC protocols now enables you to confidently discuss the critical role and limitations of rapid POCT results during a CBD assessment focused on acute metabolic conditions.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to interpreting and communicating POCT results? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely flag POCT results that conflict significantly with laboratory results or the patient’s clinical state (e.g., unexpected low glucose), immediately requesting definitive laboratory verification.
- Looking holistically at your training journey, how has this initial POCT experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying appropriate testing strategies and managing acute paediatric conditions? For example, how this foundational experience has supported your development in understanding the balance between speed and accuracy and informing views on the role of POCT in clinical pathways.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Identify the appropriate specialist testing for the major categories of inborn errors of metabolism. |
| # 4 |
Outcome
Apply the appropriate testing strategy for paediatric clinical scenarios. |
| # 6 |
Outcome
Select and perform the appropriate investigative strategy for the common, acute presenting paediatric disorders. |
| # 7 |
Outcome
Select and perform the appropriate investigative testing strategy for inborn errors, including those relevant to developmental delay and dysmorphism. |
| # 8 |
Outcome
Apply the investigation of inborn errors of metabolism to adults. |