PRACTICE GUIDELINES

FOR COMMUNITY
PHARMACISTS: POCT

ACPN PG01
 ACPN PG01

Background/Case

According to the WHO, over 80% of the African population and the rest of the developing
world lack access to essential diagnostic tests. A direct consequence of lack of access to
diagnostic tests is poor diagnostic accuracy which is obtainable in most African countries. The
challenge of poor diagnostic accuracy contributes to low life expectancy, misuse of
antimicrobials and suboptimal health outcomes for patients.

In Nigeria, diagnostic accuracy is abysmally low. Bill and Melinda Gates-funded Primary
Healthcare Performance Initiative puts diagnostic accuracy in Nigeria at 36.4%. The obvious
implication is that less than 4 out of every 10 persons who visited a healthcare provider are
correctly diagnosed. Sadly, the majority of healthcare consumers in Nigeria seek healthcare
services in community-based care settings where healthcare providers lack access to a broad
range of essential diagnostics.

In pursuit of Universal Health Coverage (UHC) and the need to entrench equitable access to
diagnostics, the World Health Organisation (WHO) rst published its Essential Diagnostics
List in 2018 with a revised edition in 2021 following the outbreak of the COVID-19
pandemic.

In June 2023, at the World Health Assembly, the WHO tasked member countries to adopt a
national Essential Diagnostics List and explore opportunities to improve access to diagnostics
in community-based settings through point of care testing (POCT).

Interestingly, in these community-based healthcare settings, Community Pharmacists (CP)

already play a frontline role in providing indispensable healthcare services: ranging from
pharmaceutical care, treatments of illnesses, medication dispensing, drug information to
monitoring and support for chronic illnesses (e.g. diabetes) . Hence, integrating POCT into
the spectrum of healthcare services being rendered by CPs aligns with the objective of the
WHO and Federal Ministry of Health (FMoH) to provide equitable access to essential
diagnostics as a key element of the UHC.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

In January 2015, a concession was granted by the National Malaria Control and Elimination
Programme for community pharmacists to carry out rapid diagnostic tests for con rmation
of malaria before dispensing anti-malaria medicine and in March 2023, the FMOH launched
the task shifting and task sharing policy that supports primary healthcare services in
community pharmacies

De nition of Key Terms

Point of care testing is the use of approved, portable diagnostic technology by a trained
healthcare provider to deliver a ordable, rapid, timely, and accurate tests at the place of care
for the purpose of screening, monitoring, preventive care or diagnosis.

Point of care technology is de ned as any approved medical device and/or system that enables
diagnosis, monitoring or screening of patients at the point of care by appropriately trained
users.

POCT technology includes screening and monitoring equipment such as blood pressure
monitors, glucometers, digital cholesterol devices, pulse oximeters, spirometers etc, and
diagnostic test kits such as Hepatitis B test strips, Typhoid cassettes, HIV test strips etc.

Point of care tests are rapid medical tests performed by trained personnel using approved,
portable diagnostic devices or tools at the point of care, outside traditional laboratory settings.
Point of care tests include tests to detect diseases of public health importance such as Syphilis,
as well as tests associated with non-communicable diseases such as cholesterol pro le.

POCT is a part of the framework of services for community pharmacists as contained in the
four-part compendium of minimum standards for the assurance of Pharmaceutical Care in
Nigeria. The framework recognises that community pharmacies have the potential to deliver
new prevention services that include testing, health promotional services that are based on the
health status of the patient and clinical services that incorporate monitoring that is timely,
convenient to patients and form part of an integrated pathway.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

As the technology to provide self-care and self diagnosis increases, so will the need for CPs to
lead screening services increase. There is therefore a need to provide POCT practice guidance
for CPs for accurate, ethical and professional services to patients, devoid of con ict of interest
and enabling cooperation with other healthcare professionals.

1. External Communication.

Signage shall be devoid of direct advertisement or promotion of the POCT being o ered
by the pharmacy.
Noti cation on POCT service shall be indoor and it shall be general in nature with no
speci c mention of
Pre-test engagement shall be robust and aligns with standard practices as it relates to the
test.
Discuss why the test is to be done
Mention how the sample will be collected e.g. by blood by lancing
Mention what to expect e.g. slight pain
Allay fears about test outcome and mention
Possibility of referral for further care where necessary
Results shall be communicated to the patient and lled in the patient’s electronic or
physical folder.
Point of Care tests are required to guide clinical judgement and referral decisions, hence
written report shall not be provided for the patient, however reports can be part of the
referral documents to other healthcare providers.
Referrals, either electronic through www.healthserves.com or referral note, shall be well
documented and open for retrieval by the Pharmacy Council of Nigeria.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

2. Regulatory compliance

Ensure compliance with all applicable regulatory requirements, including those set by
the Pharmacy Council of Nigeria (PCN) and any other agency of the Federal
Government of Nigeria .
CPs shall respect the policy of the national malaria elimination programme, NACA and
other agencies ofthe Federal Government of Nigeria
Only registered and validated devices and screening strips shall be used
CPs shall ensure the revalidation of testing equipment such as BP machine and blood
glucose metre at least once in a year.
3. Human Resources & Training

The Superintendent Community Pharmacist (SCP) shall receive appropriate training

and certi cation in POCT.
The SCP shall train support sta members such as Pharmacy Technicians involved in
point of care testing on the procedures, protocols, and equipment involved in the testing
process.
The training shall include proper infection control practices.
Sta members shall also be trained on the applicable regulations and standards.
Sta shall be a t and proper personnel with requisite quali cation and training.
Sta shall have proper orientation in communication techniques and customer service.
All sta shall have appropriate training on the con dentiality of healthcare information
and shall sign a deed to the same e ect.
There shall be a reference book on point of care testing in the pharmacy for training and
guidance.
Ensure continuous training of Sta members to enhance their knowledge and skills in
point of care testing.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

4. Patient screening

Pro le patients to ensure that they meet the appropriate criteria for testing
Provide appropriate pre and post test counseling
Provide education on the test, the possible results, and any follow-up care that may be
necessary.
Ensure that patients provide informed consent for the testing.
Assure patients of con dentiality.
5. Test administration

Administer the test according to the manufacturer's instructions and standard

speci cations and procedure.
Record all relevant information, such as the test result, the patient's information, and
any notes or comments from the test administrator.
6. Test results interpretation and reporting

Interpret the test results according to the manufacturer's instructions, and provide
appropriate counseling and education on the implications of the results.
The need for referral to licensed medical laboratories and other healthcare facilities shall
be of great importance in case management.
CPs are encouraged to report the summary of encounters and results of POCT to the
CHIS of the FG and to the R and D department of ACPN

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

7. Equipment maintenance and quality control

Equipment shall be of approved quality and standards only

Equipment shall have routine maintenance and quality control policy.
Equipment shall be stored properly
Documentary evidence of maintenance and QC checks shall be made available to
regulatory authorities as and when requested
Internal Quality assurance (IQA) shall be conducted routinely with samples of known
concentration or validated samples
8. Data Protection & Governance: Record Keeping, Privacy and Con dentiality

Maintain accurate and complete records of all testing procedures, results, and follow-up
care, as well as any adverse events that may occur during or after testing.
Community Pharmacists should be encouraged to take advantage of the Community
Pharmacy software for reporting, data collection and documentation.
(Data generated should be for Pharmacists consumption only)

Sta members should also ensure that patient records are stored securely and in
compliance with applicable regulations.
Protect the privacy and con dentiality of patient information in accordance with
applicable laws and regulations
Ensure that all sta members are trained on privacy and con dentiality best practices in
order to avoid unintended disclosure associated with accessing POCT in community
pharmacy settings.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

9. Patient follow-up

The pharmacy shall have a written guideline on referral protocols with details of how
other healthcare providers e.g. private, NGOs or government establishments may be
contacted.
Provide appropriate follow-up care and referrals as needed.
Ensure that patients are fully informed of any necessary follow-up care and any potential
risks or complications associated with the test.
Sta members should also ensure that patients are informed about their rights and
responsibilities.
10. Continuous quality improvement

Continuously monitor and evaluate the point of care testing program to identify areas
for improvement.
Implement appropriate changes as necessary to ensure the highest quality of care and
patient safety.

PRACTICE GUIDELINES FOR CPS: POCT

 ACPN PG01

11. Governance Structure

●The overall responsibility of quality-assured and professional POCT service shall be that of
the Superintendent Community Pharmacist (SCP).
● Such SCPs must have undergone a structured training on POCT, either by accredited
training institutions or a certi cated practice enhancement program of ACPN.
● Such SCP shall have capacity to train support sta on pre-test activities such as
communicating available testing services, recording patient details and disposal of biological
wastes.
●Certi ed SCPs shall provide a monthly report on POCT contribution to their organisation
● SCPs with POCT certi cation shall attract additional 2 points on CP rating scale for
employability.
● Rating scale of Contribution and employability shall be issued by ACPN Research and
Development department annually, upon request and based on set criteria.

ACPN POCT Guidelines contributions are from

1.ACPN Practice guidelines Committee:

Pharm Roland Tomiwa
Pharm Adebayo Gbadamosi
Pharm Freeborn Okpegwa

2.Akindele Opeyemi: Global Network

3.Omokhafe Ashore: Director for the quality of medicines and quality of healthcare practice
4. Ezeh Ambrose Igwekanma. General Secretary, ACPN
5.Oladigbolu Adewale (First Global Champion of FIP), National Chairman of ACPN

PRACTICE GUIDELINES FOR CPS: POCT