Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi : a feasibility study

Abstract

Background To achieve good outcomes in critically ill obstetric patients it is necessary to identify organ dysfunction rapidly so that life saving interventions can be appropriately commenced. However, timely access to clinical chemistry results is problematic even in referral institutions in the sub Saharan African region. Reliable point of care tests licensed for clinical use are now available for lactate and creatinine. Aim We aimed to assess whether implementation of point of care testing for lactate and creatinine is feasible in the obstetric unit at the Queen Elizabeth Central Hospital (QECH), Malawi, by obtaining the opinions of clinical staff on the use of these tests in practice. Methods During a two month evaluation period nurse-midwives, medical interns, clinical officers, registrars and consultants were given the opportunity to use StatStrip® and StatSensor® (Nova Biomedical) devices for lactate and creatinine estimation as part of their routine clinical practice in the obstetric unit. They were subsequently asked to complete a short questionnaire. Results 37 questionnaire responses were received, 22 from nurse-midwives and the remainder from clinicians. The mean satisfaction score for the devices was 7.6/10 amongst clinicians and 8.0/10 amongst nurse-midwives. The majority of participants stated that the obstetric high dependency unit (HDU) was the most suitable location for the devices. For lactate, 31 participants strongly agreed that testing should be continued and 24 strongly agreed that it would influence patient management. For creatinine, 29 strongly agreed that testing should be continued and 28 strongly agreed that it would influence their patient management. 20 participants strongly agreed that they trust point of care devices. Conclusion Point of care clinical chemistry testing is feasible, practical, well received by staff and was considered by staff to have a useful role to play in the clinical care of very sick obstetric patients at this referral centre.