PointofCare(POC)GlucoseTestingDated:December2017

Reference:PolicyLAB23-A;PointofCareNovaStatStripGlucoseMeter

§ TheNovaStatStripBloodGlucosemeterisUHB’sapprovedGlucometerforpatienttesting

§Operatorcertificationstatusmustbekeptcurrent§UseUniversalPrecautionswhentestingasperhospitalpolicy§ Followpatientidentificationprocedureswhentestingasperhospitalpolicy

§ RuntwolevelofQualityControlonevery24hours§ CleanandDisinfectmeteraftereverypatienttesting

MeterAssignments

•NovaStatStripMetersareassignedtonursingunitsbythePointofCareLab

•StaffshouldNOTmove metersfromtheirassignedunits

• Ifameterisneededinaparticularunit,contactthePointofCareLabimmediately

NovaStatStrip Test:StripVials

STATSTRIPVIALS:• Containadesiccanttoprotectagainsthumidity• MustbeCLOSED withitslidwhennotinuse

• Storeatroomtemperaturebetween15 to 40degreesCentigrade(59to104degreesFahrenheit)• Whenopeninganewvialofstrips,writeonvial:• DateOpened ANDDateExpired• Expirationdateis180 daysfromopeningorlabelexpirationdate,whicheverisfirst• Initialsdonotneedtobewrittenonvial

WhenToPerformQualityControlTesting?

• Every24hours foreachMeter(2levelsofControl– Level1andLevel3)• WhenaNEWVIALofteststripsisOPENED• Aftermajormaintenanceorrepairofthemeter,i.e.batterychange.• Whenthemeterisdropped• Whenanewmeterisused• Whenresultsarequestionablebasedonclinicalsigns&symptoms• Wheneverproblems (storage,operator,instrument)areidentifiedoranytimethereisaconcern

ControlSolutionsandTesting• Storeatroomtemperature,15-30oC(59-86oF)• Controlvialsmustbecoveredwiththeirlidswhennotinuse• WhenopeninganewControlSolutionwriteonbottle:• DateOpened ANDDateExpired• ExpirationDateis90daysfromopeningorlabelexpirationdate- whicheverisfirst• InitialsdoNOTneedtobewrittenonvial

• Run Level1andLevel3controlseach24hourperiodoneachmeter• TotestGentlyMixcontrolsolutionvialbeforeusing• Discard1stdropofControlSolution• Use2nddropofsolutionfortesting

§ AfterControlTestingselect“MeterCleaned”comment

ControlTestTroubleshooting

• Ifacontrol leveltestisoutofrange:ØREPEATCONTROLleveltest

• IfcontrolleveltestresultsareAGAIN outofrange:ØOPEN a NewControlvial andruntest

• IfcontroltestresultsCONTINUE tobeoutofrange:ØOpen aNewStripvialandruntest

• IfcontroltestresultsareSTILL outofrange:• CallPointofCareatext.1679ortheBayRidgeLaboratoryat718567-1158forassistanceduringtheday• Offhours:GotoLab(2nd floor)andobtainanewmeter

PatientTesting• StartingaTest• Enterpatient7digitidentifier(Financial#)• Identify specimensource(capillary,venousorarterial)

• ApplyingBloodSampletoStripMaintainmeterinahorizontalpositiontokeepbloodoutofthemeter• Discard1st dropofblood.Use2nd dropofblood.• Allowblooddroptotouchthetipofthestrip.Fillstripcompletely• Donotmovefingerfromstripuntilmetercountdownbegins• NOre-applicationofbloodoncethetestinghasstarted

• EnterCommentsAfterEachPatientTest•Canchooseupto3comments• Highlight ALLdesiredcomments ATONCEand‘Accept’• MUST select ‘Clean/DisinfectMeter’asacomment• AlwaysverifycommentsdisplayonpatientresultscreenandAcceptagain.

PatientTesting

• IfResultsAreOutsideUnitSpecificActionRange• SelectComment“Repeattest”• TestMUST berepeatedtoconfirmresults.• Afterconfirmedrepeatselectneededcomment(s)suchas:

Clean/DisinfectedInitiateHypoglycemiaProtocolCaregiverNotifiedSendtolab

• Followappropriateprotocol

UnitSpecificActionRanges• Pediatrics: Lessthan70mg/dL – morethan200mg/dL• NICU: Lessthan45mg/dL – morethan150mg/dL• NewbornsonL&DandMother/BabyUnit

Lessthan25mg/dL:birthtothe1st4hoursofageLessthan35mg/dL:4to24hoursofage

• Ambulatory: Lessthan70mg/dL – morethan450mg/dL• CTICU: Lessthan60mg/dL– morethan120mg/dL• AdultMedical/Surgical:Lessthan70mg/dL– 450mg/dL

ActionRange Comment Code ActionOutofInstrumentReportableRange<10or>600mg/dL

RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotifiedandSend toLab Send specimentoLaboratory

RepeatTestifOutsideActionRangetoConfirmResults

UseofCommonCodesForActionRangesUnit ActionRange Comment Code Action

Adult– Inpatient <70or>450mg/dL RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotified InitiateInpatientHypo/HyperglycemiaProtocol

NICU <45or>150mg/dL RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotified InitiateNICUHypo/HyperglycemiaProtocol

Newborn <25or>150mg/dL 0- 4hrs<35or>150mg/dL 4-24hrs

RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotified InitiateNewbornHypo/HyperglycemiaProtocol

Pediatric <70or>200mg/dL RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotified InitiatePediatricHypo/HyperglycemiaProtocol

CTICU <60or>120mg/dL RepeatTest Repeattesttoconfirmresult

ConfirmedResult CaregiverNotified InitiateCTICUIntensiveInsulinInfusionProtocol

Clean & Disinfect Meter

CleanMeter DisinfectMeter• Wearprotectivegloves• Makesureteststripisremovedfrommeter• Laymeteronflatsurface• ObtainafreshgermicidalwipeorClorox

Bleach (hospitalapproved)• Wipeexternalsurfaceofmeterthoroughly

withthefreshwipe• Discardusedwipe&glovesintoappropriate

container

• UsefreshCloroxbleachgermicidalwipe,thoroughly wipe surfaceofthemeter(top,bottom,left&rightsides)

• Avoidthebarcodescanner&electricalconnectorwhenwiping

• Ensuremetersurfacesstaywetforaminimumof3minutesandisallowedsurfacestoairdryforanadditional1minute

• Disposeglovesintoappropriatecontainer

Clean & Disinfect Meter With Hospital Approved Disinfectant After Each Patient Test A 2-Step Process

IsolationPrecautions

• UseUniversalPrecautions

• CleanandDisinfectStatstrip GlucometerAFTEREACHPATIENTuse

• UseaseparateStatstrip meterbasedonclinicalsituations(e.g.Hemodialysis)

POCTGlucoseResultsDocumentationResults&interventionsaredocumentedin

HealthBridgeFlowsheet/PointofCareTesting

CriticallyIllPatientsForthePurposesofGlucosePointofCareTesting

*CAPILLARYsampletesting(fingerstickblood)mayNOT beused*

ForthePurposesofGlucosePointofCareTesting:“CriticallyIll”patientsarethosewith:

• Unstablehemodynamics– lowperfusionindex,useofvasopressor,presenceofedemaandlowmeanarterialpressure

• DecompensatedheartfailureNewYorkHeartAssociationClassIV• SevereDehydrationasaresultofdiabeticketoacidosisorhyperglycemichyperosmolarnon-ketoticsyndrome

• Arterialocclusivedisease

Check‘CriticallyIll’Patients:OptionOne

UsingtheNovaStatStripMeter

• Collect ArterialorVenousbloodsample• PerformglucoseontheNovaStatStripProcedure:

ØCollectbloodinalithiumheparincollectiondevice(ABGsyringe)

ØDrawappropriatediscardsampletoclearthearterialorvenouslinebeforedrawingabloodsamplefortesting.

ØSamplemustbetestedwithin30minutesfromcollection.

ØIdentifyspecimensourceasArterialorVenousØPlacebloodsampleonNovaStatStripandfollowtestingprocedure

SendawholebloodspecimentotheLab

Procedure:

• Collectbloodinagreytoptubeor addonaglucosetesttoanarterialorvenousbloodgassenttolab.

• Drawappropriatediscardsampletoclearthearterialorvenouslinebeforedrawingabloodsample.

Check‘CriticallyIll’Patients:OptionTwo

FingerstickGlucose:WhentoCheck?

qMorningfingerstickglucoseischeckedatorafter7:00a.m.,unlessclinicallyindicatedorperunitpolicyorprescriber’sorder(Rehabilitation,OB,CriticalCare,etc.).

q Fingerstickglucosemustbechecked:Within1hourpriortoadministeringprandialorcorrectioninsulin.Ifitismorethan1hoursincethetimeofthetestandinsulinadministration,testagain.

CareofVisitorsandEmployees

•UseoftheGlucoseMeterisNot forScreening

•DoNOTusetheGlucoseMetertocheckavisitor’soremployee’sbloodglucose

Ø EmployeesorvisitorswhoareillMUSTbeReferredtotheEDimmediately

AllOperatorsmustfollowthere-certificationscheduleandrecertificationtestperformancerequirements:1. InitialCertification2.Renewin6months,andthenagainin6months,then….3. AnnuallyRe-certification Steps- Goto:http://www.downstate.edu/ogm/Step1:ReviewtheRe-certificationpresentationStep2:Complete thePostTestStep3:UponsuccessfullycompletionofthePosttest,printyour

CertificateofCompletionforyourrecords.Step4:Completetwolevelsofcontrolsandonepatienttestonyour

unitimmediatelyaftercompletingtheexam

Re-certificationInstructions

Troubleshooting Meters and Patient IdentificationPossibleProblem Recommended Solution

Scanningofbarcodeormanualentryofstriplotnumber,QClotnumberorOperatorIDnumberinerror

Checkandre-scanormanuallyre-enterPatientFinancialNumber

ScanningormanualentryofPatientMedicalRecordNumberinsteadofPatientFinancialNumber

Checkandre-scanormanuallyre-enterPatientFinancialNumber

GlucometerdidnotobtainpatientregistrationinformationfromHospitalRegistrationSystembecausemeterwasnotdocked(wired)orbatterylowpreventingcommunication(wireless).

Dockmetertoallowglucometertoobtainupdatedpatientregistrationandfinancialidentifierinformation.

ErrorinmanualentryofPatientFinancialNumber Checkandre-scanormanuallyre-enterPatientFinancialNumber

UseofanunreadableordamagedPatientFinancialNumberbarcode

Check,reprintPatientIDbarcodeandre-scanormanuallyre-enterPatientFinancialNumber

GlucometertestingmustbeperformedpriortopatientregistrationbecauseofanEmergencysituation

AppliesONLYtoED,NICU,L&DandCATHLabareas.Non-RegisteredPatientProceduretobefollowed.

ALLotherunitsmayNOTperformtestingwithINVALID,NEWorNOTINSYSTEMpatientfinancialnumbers.OperatorMUSTinvestigateandcorrectbeforetesting.

Point of Care Glucose Training

Thank you for viewing the POC Glucose Training presentation

Click here to take the Post-Test