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Cascade Training for Blood Glucose Meter

Working in Partnership


Cascade Training Introduction This resource folder has been provided for your information when carrying out training with your counterparts. Please feel free to add any other relevant diabetes information. If you have any questions or concerns, please do not hesitate to contact:

HOSPITAL CONTACTS:


Hazard Warning Notice The need for Quality Assurance and Training in the use of Blood Glucose Meters was identified in the hazard warning notice (HN(hazard)(87)13). The notice states that: “Use of Blood Glucose Meters by untrained staff, without adequate management supervision of the equipment and without the use of Quality Control Procedures, can lead to misleading results, adversely affecting the treatment of patients.”

The Hospital Procedure for following the guidelines set by D.O.H is as follows:

Quality Control must be carried out every 24hrs All staff must be trained prior to using the PCx meter for the first time

! !


Health and Safety Health and Safety is very important when using the Glucose Meter in your clinical environment. To ensure standards are met, please adhere to the following guidelines:

• Always clean patients’ hands/fingers prior to doing a test. (Especially if the patient has been reading a newspaper, eating fruit etc.)

• Take the workstation with you to the patient’s bedside.

• Take small sharps bin with you to patient’s bedside.

• Wash your own hands and put on gloves prior to testing

patient.

• Dispose of all used SHARPS AND STRIPS in sharps bin. DO NOT PUT USED SHARPS BACK IN WORKSTATION!

Always ensure meter is clean after use and workstation left tidy and safe.

Optium Xceed™

First User Training

Optium Xceed™ Meter

Oversized Backlit Display

Backlight Button :On / Off

Forward Scroll Button* :* For HOME PATIENTS ONLY

Scrolls forward through memory & averages

Changes settings i.e. date, time, etc.

Access LOT Memory & Error CodesMode Button :On / Off

Assigns Control Icon to QC Tests

* For HOME PATIENTS ONLY

Switch from Memory ~ Averages

Access Change Settings Mode

Access LOT Memory & Error Codes

Strip Port :Highlighted yellow for easy identification

Strip & Precision Link Port

Back Scroll Button* :* For HOME PATIENTS ONLY

Scrolls back through memory & averages

Changes settings i.e. date, time, etc.

Battery Cover (at rear) :1 x CR2032 Lithium Battery

Optium H™ Test Strips

20 Second Test Time

Individual Foil Wrapped Strips

Tip/Top Fill

Fill Trigger electrode designed to prevent short sampling

Free From Many Common Interferents

Apply a second blood drop within 30 seconds

The MHRA say training should include

• Basic principles of testing

• Demonstration of proper use of system

• Consequences of improper use

• Instruction in sample collection

• Instruction in the importance of complete documentation of all results

• Appropriate calibration and QC testing

• Practical experience to satisfy instructor that trainee is competent

Calibration

• To obtain an accurate blood glucose reading, the meter must be calibrated once for each new box of electrodes

• Retain the calibration bar for the duration of that box

• The meter will beep once the LOT number is displayed (if beep function activated)

Blood glucose testing

• Open the test strip using the triangular notch in the foil

• Fresh test strip for every test


• Insert test strip and check display,

• Check lot number

• Wait for flashing symbol

•(b)

•(a)

Prepare the sample site then:

• Collect a drop of blood

• Touch and hold the drop of blood to either tip or top of strip

• Strip sample chamber provides a visual confirmation of sufficient sample

• Move finger away from the electrode when ascending bars appear at the top of the display (beep sounds if activated)



• The meter will count down from 20 seconds

• If the test fails to start, a second drop can be applied within 30 seconds of applying the first drop of blood

Result & Memory

• The result will be displayed (beep will sound if activated) and the meter will automatically turn itself off after 60 seconds

• To access the last results only press the centre on/off button once. The last result will appear, immediately followed by the test result recorded with the date and time

(Please note: The Optium Xceed™ can display the last 450 blood glucose readings with date and time, this feature is only for patients testing at home)

Display messages

Message Explanation• LO Result less than I.I mmol/L• HI Result above 27.8 mmol/L• KETONES? Result higher than 16.7 mmol/L

Battery Icon;• Displayed with results Batteries becoming low• Displayed alone Batteries exhausted

Display messages

Message Explanation• Test Error 1 Temperature

• Test Error 2 Meter Error

• Test Error 3 Test Strip Error

• Test Error 4 i) Extremely high result

or

ii) Problem with test strip

• Test Error 5 Blood applied too soon

• Test Error 6 Calibration error

• Test Error 7 Damaged strip

• Test Error 8/9 Meter Error – contact CCL

Limitations of use

• All meters have limitations and these are detailed in every box of test strips in the insert

• The system should always be used within these limitations to ensure accurate results and prevent inappropriate treatment

• For the majority of tests the limitations will not be an issue

Limitations of use

• Care should be taken with those patients who are extremely unwell particularly if they are:

- Severely dehydrated

- Severely hypotensive or in shock

- In a hyperglycaemic-hyperosmolar state e.g. DKA

• In these cases test results may be erroneously low

• If in doubt, send a venous sample to the lab

How to ensure the meter is performing correctly

• By running Quality Control tests on a regular basis, as per your hospital protocol

• Use MediSense Control Solutions

• To adhere to shelf-life, date bottles once opened and use within 90 days

• Check results against inserts

Demonstration

• Take a meter and perform a test using a capillary sample or the control solutions

• For the quality control tests find the record book and document your result

The importance of performing QC Tests

• If QC is not performed, misleading results may lead to inappropriate treatment

• Always record the results

• Follow your hospital protocol to avoid putting your patients at risk

• Under MHRA (Medicines and Healthcare products Regulatory Agency)guidelines it is your responsibility to perform/document QC results

• This should be in accordance with the manufacturers instructions, detailed in a Standard Operating Procedures (SOP)

Standard operating procedure

• According to MHRA guidelines on near patient testing there must be an SOP in place wherever POCT is performed

• Abbott supply the department with instruction manuals and procedures for the use of all Abbott blood glucose testing equipment

Standard operating procedure

• It is essential that any SOP’s written by the hospital reproduce the instruction manual guidelines exactly

• SOP’s must be regularly reviewed by a nominated person to ensure they follow the CURRENT VERSION of the manufacturers instructions

• Failure to adhere to the most current instructions could result in you as an individual being liable for any error in testing

Source: Management and use of IVD point of care devices – MDA bulletin

External Quality Assurance (EQA)

• Whereas QC is a means of checking the patient results are reliable, EQA involves the analysis of samples with unknown values from anexternal source

• These may be sent out on a regular basis from the laboratory

• Results are then subject to analysis to compare results across different sites

MHRA say training should include;

• Basic principles of testing

• Demonstration of proper use of system

• Consequences of improper use

• Instruction in sample collection

• Instruction in the importance of complete documentation of all results

• Appropriate calibration and QC testing

• Practical experience to satisfy instructor that trainee is competent

Any Questions?

Post Training Quiz1. What type of glucose meter do you have in the ward/department?

2. What are the strips called which you use in this meter & where can you get them from?

3. What is calibration and when should you carry it out?

4. Which way do the strips go in the meter?

5. Can you apply a second drop of blood to the same strip?

6. Do you clean hands before you do a test?

7. How often should Quality Control Tests be carried out?

8. What does "Ketones?” mean?

9. What does “LO” mean?

10. What does “HI” mean?

11. How long do the Q.C solutions last for?

12. Can the batteries be replaced?

13. What types of batteries are required?

14. Where do you get replacement meters?

Post Training Quiz Answers1. The Optium Xceed™ meter is used in this department

2. Optium H strips are used with the meter & are available from pharmacy

3. Calibration sets the meter up to use a particular box of strips & should be carried out whenever a new box of strips is opened

4. The test strip should be inserted with the contact bars facing up

5. You can apply a second drop of blood within 30 seconds

6. You should always clean your hands before performing a test

7. QC tests should be performed within the guidelines stated on page 2

8. KETONES? = Blood glucose is above 16.7 mmol/l

9. LO = Blood glucose is below 1.1mmol/l

10. HI = Blood glucose is above 27.8 mmol/l

11. QC solutions last 90 days from opening

12. Yes, the batteries can be replaced by the user

13. The Optium Xceed™ uses 1 coin cell battery (CR2032)

14. To obtain replacement meters please refer to the details on page 2

Congratulations !

You have completed the training session

Thank you


Cascade Training Checklist Please make sure you go through the following tasks with your trainee and tick off once completed. • Hazard Warning Notice • Optium Xceed Workstation • Calibration Procedure • Blood Glucose testing procedure • Display messages • Health and Safety • Quality Control Procedure • Post assessment Quiz Date training carried out: Print Name Trainer……………………………………………… Signature Trainer……………………………………………… Print Name Trainee…………………………………………….. Signature Trainer……………………………………………… To be retained by trainee


Name of Hospital……………………………………………… Name of Ward or Department ………………………………………………

Date Trainer Print Name

Trainer Signature

Trainee Print Name

Trainee Signature

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