A Quality Improvement and Patient Safety project for Kaleida Health

April 2010

Kaleida Health’s commitment to patient safety is:

That all diagnostic testing and procedures are performed as ordered by accreditation agency mandates

To have, and follow, a consistent, concise and accurate means of identification confirmation when performing blood glucose (BGT) point of care testing (POCT).

How Kaleida will reach this National Patient Safety Goal (NPSG)

Double identify all patients prior to any treatment-

Why is this so important?Patient ID errors have the potential to occur

during all phases of treatment and diagnosis.Our mandate by accreditation agencies is to

reliably :identify the individual as the person for whom

the service or treatment is intended, and to match the service or treatment to that

individual.

After much consideration, BGT was chosen as the stepping off point.

Why the emphasis on double identifiers for Blood Glucose Testing?

Test is performed frequentlyNumber of tests performed make it high

volumeBGTs are done in all patient care areas

Moving forward all POCT will have similar requisitions for use in double-identifying patients

What is the new process?1. Obtain a written order from an LIP (MD,

NP, PA) for BGT testing.2. Make sure order specifies:

Patient name Frequency of testing Date and Time.

3. Enter this as a new order in PowerChart

How do I enter the order in PowerChart?1. Click on Nursing Orderable>Request for POCT>Glucose Finger

stick, then enter requested information:� Routine/Priority � Requested date and time of start� Frequency � Duration

2. Place the requisition that prints from your unit printer in the

designated time slot of the BGT binder or folder.

Duplicate orders

Duplicate warning alert

Check for duplicate orders

If you find a duplicate requisition cancel it!To cancel or d/c

1. Enter PowerChart2. Go to Nursing Orderable 3. Highlight the desired occurrence- make

sure you have the correct occurrence4. RIGHT click5. Chose the occurrence to cancel or d/c

To d/c all occurrences – d/c the parent order and all child orders associated will also be cancel

To d/c the individual occurrence just cancel that single occurrence.

Be careful!Perform the right test

on the right patient at the right time.

Procedure for drawing a blood glucose test:1. Wash hands-

2. Double identify patient using the POCT BGT requisition and patient ID band.

3. Perform the BGT per protocol- Scan the patients ID band (do not scan the

requisition - the requisition barcode is invalid)4. Document results of BGT on requisition5. Communicate the result of the BGT to the nurse

caring for the patient6. Return requisition to the designated folder or binder

on your unit

Results are not normal?Draw a Confirm Glucose Test

Remember: you must draw a glucose in an SST tube and send it to the lab if blood glucose results are: less than 50 in an adult or less than 45 in a neonate.

greater than 400 in any patientBe sure to:Notify the nurse caring for the patient

immediately so that a STAT blood glucose level bar code label can be generated.

Procedure for Confirming a Glucose1. Double identify the patient using the patient

ID band and Bar code label2. Obtain blood sample 3. Label blood sample at the patient bedside,

also indicating the “actual result” on the label4. Deliver STAT sample to the lab5. Document and follow process used for

reporting critical values in the Critical Values Communication Book

Sometimes a confirmation is not required:

If the LIP (MD, NP, PA) determines that a confirm glucose is not required:check the appropriate box on BGT

requisitionreturn the requisition to the BGT book in

appropriate time slot as directed

Note: Order requisition is not a permanent part of the medical record.

What happens if I need a reprinted requisition? For a reprint

1. Enter PowerChart2. Go to Nursing Orderable 3. Highlight the desired reprint- make sure

you have the correct occurrence4. RIGHT click5. Drop down to Print> Reprint Requisition

Down time procedureDowntime procedures for both PowerChart and the Glucometers remain unchanged.

Thank you!Thank you for what you do every day to keep

our patients safe.If you have any questions:

Call Clinical education, the Laboratory, Quality Director,

Or call 859-8740