point of care (poc) glucose testing · nova statstrip test: strip vials statstrip vials: •...
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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.
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