DEPT: Nursing/Lab

PANA COMMUNITY HOSPITALEFFECTIVE DATE:9/09,12/10,02/11,04/13,6/13,2/15

POLICY AND PROCEDUREPREPARED BY: NW / HJ

APPROVED BY: VCoen &

Dr. A.Frigy, POC/Lab Director

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POINT OF CARE BLOOD GLUCOSE MONITORING

PROCEDURE

The following equipment should be at the patient’s bedside prior to testing:

Blood Glucose Monitor

Appropriate test strips

Lancets (single-use, auto-disabling type)

Alcohol swabs

Cotton ball, tissue, or gauze for wiping finger after stick

Disposable gloves (per standard precautions)

Identify the patient per PanaCommunity Hospital policy; minimum of two unique identifiers name/birthdate.

Follow instructions in operation manual for testing as found in section 3 of manual. Operating

Manualis available online on the shared drive and a paper copy is available in each department,

if necessary.

In the event of a result below 50 or above 400 (PCH Critical Value), or concerns about the

validity of the result, the test will be repeated. If the results are consistent, the attending

Physicianshall be notified for further orders.

Results are documented as follows:

Med/Surg documents in the EMR on the flowsheet under measurements which will “flag” a result outside the PCH normal range.

ED documents on the Nursing Record

CardioPulmonary Rehab documents on the patient record

Surgery documents on the Same Day Surgery Form.

Pana Community Hospital reference lab normal range on a fasting capillary glucose is

70-110 mg/dL. These will be considered as normal limits for the POC testing.

The machine is cleaned/disinfected after each patient use per the operating manual.

CONTROLS

Following the directions in the operating manual the quality controls will be done each day of use. The monitor will be locked out for testing until the QC has been done. If the quality controls fall outside the parameters on the strips, repeat, and if still out of compliance use a different meter for patients until the machine in question can be checked.

The control material expires 90 days after opening unless the manufacturer’s expiration date is prior to the new expiration date. The expiration date must be clearly written, avoiding writing over the manufacturer’s expiration date, on each control solution. Check expiration dates prior to each use and discard if the control solution is not labeled according to these guidelines.

INTENDED METER USES

Pana Community staff is educated and trained on the proper and intended uses and limitations for performing a capillary or fingerstick blood glucose test in accordance with the Precision Xceed Pro operator’s manual.

The meter alone is not used to diagnose diabetes or other conditions which may be noted by extremely low or high blood glucose levels. Test results are to be interpreted with respect to the patient’s condition.

Unexpected low or high glucose levels are to be repeated and confirmed through laboratory venous samples.

Caution is to be used when patients are critically ill and a fingerstick capillary sample is obtained as an assessment indicator by nursing personnel. All blood glucose results are to be confirmed through the laboratory venous sample prior to initiation of treatment for the patient.

LIMITATIONS

  • Not designed for use with serum or plasma samples.
  • Hematocrit range must be between 20%-70%.
  • Test results may be erroneously low if the patient is severely dehydrated, severely hypotensive, in shock or in a hyperglycemic-hyperosmolar state (with or without ketosis).

QUALITY CONTROL REPORT

All licensed Nursing personnel and licensed CardioPulmonary staff are authorized to do POC testing after initial training and meeting competency assessments.

Quality information will be downloaded once a week (Thursday) following the instructions in the operating manual. The Laboratory Management team will be responsible for review, maintenance, and reporting to the proper entity this information.

Nursing staff (glucometer operators) will be given competency exams on hire, semiannually thefirst year, and then during annual performance review for Point of Care testing. A passing grade of 80% must be obtained on the exam or it will be repeated until such grade is obtained.

If maintenance or repair is performed on a meter or a new meter is obtained from Abbott the following procedure is to be followed prior to the meter being entered into service in a patient care area.

Laboratory personnel will perform linearity testing to validate the AMR (analytic measurement range):

  1. Laboratory personnel will order calibration verification controls from Abbott.
  2. The linearity procedure in the Precision Xceed Pro Operator’s Manual will be followed.
  3. The data will be downloaded to precision Web.
  4. A Linearity graph will be printed per manual instructions.
  5. The graph will be submitted to the Pathologist for review.
  6. After approval of the Pathologist, the meter will be placed into service.

REVIEWED / REVISED

______Alan F. Frigy, MD

Pathologist/POC Director

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