36C26219R0026-026.pdf

VISN 22 Consolidated Pathology & Laboratory Medicine Service

VA Loma Linda Healthcare System Loma Linda, CA 92357

Issue Date:

01/15/2019

Approved by:

Heather Rojas (Physician)

Version

Document Owner:

Marilyn Malto (ATC)

POC-S8531.A3 NURSING JOB AID FOR ACCU-CHEK INFORM II WHOLE BLOOD

GLUCOSE TESTING

Printed copies are for reference only; Please refer to the electronic copy for the latest version

PROCEDURE DOCUMENT: Policy and procedure is found in:

- SHAREPOINT: Intranet -> Sharepoint –> Policies & SOPs -> SOPs –> Pathology and Laboratory ->

Laboratory Handbook –>Double click on “POC-S8531 ACCUCHEK INFORM II PROCEDURE”.

- CPRS: Tools-> Policies & SOP->Pathology and Laboratory->Laboratory Handbook->Double click on

“POC-S8531 ACCUCHEK INFORM II PROCEDURE”.

ACCESS CODE: It is against policy to use access codes belonging to other staff or lending your access code to other staff. Access to meters will be temporarily or even permanently disabled if found non-compliant.

Call (909)503-2865 or check with site trainers with any problem including request for a reprint or concern about your access code.

PATIENT IDENTIFICATION: Inpatient -> Scan patient’s armband and must confirm at the meter before testing.

Outpatient-> Use two patient identifiers before manually entering patient’s ID into the meter. DO NOT scan patient’s VHIC cards.

MAINTENANCE: Wipe visibly blood contaminated meters with Sani-Cloth Bleach Disposable Germicidal wipes or Super Sani-Cloth Disposable Germicidal Wipe for meters with no visible blood after each patient testing, Allow the surface of the meter to remain damp, 4-minute contact (dwell) time for Sani-Cloth Bleach Disposable Germicidal wipes and 2-minute contact time for Super Sani-Cloth wipes. Use Sani-Cloth Bleach Disposable Germicidal Wipes after using the meter on a patient with or suspected carrier of C.dificile, with a contact (dwell) time of 4 minutes. Meters could be dried thoroughly with a dry cloth or gauze after the required contact (dwell) time.

1. DO NOT disinfect the meter while performing a patient or control test.

Meters are disinfected by gently wiping the outside of the meters three times horizontally and three times vertically and three times wrap around avoiding the strip port. Air dry and visually verify that no liquid is seen in the strip port. Ensure that meter is thoroughly dried before returning to its base or before use.

2. Disinfecting base unit. Wipe visibly blood contaminated base unit with Sani-Cloth Germicidal Bleach

Wipes or with Super Sani-Cloth if no visible presence of blood. Do not wipe over the black connector in the base unit cradle at the back of the unit. If solution enters these areas dry it off immediately using soft dry cloth or gauze. Visually verify that connector area and cables are dry before plugging the cables into the base unit.

QUALITY CONTROL: Add the comment “Cleaned Monitor” after testing and passing liquid controls Double check level of QC bottle/solution before dosing.

1. If both, Level 1 and Level2, quality control test result “PASS” (falls within the acceptable control range), it is acceptable to proceed with patient testing.

2. If a quality control result fails:

a. First “FAIL” – Check lot #s and expiration dates. Gently remix. Repeat test. Add comment “Will

Repeat the Test”

b. Second “ FAIL” – Repeat testing using a new bottle of strips and a different bottle of control.

c. Third “FAIL” - DO NOT USE THE METER FOR PATIENT TESTING. Call the Ancillary Testing

Coordinator at 503-2865 or ext. 1957 to help troubleshoot the problem.

d. If the Ancillary Testing Coordinator is not available, borrow a meter, reagents and QC controls from another ward, or send patient sample to the lab for testing.

3. Any quality control result that falls outside the acceptable control range, along with any corrective action to restore that result to acceptable range, must be acknowledged using proper comment codes.

4. In areas where the Accu-Chek Inform II System is not being used daily, quality control must be performed and passed before patient testing. Note: Never use control solution intended for outpatient meters.

RESULTS: (MUST) Add comment “Cleaned Monitor”and “Action Taken” after each patient testing.

v It is very important to turn off and dock the meters after testing to upload results to VISTA and CPRS and to recharge battery.

v In the event that computers are down results can be retrieved directly from the meter under “Review Result” menu, then type the full SS# (patient ID).

VISN 22 Consolidated Pathology & Laboratory Medicine Service

VA Loma Linda Healthcare System Loma Linda, CA 92357

Issue Date:

01/15/2019

Approved by:

Heather Rojas (Physician)

Version

Document Owner:

Marilyn Malto (ATC)

POC-S8531.A3 NURSING JOB AID FOR ACCU-CHEK INFORM II WHOLE BLOOD

GLUCOSE TESTING

Printed copies are for reference only; Please refer to the electronic copy for the latest version

REPEAT TESTING:

Ø Make sure to wipe first drop of blood Ø Repeat testing can be done on the same 2nd drop of blood Ø Two separate meters can be used for immediate repeats.

Ø Multiple testing can be done from 1 drop of blood

1. If Hypoglycemic value of <60 mg/dL (includes critical low values <50 mg/dL), and > 400 mg/dL,

2. Results that are “LO” (<18 mg/dL) and “HI” (>600 mg/dL)

Note: Draw lab glucose if results from repeat testing are still <18 or >600 mg/dL and document in the hypo/hyperglycemic template if Provider opts not to draw lab glucose.

3. When error was detected on the first testing. Document in the hypo/hyperglycemic template.

4. When result contradicts the patient’s condition.

5. If first and second result has >10% difference (draw blood and send to Lab for testing).

Note: 10% calculation is to make sure we are in compliant with the manufacturer’s and/or regulatory agency’s requirements to confirm accuracy of results.

HYPO/HYPERGLYCEMIC TEMPLATE in CPRS:

1. To be used when: hypoglycemic value of <60 mg/dL (includes critical low values of <50 mg/dL) and >400 mg/dL, (LO) <18 mg/dL or (HI) >600 mg/dL.

2. Must be created by staff that performed the glucose finger stick. Follow up can be added as addendum.

3. Select patient - New note – Assign Location (ward/unit/module) – ok – Type Hypo as the “Progress

Note Title” – Fill in template - Sign note.

4. Document follow-up intervention under Addendum:

To add Addendum : Select patient -> Select pertinent template –> Options (Make Addendum) –>

Template –> Shared –> Hypo/Hyperglycemia –> Double click Hypo/Hyperglycemia Adverse Note –> Fill in template –> Sign note.

COMMENTS: - Add “Clean monitor and Action Taken” every patient testing.

- Add “Clean monitor” to every control testing.

- 3 comments can be added to a result. These comments are to reflect any follow up done and/or acknowledgement of correct results.

CALIBRATION: Code key comes with every single box of strip, and serves as calibrator. Strip code is now programmed electronically by the Ancillary Testing Coordinator so it is not required to change code key every time a box of strip is opened. Never use strip that are intended and distributed for outpatient meters.

LIMITATIONS:

• The AccuChek Inform II meter must not be used in a critically ill patient.

• Critically ill is defined as patient requiring ventilator, with mean arterial pressure <60 mmHg despite the use of vasopressor agents.

• If peripheral circulation is impaired, collection of capillary blood from the site is not advisable as the results might not be a true reflection of the physiological blood glucose level. This may apply during severe dehydration as a result of diabetic ketoacidosis or hyperglycemic hyperosmolar non-ketotic syndrome, hypotension, shock, decompensated heart failure NYHA Class IV or peripheral arterial occlusive disease.

TROUBLESHOOTING: Liquid Controls must be run when accuracy of result is questionable or when meters are suspected of malfunction. If Liquid Controls fail, don not use meter,then draw blood and send it to the main laboratory. Label non-functioning meter and bring it to the Ancillary Testing Coordinator for further troubleshooting.

It is mandatory to report all problems encountered during the use of these meter by calling or texting (909)503-2865), Ancillary Testing Coordinator anytime. DO NOT LOG IN TICKET FOR

BIOMED NOR IT.

2019 TEST PATIENT SS#: 000001026 = 401