2Why is Training Necessary Medication & Healthcare Products Regulation AgencyNursing & Midwifery CouncilRCHT: Medical Devices Training PolicyRCNDepartment of HealthCare Quality Commission: Outcome 11 Safe Use of Medical Devices‘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’.MHRA 1996
3Equipment Require on the wards Nova Stat Strip Connectivity Meter and Docking StationWork Station containing:Owen Mumford Unistix lancetsGauze for wiping finger after obtaining sample.Stat Strip Glucose Test Strips, 50 strips per vialStat Strip Glucose Control Solution, Level 1(low), one vialStat Strip Glucose Control Solution, Level 3(high), one vial
4When should you not use the Nova Stat Strip to test glucose? When contraindications are presented.Severe dehydrationDiabetic Keto-acidosisHypotensionUnconscious patientsShockPeripheral Circulatory failureHyperosmolar non-ketotic Coma (HONK)The MHRA recommend that therapeutic decisions should not be based on a capillary sample in these circumstances.Venous samples should be sent to lab for verification of blood glucose level.
5Spare battery at rear of docking station. Charging Light: Amber = ChargingGreen = ChargedGreen light onwhen connectedto the networkCharging Light:Amber = ChargingGreen = ChargedGreen light onwhen data isflowing
6Storage and StabilityThe workstation and contents should be stored between 15° C and 40°C and away from moisture (<85% humidity). The test strips are stable for 6 months after opening. Write start date and expire date on the test strip container The quality control solutions are stable for 3 months after opening. Write expire date on the bottle. Clinical Chemistry will distribute new bottles every three months.
7Please take care to keep moisture out of the test strip area. Cleaning the MeterClean and disinfect the meter after each use using a sani-cloth disinfectant wipe (yellow top), blot with a dry paper towel and then follow with a water dampened cloth to remove any residue of cleaning solutionPlease take care to keep moisture out of the test strip area.
8Children younger than one year Sample CollectionChildren younger than one yearCollect from the lateral areas of the sole (see shaded area in diagram 1)During blood collection, the child must be held with foot facing towards the floor. A site which has all ready been punctured must not be punctured a second time.To improve blood flow you can warm the heel prior to sample collection for example by wrapping in a warm, moist cloth.The heel must be disinfected and then dried completely.
9Children >1yr and Adults Collect capillary blood from the side of the fingertips (see shaded area in diagram 2) Thumb and index finger should be avoided for the puncture.The patient’s hands should be washed with warm soapy water or water and a damp gauze. Alcohol wipes / gel should not be usedCollecting BloodPlease note: the lancets are single-use, disposable devicesTwist the sterility cap, remove and dispose.1. Hold the device between index finger, middle fingerand thumb.2. Press device firmly against chosen puncture site3. Using your thumb, press down trigger completely.4. Remove device from puncture site and dispose in sharps bin as per Trust sharps policy
10How to take a sample using the Nova Stat Strip When the drop of blood appears, touch the end of the test strip to the blood drop.The Strip fills via a “top fill” mechanism. Therefore the meter, with the strip in place, has to be inverted down, onto the drop of blood.The meter will beep when the test strip is full
11Running a patient sample Remove meter from docking station.Press “Login”. Press “Scan” whilst pointing bar code reader at you barcode password. ( meter should be held at least 4 inches from barcode)From the Patient Test screen press “Accept”Scan strip lot number than press AcceptEnter the patient’s 10 digit NHS number (not CR/Hospital number)For patients with unknown NHS numbers scan in the emergency barcode located on the inside of the workstation lid.Follow guidelines for using the lancetWhen ‘Apply Sample’ message appears apply strip to sample site until the meter beeps.Accept or Reject Results ( Comment when necessary, Rejects will require a comment)
12Screen CommentsStatStrip glucose meter reads between mmol/LGlucose: < 4mmol/l - Diabetic - HYPO – TreatGlucose: <4 mmol/l - Not Diabetic – ReviewGlucose: mmol/l -"Normal - No Action"Glucose: > 9 mmol/l - "Review needed"Glucose: > 15mmol/l " Review Ketone TestIf result is greater than 33.3mmol/L, meter displays HIIf result is less than 0.6 mmol/L,meter displays LOThe result must be entered in the patient’s notes, along with any appropriate action taken.
13Report abnormal or unexpected results to nurse in charge or doctor Any sample giving a meter result below 2.8 mmol / L or above 25 mmol / L and any unexpected result not in keeping with the clinical picture or a sample which gives more than one error message MUST be confirmed by sending an urgent venous blood sample to Clinical Chemistry.Any result less than 4 mmol /l or greater than 9mmol/l consistently or 15mmol/l at any one time should be reported to a trained member of the nursing or medical staff.
14Quality Control Regime QC testing checks that the meter is working correctly that you have the correct technique QC testing is mandatory Two levels (level 1 & level 3) If no QC is successfully completed within the given timeframe, the meter will lockout. If QC still fails… Ring POCT IMPORTANT: the meter will ‘lock out’ if the QC fails. Patient tests cannot be performed until successful QC has been performed. In the instance that lockout is activated, both levels of QC (1 & 3) will need to be run
15Trouble shootingData won’t download: Make sure the docking station has a network connection point.Checked but still won’t work. Contact Chemistry!Meter reads flow error: To much blood on the sample stick.QC failure: Check the expiry date on the sample pots and stat strips or to much solution the stick.Bad Strip message: Try new stripBad Sample: Take another sample verifying puncture site is suitably clean.