Module 2: Testing Controls and Patients Module Objectives How to run control samples How to run patient samples

Performing a Control Test Press on-off button to turn meter on. Select 2 - Control test Two levels of control: Low and High Controls are run once every 24 hours. Patient testing cannot be performed without successfully completing control testing.

Scan Operator Identification When scanning the barcode hold the glucometer 3 - 12 inches away from the barcode. A red line is visible when the scan button is pressed and held.

Scan Control Bar Code Scan control bar code. Make sure to run the control that is scanned. Once strip is scanned, the meter will evaluate for appropriate control values.

Scan Strip The strip used for control testing should be scanned just prior to use. Once scanned the foil packet is opened and the strip inserted into the sample port of the meter. Scan test strip lot number

Open and Insert Strip The strip is inserted into the glucometer with the contact bars facing up and toward the meter. The end that the sample is applied to is furthest from the meter. No fluid should come in contact with the meter.

Controls Controls are two levels: Low and High When initially opening control bottle, label it with your initials and a 90 day expiration date. (example: today is 02/08/11 the expiration date would be 05/08/11 – write Exp. 5/8/11 on bottle). Note that if the manufacturer’s expiration date of the bottle is less than 90 days, use the expiration date on the bottle. Controls should be stored at room temperature. Gently roll the controls to mix prior to use.

Control Application Open control vial and wipe tip with a clean gauze to remove excess or dried control fluid. Glucometer will prompt you to apply control solution. Apply drop of control. Meter will indicate sample accepted. Make sure you use the correct level of control. Apply a small drop of control solution to test strip target area

Keep Glucometer Horizontal Do NOT let control solution run into sample port! Keep meter horizontal (flat) to avoid contamination. Do not lift meter to view display until after the test strip has been removed.

Control Result Display The monitor will display the control test result after the countdown is complete. Results will display as Pass/Fail. Repeat procedure using the second level of control. Both levels of control must be in the PASS range to run patient testing. Failed control testing should be repeated. A second failure needs to be investigated. Upon second failure open new control and repeat control testing. If controls are in range, resume patient testing; if controls are still out exchange meter in the Laboratory.

Sampling onto the Strip Always clean the puncture site and allow site to dry. Use whole blood collected by appropriate collection procedures.

Sample Collection Methods Most samples are collected on adults and children following the finger stick collection method. Heel sticks are performed on infants. Whole blood collected from line draws is acceptable provided the collection is done appropriately.

Performing the Patient Test Verify Physician Order to perform glucose testing. Identify patient (two identifiers). Turn glucometer on. Verify two levels of control were performed (meter will indicate if controls are needed). Scan or enter Operator Identification by scanning barcode on back of employee KH ID badge. Scan patient wristband. (If patient is not registered manually enter designated ID#, or press “alpha” key, and enter patient last name, first name using appropriate keys.) Scan test strip barcode. Open strip and insert into meter with contact bars up and facing the meter. Perform blood collection procedure and place drop of blood onto test pad. Keep meter horizontal. Meter counts down time to result. Result will display in mg/dL. Discard strip and collection supplies as regulated medical waste. Thoroughly wipe down meter with CaviWipe. Dock meter to transmit patient results into PowerChart.

Performing a Patient Test Patient testing should be performed as indicated by the physician orders. To begin patient testing, press the power button on the meter to turn the meter on.

Finger Stick Preparation Perform hand hygiene. Instruct patient to perform hand hygiene with soap and warm water if possible. Patient’s hands should be warm. Position patient comfortably. Put on clean disposable gloves. Choose puncture site; it should be vascular. In adult or child, select lateral side of middle or ring finger, be sure to avoid central tip of finger, which has a more dense nerve supply. Hold finger to be punctured while gently massaging finger toward puncture site. Clean site with alcohol pad and allow to dry completely. Do not wipe dry.

Finger Stick Puncture Prepare lancet. Place lancet firmly against puncture site on finger and depress lancing device, piercing skin. Lancet should be held perpendicular to puncture site. After use, discard lancet into sharps container only. Wipe away first drop of blood with clean gauze. Lightly squeeze puncture site to form a second drop and apply to glucometer strip as prompted. Apply pressure to the puncture site with 2nd clean gauze until bleeding stops. Apply band-aid to the puncture site – only if necessary. Clean up used supplies and dispose of into regulated medical waste. Remove gloves and perform hand hygiene.

Performing a Patient Test Select 1 - Patient Test. Scan your operator identification (barcode on the back or your name tag).

Operator Identification Options Scan bar code on the back of your Kaleida Health Identification Badge.

Scanning the Operator Identification When scanning the barcode hold the glucometer 3 - 12 inches away from the barcode. A red line is visible when the scan button is pressed and held.

Patient Identification After using 2 patient identifiers to confirm the patient’s identity, scan the patient’s wristband barcode to enter the patient’s FIN NBR into the Glucometer. If a patient is not identified by this method the result will not cross into the patient’s chart.

Caution Patient Identification Entry of random numbers as a patient identification may lead to failure of results to post in the correct medical record. This could also result in results posting to the wrong medical record. Always properly identify the patient being tested with 2 patient identifiers. If performing BGTs on multiple patients (and leaving the glucometer power on), it is NOT necessary to re-scan operator ID each time. Always read and follow instrument prompts.

Strip Identification The strip used for patient testing should be scanned just prior to use. Once scanned the foil packet is opened and the strip inserted into the sample port of the meter. Scan the test strip barcode

Inserting the Strip The strip is inserted into the glucometer with the contact bars facing up and toward the meter. The end that the blood is applied to is furthest from the meter. No blood should come in contact with the meter.

Apply the Blood Sample to the Target Area of the Test Strip

Result Display

Glucometer Result Range Glucometers are validated to report adult glucoses from 50 mg/dL to 400 mg/dL. The normal range for an adult or child fasting glucose is 60 – 110 mg/dL. If results are less than 50 or greater than 400 mg/dL the person performing the test (if other than a Nurse) must notify the Nurse immediately and it is recommended that a venipuncture is performed and a sample is sent to the Laboratory for a STAT glucose confirmation. It is important to let the laboratory know that the venous sample is a confirmatory for a BGT. Order Glucose as a STAT in PowerChart. Send sample with the glucometer result written on the barcode label affixed to the tube for follow-up by the laboratory.

Comment Codes If QC fails or if a patient result is <50 or >400 mg/dL the meter will prompt you to “Scan or Enter Comment Code”. Comment codes are located inside the top lid of the glucometer storage box. Enter comment code number and press the ‘Enter’ key. Once comment code is entered, meter will prompt you to repeat test or perform next patient (or control).

Comment Codes 1 – Repeat Test 4 – Procedure Error (i.e., applied wrong control) 9 – STAT Glucose sent to Laboratory 11 – Patient Refused Draw 99 – Training

Interferences REASONS GLUCOSE RESULTS MAY BE HIGHER THAN EXPECTED: Hematocrit too LOW (<20%) Serum or plasma samples used instead of whole blood Room temperature too high (>104 degrees F) Relative humidity too high (>90%) Venous blood tested in capillary or arterial mode REASONS GLUCOSE RESULTS MAY BE LOWER THAN EXPECTED: Hematocrit too HIGH (>70%) Relative humidity too LOW (<10%) Interfering substance present (Acetaminophen >100 mg/mL) Hyperglycemic-hyperosmolar state (with or without ketosis) Severe dehydration, hypotension, or shock Water or alcohol remaining on the puncture site. Venous or arterial whole blood sample not tested within 30 minutes after collection

Maintenance Glucometer must be cleaned with a CaviWipe after EACH use! Never spray cleaner on the meter. Port protector needs to be cleaned with a CaviWipe when visibly soiled and should be replaced when resistance occurs upon strip insertion.

Glucometers must be cleaned with CaviWipes after EACH use Studies have shown that failure to clean glucometers after each use can result in blood-borne pathogen transmission between patients! Glucometers must be cleaned with CaviWipes after EACH use

Additional Resources Kaleida Policy LB-POC-01 Quick Reference Guide Reference Card (inside case lid) Operator’s manual located in laboratory

The Next Step Please complete the 2011 Glucometer Course and quiz on Kaleidascope in Talent Management. Upon scoring 80 – 100% on the quiz, please print a copy of your Certificate of Completion (in Learning History on Talent Management) Make an appointment to demonstrate competency for glucometer testing. Contact Clinical Education. Once you have successfully completed all steps your recertification date will be updated into the glucometer.

To access your Certificate of Completion Log in to Talent Management, select the Learning tab, then select Learning History from the drop-down menu. Under 2011 Glucometer Review, select ‘Print Completion Certificate’. Bring this certificate to Clinical Education.

Thank you Thank you for completing this portion of the training. Point of care testing is a responsibility, and in performing testing you need to be committed to doing it properly. If you have questions or concerns please contact us in Clinical Education or your site Laboratory. We are committed to providing the highest quality testing - YOU play a key role!