SURESTEP®FLEXX GLUCOSE MONITOR Nursing Orientation Ann E. Snyder MT(ASCP) Point-of Care Testing Coordinator

OBJECTIVES Upon completion of this presentation the participant will be able to: Describe use and storage of glucose test strips. Describe use and storage of glucose control solutions - High and Low Identify the function and location of key parts of the SureStep Flexx Glucose Monitor. Describe the process for cleaning the Glucose Monitor

OBJECTIVES Demonstrate use of the SureStepFlexx glucose meter by: entering operator ID using the barcode scanner testing quality control Guiding Messages/QC Messages for FAILED quality control entering Visit number (V00XXXXXXXXX) State critical ranges for adult/ pediatric and neonatal patients.

OBJECTIVES Demonstrate how to review patient data stored in the glucose meter. Explain the process for ordering necessary equipment and supplies for glucose testing. Describe requirements for 6 month competency/ Annual Certification. Location of the four (4) policy/procedures pertaining to glucose testing at GBMC.

SureStep®ProTest Strips (Reagents) Lot #, code # and expiration date are located on the side of the reagent bottle. Document open date on vial when first opened. SCOTCH TAPE IS OUR FRIEND Test strips can use capillary, venous or arterial blood. Store tightly capped in original bottle Remove test strip and replace cap (twist closed) immediately. Introduce test strips, have group turn strips over to note change in structure and absorbency.

SureStep®ProTest Strips (Reagents) Do not transfer test strips to a new bottle or other container. Do not use if bent,torn,cut or damaged in any way. Discard unused portion four (4) months after opening bottle!

SureStep®Pro Glucose Control Solutions LOW and HIGH levels of quality control tested once every 24 hours when testing patients. Lot # and expiration date located on side of bottle. Solution expires in 3 months after opening - Discard unused portion. Do not refrigerate, store at room temperature. CAUTION: Solution contains dye that stains clothing. Always shake solution before testing.

SURESTEP FLEXX BLOOD GLUCOSE MONITOR Where is the: On/Off Button LCD Touch Screen Quick Keys Test strip holder Serial number Battery Replacement Barcode Scanner Provide demonstration of key parts of the machine. You should ideally have one per person or have one per table of 2 people (if limited supply).

Cleaning the Meter DO: DO NOT: Disinfect/Clean as warranted, tap water ONLY. Clean strip holder by popping out and placing under running water. Gently wipe lens area with a damp cotton swab. Document “Cleaned Meter” in the QC Notes. DO NOT: Submerge in water. Use paper towels, alcohol, glass or abrasive cleaners, phenol or ammonia products.

BARCODE SCANNER Location - a low grade laser at the end of the instrument. Safety Issues - do not look directly into the light - do not shine the light into someone’s eyes The beam does not transport the person to another room. Point out location of barcode. LASER BEAM

METER OPERATION Status Screen Main Menu - Patient Test - QC Test - Review Data Quality Control Tests (Use Operator Certification Checklist) Have participants view the checklist.

QUALITY CONTROL ALWAYS confirm open/expiration dates ALWAYS confirm lot number of quality control and test strips in the glucose meter before proceeding with test! The highly absorbent application area removes moisture away from the surface of the strip. (Practice applying sample to test strip by touching test strip with the control solution to absorbent area of strip) Apply control solution to test strips. Two Minute (2) wait time to insert the qc or blood specimen into meter!!

QUALITY CONTROL All QC documentation and maintenance will be done in the meter. Operator will only see “Passed” or “Failed”. Meter will “Lock out” if meter indicates FAILED every FAILED QC must have a QC comment - “Enter Note” button Have group fail qc to demonstrate use of QC Messages: Failed and Comment Messages.

CORRECTIVE ACTIONS IF QUALITY CONTROLS INDICATE “Failed” Retest patient Clean the meter Use new control solutions Shake control solutions before use

PATIENT TEST Visit # (V#) is printed on admit label or patient ID bracelet. Unregistered Patients - Last Name, First initial; use only until Visit # available. (Alpha/numeric patient ID function is available ONLY to NICU/NBN. Isolation Patient - set up instrument in the CLEAN AREA OUTSIDE PATIENT”S ROOM, and collect the blood. You may not add blood to the pink test area if the first sample did not completely cover the required test area

Patient Barcoding is Here Hurrah! Patient Barcoding is Here

POSITIVE PATIENT IDENTIFICATION Patient ID Bracelet POSITIVE PATIENT IDENTIFICATION Patient Last Name, First Name Age DOB XX/XX/XX DOS XX/XX/XX V00XXXXXXXXX MR:M000XXXXXX Attn Dr. Doctor, Hello M.D. Svc. GOR

CRITICAL WARNING MESSAGES Critical Range for Adult/Pediatric Patient “Critical Low” “Critical High” <50mg/dL or >450mg/dL. “HIGH” = glucose > 500 mg/dL Critical Range for Neonate Patient <45mg/dL or > 150 mg/dL. Hematocrit Limitations: - Adult/Peds: 25-60% - Neonates: 25-65% Patients with results beyond these percent limitations may have inaccurate blood glucose meter results Stress false results with high/low hematocrit ranges.

CRITICAL WARNING MESSAGES Critical values must be confirmed by repeat on the SureStep Flexx glucose meter. Each critical value must be accompanied by a patient message which is selected from the glucose meter. “Critical glucose values that do not fit with the clinical and physical presentation, as determined by the nurse, will be repeated and notified directly to the physician.” It will be the responsibility of the physician to determine whether a confirmatory stat serum glucose (red top tube) is to be drawn and sent to the laboratory.

Patient Messages 1. Procedure Error 2. Repeated Test 3. MD Notified 4. RN Notified 5. Known DKA/HNK 6. SS Insulin 7. Treated Patient 8. Sent to Lab to Confirm

DATA REVIEW Enter V# to review glucose tests performed on the patient. Meter stores 1500 data points of quality control and patient data. Stores patient data for one month.

DOWNLOADING DATA Meter should not be stored in the cradle when not in use. Data Transfer begins when the meter is placed in the cradle. Download data after each series of patient testing. Meter is set to “lock out” operator if downloading has not occurred.

ORDERING SUPPLIES Use Laboratory Order Form. (See Handout) Monitor stocking of order form supply. Monitor Supplies include: - SureStep®Pro Test Strips (50/box) - SureStep®Pro High Control - SureStep®Pro Low Control

Competency Assessment New Staff - each operator must perform quality control once within first 6 months of training to maintain competency - meter will indicate “Non-Certified Operator” and prevent the operator from performing patient testing Annual Competency Clinical P&Ps on GBMC Intranet PPP updated 03/04/05 May need to explain how to access Netscape to access Intranet for Clinical P&Ps.

CONGRATULATIONS