Jefferson Blood Glucose Monitoring -Accu-Chek Inform II

1. Jefferson Blood Glucose Monitoring -Accu-Chek Inform II Content Experts: Lilah Evans MT (ASCP), Sue Gallo MT (ASCP), Terri Schwartz MSN, RN

2. Learning Objectives At the conclusion, participants should be able to: • Demonstrate how to perform a patient test on the Accu-chek Inform II glucose meter. • Discuss how to perform Quality Control testing on the Accu-chek Inform II glucose meter. • Recall how to properly handle glucose reagents. • Discuss cleaning and troubleshooting of the meters.

3. Glucose System Components • Accu-Chek Inform II meter w/ rechargeable battery • Base unit–charges battery, receives patient & reagent info from system • Storage Case – conveniently stores and transports meter and supplies • Quality Control – 2 vials of liquid quality control (“hi/lo”) • Testing Strips – small sample volume

4. Overview of Front of Glucose Meter Test strip port Alphanumeric touch screen Power button

5. Glucose Meter Base Unit • Return the Inform II meter to any base unit when finished with patient testing to charge the battery. • A drained battery will take 1 hour to reach full charge. • Docking the meter also synchronizes the information in the meter with the system (patient lists, operator lists, strips and controls).

6. Glucose Reagents • Only Accu-Chek Inform II Test Strips and Glucose Control Solutions can be used with the hospital Inform II glucose meter.

7. Glucose Test Strip • Test strips are stored in the tightly capped original container. There is a dessicant in the cap that keeps the strips from being exposed to humidity. • The container must remain closed. Improperly stored Test Strips will produce inaccurate results and must be discarded. • Test strips can be used until the expiration date printed on the vial. • You may discard the code key that comes with every vial of strips.

8. Glucose Liquid Quality Controls (QC) • Opened control solutions expire 3 months from opening or the “Use by” date on the bottle, whichever comes first. • Control solutions must be dated with both the open and discard dates.

9. Glucose QC • Both low and high level control must be tested every 24 hours. • Each time QC is tested, the 24-hour clock resets. • The Inform II meter is locked for patient testing until both low and high level QC PASS. • QC should also be tested following these conditions: • Patient test results are questionable. • New test strip vial is opened. • New control solutions are opened. • The Inform II has been dropped or mishandled.

10. Performing Glucose QC • Perform hand hygiene and don gloves before performing glucose testing. • Turn the meter on by pressing the power button on the front. • The meter will automatically perform several system checks. • Enter your operator ID. • Aim the meter at the barcode on the back of your TJUH badge • All employees must scan their ID using the scan button. • Manually enter your ID using the keypad if you encounter scanning problems.

11. Performing Glucose QC continued • Press the Control Test button • At the top of the screen, you will see that you are on the Control Test screen. • Choose one vial of liquid control, and press the barcode icon to scan. • Scanning the barcode will automatically identify the correct level you are testing - no need to select the specific level on screen.

12. Performing Glucose QC continued • At the top of the screen, you will see that the meter is requesting the lot number of the strips you are using. • Aim the scanner at the vial of strips and press the barcode icon to scan.

13. Performing Glucose QC continued • The meter is now ready for you to insert a strip. • The gold end of the strip goes into the meter with the writing side up.

14. Performing Glucose QC continued • The meter is now ready for you to apply the control solution to the strip. • Hold the meter horizontally when performing QC and dispense a small drop into the sample window at the end of the strip.

15. Performing Glucose QC continued • An hourglass will be displayed briefly. • If the hourglass does not appear and the blood drop icon is still flashing, you can add more sample within five seconds. • The glucose meter should remain horizontal during testing.

16. Performing Glucose QC continued • After 5 seconds, the Pass/Fail QC results will be displayed. • Press the checkmark (√) to accept the result and return to the menu. • If that level of QC has Passed, repeat the QC process with the other level. • Both High and Low QC levels must pass to unlock the meter for patient testing.

17. Performing Glucose QC continued • If QC should fail, an “Out of Range” message will display onscreen and the comment bubble icon will flash. • Touch the comment bubble ( ) to select the appropriate comment(s). • Repeat QC. If QC fails again, try another vial of strips or another bottle of liquid QC. • Both levels of QC must pass to unlock the meter for patient testing.

18. Glucose Patient Testing • Once both levels of QC have passed, the meter will be unlocked for patient testing. • Arterial, venous, capillary, or neonatal whole blood specimens are acceptable. Cord blood samples cannot be used. • Hematocrit should be between 10–65 %. • Lipemic samples (triglycerides) in excess of 1800 mg/dL may produce elevated results. • Blood concentrations of galactose >15 mg/dL will cause overestimation of blood glucose results. • The performance of this system has not been evaluated in the critically ill.

19. When should a venous or arterial sample be tested instead of a finger stick? • Finger stick or capillary samples should not be tested on patients exhibiting decreased peripheral blood flow. • Examples: • Severe dehydration caused by diabetic ketoacidosis • Hyperglycemic hyperosmolar non-ketotic state • Hypotension • Shock • Peripheral vascular disease • In these cases, venous or arterial blood samples should be obtained.

20. Performing a Glucose Patient Test • Once both levels of QC have passed, the meter will be unlocked for patient testing. • Turn the meter on using the power button on the front of the meter. • After the meter performs its self-checks, scan your Operator ID.

21. Performing a Patient Test continued • Press the Patient Test button • Identify the patient as per hospital policy and scan the Patient ID • Aim the scanner at the barcode on the wristband and press the barcode icon • Alternately, enter the 8 digit medical record number using the keypad.

22. Performing a Patient Test continued INPATIENT PATIENT ID • If the patient has been admitted to your inpatient unit, the patient’s MRN and name will be displayed on screen. • Verify that the patient information is correct and touch YES or NO accordingly. • For Outpatient Testing, see the next page.

23. Performing a Patient Test continued PATIENT NOT FOUND MESSAGES (Includes Outpatients) • If the patient name does not appear for inpatient units: - Redock the meter to update patient information - Redock the meter if the patient is a recent admission or transfer. - Check that the Patient’s ID bracelet is not smudged and barcode is clear. • If the patient’s name still does not appear, or if the patient is an outpatient, you must double check the number on the wristband against the number you entered into the meter. • Once you have re-verified the patient’s identification, • Touch YES if displayed MRN matches that on the patient’s wristband. • Touch NO if displayed MRN does not match the wristband.

24. Glucose Patient Testing continued • Hold Accu-chek meter horizontally. • Always wipe away the first drop of blood from a finger stick before touching test strip to finger. • Avoid getting blood in the test strip port. • Only a small quantity of blood needs to be applied to the strip. • If the hourglass does not appear and the test has not started, you may add more blood to the strip within 5 seconds.

25. Glucose Patient Test Results • Touch the Checkmark ( √ ) icon to accept the result. • Optional: touch the Comment Bubble ( ) icon and enter a custom comment or select one from the list. • Enter the glucose result into the Clinical Information System immediately.

26. Glucose Results: Normal & Critical Ranges • Normal fasting range for a glucose patient result on the Inform II is 60 – 100 mg/dL. • Test results <10 mg/dL will be displayed as “LO” and > 600 mg/dL) will be displayed as “HI”. • The Inform II requires entry of a comment to a critical test result. Multiple pre-defined comments are available, or users can enter a free text comment. • Critical glucose patient results are: Adults: <40 mg/dL or >500 mg/dL Neonates: <50 mg/dL or >500 mg/dL

27. Critical Results Any critical result MUST be communicated to the physician and addressed: • Document action in the meter using an appropriate comment. You cannot proceed with further testing until a comment is attached to the critical results. • Critical glucose results >500 mg/dL should be confirmed by a sample sent sample to the clinical lab. • The RN must notify the physician of the critical result and document notification and verbal read back in the patient’s chart.

28. Critical Results Reference the following Nursing policies and procedures regarding critical results: • IV-B-13 Administration of Continuous Intravenous Insulin Infusion (CIII) for non-JIIP (Jefferson Intravenous Insulin Protocol) • IV-B-16 Administration of Insulin and Oral Diabetes Medication • Attachment 1: Hypoglycemic Protocol • Attachment 2: Correction Dose Insulin (CDI) Guidelines • IV-B-18 Nurse managed Jefferson Insulin Infusion Protocol (JIIP) • VI-B-1.1 Blood Glucose Monitoring With Accu-Chek Inform II • Nursing Policy 2.27 Critical Test Results Reporting

29. Troubleshooting the Glucose Meter There are only a few troubleshooting steps to try with the Inform II: • Take an ink pen and press the Reset button located on the back of the glucose meter (see picture). The meter will reset itself and then direct you to place it in the docking station to accept configuration. • When docking is complete, the meter display will read “Idle”. Do not remove the meter from the base until “Idle” is displayed. • Remove the meter from the base. Turn it on to check that the reset worked. If needed, perform Hi/Lo QC. • If these techniques do not work, contact Point of Care: Center City x51664, Methodist x242-9989

30. Infection Control • The device should be cleaned and disinfected between patients, per manufacturer’s instructions, to prevent carry-over of blood and infectious agents. • Squeeze out excess fluid from any wipes before wiping the meter. Do not allow any moisture in the test strip port when cleaning. • Accu-Chek recommends any of the following: -Alcohol Prep-Pads (70% isopropyl alcohol solution) -Clorox wipes (10% bleach solution) -Sani-Master 4 (Sani-Cloth) wipes (quaternary ammonium compounds): Center City Locations -3M #5 Quat wipes (quaternary ammonium compounds): Methodist Locations

31. Infection Control • Follow hospital infection control guidelines at all times. • Perform hand hygiene and don gloves before performing glucose testing. • Sharps must be discarded in puncture proof containers. • All other biohazardous waste must be discarded in designated containers.

32. Testing Personnel • Only trained personnel are permitted to perform point of care glucose testing. • New users receive certification upon completion of initial training. • To maintain glucose testing privileges, each user must be assessed for competence annually by passing a short quiz and through successful testing of Hi/Lo QC within 60 days of their competency expiration. • Operators who have not been recertified will be automatically locked out of the meter.

33. Course Activity Complete Congratulations You have completed the course activity, please proceed to the exam. If you have any questions/concerns with the content of this course, please send a detailed email to is.healthstream@jeffersonhospital.org. A content expert will respond to your inquiry within 10 business days.