SARASOTA MEMORIAL HOSPITAL

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1 SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE BLOOD GLUCOSE TESTING: ACCUCHEK INFORM II/ QUALITY CONTROL DATE: REVIEWED: PAGES: 1/95 3/18 1 of 8 PS1094 ISSUED FOR: Nursing RESPONSIBILITY: RN, LPN, Lab *Patient Care Technician * Multi-skilled tech * LDR Surgical Techs * Rehab Techs (IRF) PURPOSE: To determine quantitative blood glucose at the bedside by the nurse/patient Care Technician/Multi-skilled tech/ldr Surgical Tech/Rehab Tech (IRF). A quality control test should be performed to assess the usual performance against a known standard to ensure accurate testing results. KNOWLEDGE BASE: 1. A physician s order is necessary for blood testing with the AccuChek Inform II unless the patient is experiencing symptoms of hypoglycemia or hyperglycemia (or has a history of either) and quality care dictates a STAT test. 2. A Registered Nurse (RN), Licensed Practical Nurse (LPN), Patient Care Technician, Multi-skilled tech (designated departments), LDR Surgical Tech, or IRF Rehab Tech must demonstrate competency on an annual basis and upon hire. 3. Strip lot calibration is performed remotely and distributed to the meters by the laboratory via their data management system. The code key can be discarded as the lab will calibrate the lot numbers. 4. Positive patient identification is required prior to specimen collection. Refer to SMH Policy (01.PAT.09) Patient Identification: Inpatient/Outpatient. 5. The Patient Care Technician/Multi-skilled Tech/LDR Surgical Tech/IRF Rehab Tech will report all glucose results to the nurse overseeing the patient s care. The glucose results should not be Voalted to the nurse.

2 TITLE: BLOOD GLUCOSE TESTING: Page 2 of 8 PROCEDURE: Blood Glucose Testing EQUIPMENT: BLOOD GLUCOSE TESTING 1. AccuChek Inform II 2. AccuChek Inform II strips (obtained from Central Services) 3. Alcohol swabs 4. Cotton balls or 2 x 2 s 5. Disposable gloves; and 6. Lancet EXCEPTION: PROCEDURE: NICU (refer to NICU procedure Glucose Monitoring-Neonatal (nur45). 1.. TO PERFORM BLOOD TEST: (at bedside) a. Explain the purpose of the test and steps of the testing procedure to reassure the patient. For contact Isolation patients, see procedure 3. below. b. Turn on AccuChek Inform II by pressing the POWER BUTTON. c. Scan or enter your operator I.D. (zeros plus the employee ID # to make a total of 10 digits).to SCAN your badge, hold meter at 45 angle at 4-6 inches from stationary badge. LASER SAFETY: do not look directly into laser beam. d. Press PATIENT TEST. e. Enter the patient I.D., (which is the patient s admission number) by scanning the patient s Identification band. Check the meter to verify the correct patient information. If unsuccessful scanning the ID band, obtain a new patient ID band and place it on patient. Re-try scanning the new patient ID band. NOTE: In order to prevent patient identification errors, the AccuChek emergency armband is available in the PYXIS under Emergency Armband for POC or may be kept by the accuchek meter. The emergency armband can be accessed by entering Emergency Armband for POC in the Pyxis. An emergency armband is also available in the Code Blue Nurse Cart. It can ONLY be used when a patient does not have an armband or a visitor or employee has a TRUE emergency. When using the Emergency armband, a Comment must be added on the AccuChek machine that identifies the patient by using the Visit ID# or patient name. To add a comment: Before pressing the check mark button to complete the test, press the comment icon button then the custom comment icon below the preset comments. Press 123 key to type the patient ID # or press ABC key to type the patient name if no number available. If not a patient then type E for employee, V for visitor or T for training. Once you have selected the desired comment, touch the

3 TITLE: BLOOD GLUCOSE TESTING: Page 3 of 8 checkmark to return to the results screen. Then touch the checkmark to return to the main menu. f. Scan the test strip vial. Remove a test strip from the vial. Immediately close the lid on the vial. g. When the flashing strip icon appears on the meter display, insert test strip with the yellow target area facing up. (Insert the end with the gold bars.) h. Perform hand hygiene and don disposable gloves prior to testing. i. Cleanse the finger of the patient with an alcohol swab. NOTE: Alcohol at the puncture site must be dry or an inaccurate result may occur. If the patient does not have any hands, a serum glucose needs to be drawn if there is no IV access available. j. After the meter performs the strip integrity checks, a red flashing drop icon appears above the test strip on the meter display, obtain a blood sample by puncturing the side or end of the patient s fingertip with the lancet. NOTE: An AccuChek should not be repeated unless the patient has a clinically significant reason for it such as a Hypoglycemic event and is experiencing symptoms such as sweating or dizziness or if the patient tells you I am having an insulin reaction. ). Refer to the Nursing Procedure called Insulin Reaction/Hypoglycemia Protocol for the Adult Patient which is available on the nursing page of the PULSE. NOTE: The nurse may use venous or arterial blood or capillary whole blood or a heel stick with a neonate. k. Wipe off the first drop of blood using the cotton-ball. l. Touch and hold second drop of blood to the edge of the yellow window and blood will be pulled into the strip. Fill yellow window completely. m. When properly dosed, an hourglass will be displayed to show the test is running. In 5 seconds, the blood glucose value will appear. n. If needed, select a comment via the comment icon. Selection of up to three comments or a custom comment is acceptable. If no comment is needed, press the checkmark button to complete the test. o. Remove the test strip from the meter and discard in a biohazard container. p. Press POWER BUTTON to turn meter off. q. Remove the Lancet and discard in a biohazard sharps container. r. Remove and discard gloves and perform hand hygiene. s. Return the meter to the charge base to keep the meter charged.

4 TITLE: BLOOD GLUCOSE TESTING: Page 4 of 8 t. Enter blood glucose results on the Glycemic Control Flowsheet. 3. CONTACT ISOLATION PATIENTS For patients requiring contact isolation: a. Perform hand hygiene. b. Don gloves and gown. Obtain two Oxivir wipes and only the supplies needed for the isolation patient s accuchek so a lot of supplies aren t contaminated. c. Disinfect an area at the patient s bedside with a Oxivir wipe using one gloved hand (designated as the dirty hand). d. Place meter and the 2 nd Oxivir wipe on the disinfected area using the clean hand. e. Discard gloves. Perform hand hygiene. f. Apply new gloves. g. Perform AccuChek h. Clean meter with the 2 nd Oxivir wipe. i. Remove gloves and gown. j. Perform hand hygiene. CDIFF PATIENTS (Enhanced Contact Isolation) Follow above contact isolation instructions. NOTE: C-diff is a spore forming organism so it has two states of being, vegetative and spore. In the vegetative state, it can be killed with the Steris wipes, but spores require bleach for destruction. NOTE: Hand washing is needed instead of foaming of the hands for C-diff patients. NOTE: The meter must be cleaned before it is removed from the patient s room. 4. RECALL TEST INFORMATION: a. Turn AccuChek Inform II meter ON. b. Press REVIEW RESULTS from the main menu on the meter screen. c. Press BACK or FORWARD arrows on screen to locate desired record. 5. CARE OF THE METER: a. Don clean gloves. b. Clean the outside of AccuChek Inform II with a hospitalapproved germicidal surface wipe (for c-difficile

5 TITLE: BLOOD GLUCOSE TESTING: Page 5 of 8 patients, use bleach wipes) between each patient use avoiding the strip port, code key slot, and the connector. Allow the meter to air dry for the recommended contact time and then dry connectors off before re-docking the meter to help prevent corrosion. The barcode read window should be clean, clear, and dry. c. The meter should not be carried in staff pockets as that poses infection control risks. d. The meter should be used on a flat level surface as this helps prevent blood and control solutions from getting into the meter. QUALITY CONTROL: PROCEDURE: Quality Control Testing Quality control testing is performed with glucose control solution for the following indications: 1. Quality control must be done daily (may be less in an outpatient setting as AccuChek usage is less frequent) and documented with each AccuChek Inform II being used on the nursing unit. 2. Every time a new vial of test strips is opened. 3. Whenever test results contradict clinical symptoms. 4. Whenever a vial of test strips has been exposed to extreme heat, humidity or cold. 5. If the meter has been dropped. Assemble the following: 1. AccuChek Inform II meter 2. High and low glucose control solutions NOTE: Once the control solution is opened, it expires in 90 days and that date must be marked on the solution bottle. 1. Press the POWER BUTTON. 2. Enter your operator I.D. (zeros plus the employee ID # to make a total of 10 digits) or SCAN your hospital badge. 3. Press CONTROL TEST from the main menu. 4. Scan the barcode on the control bottle to select that a control level (by scanning the control bottle, the meter will know whether it is level 1 or level 2). 5. Perform the control tests level 1 or level 2. Verify results on both displays. 6. Enter comment code. If no comment code is needed, press the checkmark button to continue. 7. Press the POWER BUTTON to turn AccuChek Inform II off. WHAT TO DO ABOUT UNACCEPTABLE CONTROL RANGES:

6 TITLE: BLOOD GLUCOSE TESTING: Page 6 of 8 1. Should unacceptable control range occur, the AccuChek Inform II will give you an exception test result (fail). Repeat the test. 2. Should the unacceptable range continue, repeat the test with a new bottle of test strips and new control solution. 3. If still unacceptable, complete and attach a repair tag indicating Controls out of range. Return to Laboratory. Obtain a new AccuChek Inform II. Daily check the docking stations: 1. Verify that the docking stations display either a blue (charger only) or green (connected to the network) status light. 2. If the docking station status light is flashing red, contact the laboratory. 3. If needed, wipe the base of the docking station. 4. Do NOT unplug the AccuChek bases/downloaders. PROCEDURE: Daily Docking Station Maintenance ACCUCHEK INFORM II TROUBLESHOOTING NOTE: Refer to the Troubleshooting Guide or the User s Manual, available on the nursing unit/department. 1. QC Due: Immediately may appear on the startup screen. a. This may indicate that: 1) Controls have not been run in 24 hours. Controls must be run every 24 hours (may be less often in an outpatient setting as AccuChek usage is less frequent). This is called QC lockout. 2) The last controls may have been out of range. TROUBLE-SHOOTING: 2. AccuChek Inform II meter display does not turn on. a. Battery may be low or dead. b. To correct: 1) If low battery: place in charge station for at least 20 minutes. The meter should always be in the base unit when not testing patients so the battery stays charged. 2) If unable to correct, attach completed repair tag and send unit to Laboratory for repair or replacement. 3. Critical Results. If the following results are obtained on patient testing, the blood glucose should be repeated with a new test strip. If the results remain in the critical range, blood glucose must be drawn and submitted STAT to the laboratory for confirmation. Notify physician immediately. a. If result is less than 40 mg/dl or if LO is displayed.

7 TITLE: BLOOD GLUCOSE TESTING: Page 7 of 8 b. If result is greater than 400 mg/dl or if HI is displayed. c. If blood glucose result is less than 70 or greater than 400, the result should be communicated to the RN or LPN immediately. Follow the Hypoglycemia Protocol for blood glucose less than Temperature symbol and a flashing strip icon appear on the display at the same time. a. The temperature is above or below operating range of the test strips. Move to a testing area that is between 57 degrees and 104 degrees F (14 degrees and 40 degrees C) and wait 5 minutes before testing. Do not artificially heat or cool the meter. 6. ERROR appears on the display. a. The meter failed its series of electronic checks. Turn the meter off, then on again. If this error display still appears, testing cannot take place. Attach completed repair tag and send unit to Laboratory for repair. 7. If the AccuChek Inform II is broken or for any assistance with troubleshooting, clean the AccuChek Inform II meter. Complete and attach a repair tag. Take to Laboratory. Another AccuChek Inform II will be given to the nursing unit/department. It is the responsibility of the nursing staff to perform QC tests before using the new meter. Never use Inform II test strips after the expiration date because they may be deteriorated and may give erroneous reading. The meter should not allow you to do this. CRITICAL BEHAVIORS: 1. DO NOT cut or alter the strips in any way; keep them stored in the container with the lid closed to prevent deterioration. 2. Always wear gloves when performing blood glucose testing. 3. Always verify results by repeating the test if the meter results are inconsistent with the patient s clinical picture. Limitations of the procedure: a. Hematocrit below 10% may cause higher results. Hematocrit above 65% may cause lower results. b. Extremely high levels of the following substances at the following concentrations may produce falsely elevated glucose results: galactose >15 mg/dl, lipemic samples >1800 mg/dl or intravenous administration of ascorbic acid which may result in blood concentrations of ascorbic acid >3 mg/dl.

8 TITLE: BLOOD GLUCOSE TESTING: Page 8 of 8 DOCUMENTATION: Glycemic Control Flowsheet Open the time column. Document the blood sugar results and any insulin given. Diabetic Teaching Flowsheet: Document patient education. If pamphlets are given to patient, document in the Notes. REFERENCE: SMH Policy (01.PAT.09). Patient Identification: Inpatient/Outpatient. SMH: Author. SMH Nursing Procedure. Hypoglycemia Protocol for the Adult Patient. (dia14) Glucose Monitoring (nur45). SMH: Author. REVIEWING AUTHOR (S): Karen Diffley, BSN, RN, Nursing Standards Marsha Cooper, POC Coordinator, LAB Jordan Solich, BSN, RN, NPD, 7WT APPROVAL: Clinical Practice Council 3/1/18