Point of Care testing refers to all laboratory testing that is done outside of the walls of the clinical laboratory in the proximity of the patient.

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3 Point of Care testing refers to all laboratory testing that is done outside of the walls of the clinical laboratory in the proximity of the patient. All such tests are considered lab tests and are overseen by the laboratory. We are regulated by the College of American Pathologists (CAP), the Joint Commission, CMS and the Washington State Dept of Health. 3

4 In addition to glucose testing, other Point of Care testing at PRMCE includes: the IStat, a device for: blood gas, clotting tests, troponin and basic metabolic panels, which is used in the ED, surgery, CT and CVL. 4

5 Urine pregnancy tests are performed in AM Admit Urine Drug testing is done in Behavioral Health 5

6 INR testing is done by the pharmacists in the Anti-Coag Clinic to monitor Coumadin therapy. Hemoglobin testing is performed in Medical Short Stay prior to Therapeutic Phlebotomy. Guiac Tests are sent to the lab to be developed, so they are not considered POC test. 6

7 The Laboratory Medical Director s name is on the lab s CLIA license which encompasses all Point of Care Testing. All testing must be authorized by him since he is the one with ultimate responsibility for all lab testing done in the hospital. All POC operators must be trained and demonstrate competency in annual assessments. Our accrediting agency, College of American Pathologists (CAP) requires that we participate in a Proficiency Testing program. Twice a year, CAP sends three unknown samples to all the labs they accredit. These samples are tested on the glucose meters and the results are returned to CAP for evaluation. We receive a report showing how we compare against all the other CAP accredited hospitals and labs. 7

8 In our hospital, we use the Roche Accu-Chek Inform ll meter. We do over 200,000 patient tests per year. Testing is performed by nurses in all departments except: surgery, where only anesthesia techs and anesthesiologists do the testing. ED, where techs also do glucoses 8

9 Demonstrate meter: Power button Touch screen Scanner Wireless icon Battery icon Test Strip Port Battery contacts 9

10 Always store the meter in the base unit when not in use, not the meter tote. The meter has a rechargeable battery which will deplete if not continually recharging. The sample size is the size of a pin-head Meters must be disinfected after each patient test to prevent potential spread of disease. The only FDA approved cleaning wipes for the meters are Clorox Germicidal Wipes or Super Sani-Cloth Germicidal wipes. 10

11 The base unit serves two functions. It charges the meter s rechargeable battery and it transmits and receives data every 30 minutes. A green light on the base unit means it is turned on and the base unit is connected to the ether-net. The meter will occasionally freeze up and will not turn on. This can happen if a docked meter is removed from the base unit when the meter is displaying Synchronizing Database. If it happens, reset the meter. To reset the meter, press and hold the on/off button on the front of the instrument for 20 seconds by the clock. 11

12 Look for Docked tab in upper left of display and battery with lightning bolt in lower right of display. When the battery is completely dead, the charging display will look like the picture on the right: large battery icon with lightning bolt. 12

13 QC is written on the vial to indicate that Quality Control solutions have been tested successfully on that vial. Emphasize that patient testing may not be done with strips that lack documentation of QC. If the vial in your tote does not have documentation of QC, perform QC first, document with QC, then perform patient test. Strips are laminated on top on bottom. A drop placed on the top of the strip will not get to the testing area. Touch the front edge of the strip to the drop to dose. The Code Key chip is only used by the Point of Care Coordinators to enter a new lot of reagent strips into the Data Management System, and from there it s sent to all meters. The chip is included with every box of strips and can be discarded. 13

14 Demo strip: OK to touch all areas of strip. There is a plastic covering over the top of the yellow dosing area. The sample is applied to the front edge of the strip and capillary action wicks the sample up. Be sure to hold the meter level or pointing downward when adding sample. (prevents blood or control solution from contaminating the inside of the meter) Type Bad Dose: under dose detection, not enough blood on strip, repeat test with new test strip. Strip Defect Error: defective or previously used test strip or glucose may be out of measuring range. Repeat test with new test strip. You may see the above errors if you dose the strip before the meter is ready. Watch the prompts. Be sure to wait for flashing drop of blood icon to add sample. 14

15 Quality Control solutions are provided by the manufacturer to ensure that the meters and the strips are giving accurate results. The controls contain a known amount of glucose and have a range of expected values. When the correct result is obtained, the meter will display PASS. The meters are programmed to run QC every 24 hours and will lock out (not allow patient testing) until both levels of QC solution have been tested successfully. You must also run QC if you are opening a new vial of strips, or if you find a vial of strips with the lid off or ajar. If you try to test a patient with a different lot number of strips than was used for the QC testing, you will need to run QC on the different lot number, too. (Meter will lock out). QC solutions are good for 90 days after opening. Lab POC provides fresh controls every 90 days with expiration date stickers on them. 15

16 When asked for operator ID use your 6 digit badge ID number. This is the number directly above the magnetic strip on your badge. Students generally have a T-xxxxx ID number and will need to manually enter the number (replacing the T- with a leading zero.) 16

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18 This is true of all test systems that rely on a capillary sample. A good quality result depends on a good quality sample, and if circulation is clearly impaired, you will not get a good result. In these cases use venous blood, or get a lab glucose test. 18

19 This is true of all test systems that rely on a capillary sample. A good quality result depends on a good quality sample, and if circulation is clearly impaired, you will not get a good result. In these cases use venous blood, or get a lab glucose test. 19

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21 Wet alcohol will interfere with the glucose reaction. Let the alcohol dry prior to lancing the skin. Wipe away the first drop of blood. This prevents contamination with tissue fluid, and, if the alcohol wasn t completely dry, you will have wiped away the interference caused by wet alcohol. 21

22 Our patients have bar-coded armbands. The meters will only accept patient ID s that have been scanned. Manual entry of the CSN is not possible. 22

23 Our meters are equipped with Enhanced Patient ID. This means that when the meter scans the barcoded armband, it will display the patient s name and date of birth. Verify that the information is correct and press the checkmark to say OK. The meter is continually updating its database of patient names. Every 10 minutes it connects wirelessly for updates and every 30 minutes it connects through the ethernet. There are occasions when the patient s name won t have made its way to the meter yet. In that case, the meter will display a warning message that Patient Not Found. It will display the CSN it read and ask if its OK to proceed. Provided the CSN displayed matches the patient s CSN on the armband, press the checkmark to say OK 23

24 There are occasions where the patient s armband is not readable (wet, wrinkled) or they don t have an armband (emergency not registered yet, visitor). When there is no readable armband, use the Emergency Bar Code which is located in the inside lid of every meter tote. For patient ID, scan the Emergency Barcode, and when the meter says Patient Not Found, say OK. Notify the Point of Care office whenever the Emergency Bar Code is used, including for non-patients (family, visitors or co-workers). POC contact information is on the meter totes. 24

25 All results with proper patient ID will cross into EPIC, even abnormal, critical, LO and HI results. The only way to prevent a result from crossing into EPIC is to add the comment Procedure Err while the result is displayed. You would want to prevent a result from crossing if you have reason to believe there is something wrong with the result (wrong patient, dosing error, wrong lot number used, patient wasn t supposed to have a glucose test at that time). Even though the meters have the capability to transmit results wirelessly to EPIC, you still need to document your glucose result in EPIC. Do this using Enter/Edit Results. The name of the test is Preliminary POC Glucose. Results that come from the meter will show up as POC Glucose. There are occasions when you will want to repeat a glucose test. (See next slide). When you do a repeat, be sure to do it within 10 minutes. We have a mechanism in the Lab Information System to prevent duplicate charges, provided they are done within 10 minutes of each other. 25

26 When you get a result of LO, that means the result is less than 10. If you get HI, that means the result is greater than 600. In either case, repeat the test to verify the result is not due to an error. Repeat within 10 minutes so there is no duplicate charge. 26

27 If you get LO or HI, you need to get a lab draw so you can get a glucose value. For a LO (<10) don t wait for a lab draw to treat your patient! NOTE: Glucose Recheck test is a stat, no charge lab glucose. 27

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29 Up to three comments can be added while a result is displayed. These comments will be seen in EPIC. 29

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31 The meter must be disinfected after each patient use. The bleach solution will leave a harmless powdery white residue when dry. This may be cleaned off with an alcohol prep pad. 31

32 If you are ready to enter the glucose result into the patient s chart and don t quite remember what the value was, you can go to Review Results on the main menu and call up the result. Only the meter you ran the test on will show you your patient s result. 32

33 There is a procedure in PolicyStat: Roche Accu-Chek Inform ll Glucose Meter that contains all the information you need to know about the meter. You will be asked on your training checklist to sign that you can locate the procedure and that you are aware of the contents. It includes the chemical principle, sample requirements, limitations, troubleshooting, critical value policy, cleaning instructions, etc. If you want even more detail, you can look at the On-Line Operators Manual (accessible via the POC website on the intranet. 33

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