SUNY Downstate Medical Center University Hospital of Brooklyn Point of Care Laboratory & Department of Nursing Services Ins7tute of Con7nuous Learning Nova StatStrip Blood Glucose Meter Re-Cer7fica7on 2017 1
Recer'fica'on Instruc'ons All Operators must follow the recer'fica'on schedule and recer'fica'on test performance requirements. Step1 - Review the Re-cer'fica'on presenta'on. Step 2 - Complete the Post Test. Step 3 - Upon successful comple'on of the Post Test, print your Cer'ficate of Comple'on for your records. Step 4 Complete two levels of controls and one pa'ent test on your unit immediately acer comple'ng the exam. Ques7ons or concerns please contact the Point of Care (POC) Coordinator at 718-270-1679, or the Ins'tute of Con'nuous Learning (ICL) at, 718-270-2983. 2
PURPOSE: Nova StatStrip Blood Glucose Recer7fica7on Process This educa'onal ac'vity is an essen'al component of the Nova StatStrip Blood Glucose recer'fica'on process. The purpose is to ensure that all full-'me, part-'me, and per diem nursing personnel, including agency nursing staff, & other cer'fied operators, meet all mandatory and regulatory agency point of care (glucose) competency requirements. 3
Objec7ves: Re-Cer7fica7on Nova StatStrip Glucose Tes7ng At the comple7on of the program the par7cipant will be able to: 1. Iden'fy indica'ons for Nova StatStrip Glucose tes'ng. 2. Describe procedure for appropriate Pa'ent Iden'fica'on. 3. Demonstrate the procedure for performing glucose tes'ng. 4. Iden'fy procedure for performing glucose tes'ng in cri'cally ill pa'ents. 5. Describe the process for maintaining glucose meter in proper working order. Con7nued. 4
Objec7ves con7nued: Re-Cer7fica7on Nova StatStrip Glucose Tes7ng 6. Iden'fy meter maintenance & infec'on control preven'on. 7. States how to recall POC glucose results from the Nova StatStrip Meter memory. 8. Iden'fy correct 'mes, intervals and frequency to perform glucose tes'ng using the StatStrip Meter. 9. Iden'fy unit specific ac'on ranges and protocols in use at UHB. 10. Iden'fy the required procedures and documenta'on of responses for unit specific out of ac'on range results. 11. Iden'fy the procedure for Non-Registered Pa'ents. 12. Iden'fy troubleshoo'ng techniques for common problems. 5
Nova StatStrip Monitor Features Glucose Monitor for Capillary tes'ng and Venous and Arterial Blood tes'ng for cri'cally ill pa'ents Features 6 seconds, 1.2 ul Touch whole blood on 'p, tes'ng ranges 10-600 mg/dl Interac've touch screen follow direc'ons on screen Strip port on bodom of meter Each screen has a 'tle on top of the screen Forward budon, Backward budon, Accept budon Laser barcode scan located on top of meter Strip release budon and badery compartment on back 6
Docking Sta'on Meter must be placed in Docking Sta'on when not in use. Docking allows the Meter to: Recharge Upload pa'ent registra'on informa'on from Hospital Informa'on System Downloads data from monitor into pa'ent s Medical Record Log off operator 7
When To Perform Quality Control Tes7ng? Q 24 hours for each Meter (2 levels of Control). When a new vial of test strips is opened. ACer major maintenance or repair of the system, i.e. badery change. When the meter is dropped. When a new meter is used. When results are ques'onable based on clinical signs & symptoms. Whenever problems (storage, operator, instrument) are iden'fied or any'me there is a concern. 8
Control Solu7on When opening a new Control Solu'on Vial, write on vial: Date opened and Date Expired (90 days from opening vial, or expira'on date listed - whichever is first) NEW: Ini7als no longer need to be wri^en on vial Control solu'on is stored at room temperature, 15 to 30 degrees Cen'grade (59-86 degree Fahrenheit). 9
Control Tes7ng & Cleaning/Disinfec7ng the Meter 2 Step Process: Running controls and Cleaning/Disinfec7ng the Meter Step 1. Level 1 and Level 3 controls are to be run each 24 hour period per meter: Gently mix control solu'on vial Discard 1st drop of Control Solu'on Use 2nd drop of solu'on for control tes'ng If Pass is displayed, enter Comment, Meter Cleaned and press Accept If Fail is displayed, perform correc7ve ac7on and repeat test un7l Pass is displayed. Step 2. Clean/Disinfect Meter with hospital approved disinfectant 10
Troubleshoo7ng If any control level tests are out of range: Repeat test If results are s'll out of range: Open a new control vial and run test If results con'nue to be out of range: open a new strip vial and run test And finally, if control test results are s'll out of range: Call Point of Care at ext. 1679 or the Bay Ridge Laboratory at 718 567-1158 for assistance during the day. Off hours: Go to Lab (2 nd floor) and obtain a new meter. 11
Nova Stat Test Strips Strip vial contains a desiccant to protect against humidity. Store covered at room temperature between 15 to 40 degrees Cen'grade (59 to 104 degrees Fahrenheit). Strip vials (& Control vials) must be covered with their respec've lids when not in use. Strips remain in vial un'l needed for pa'ent or control tes'ng. When opening a new vial of strips, write on vial: Date opened and Date expired 180 days from opening or expira'on date, whichever is first NEW: Ini7als no longer need to be wri^en on vial 12
Pa7ent Tes7ng -1- Scan operator ID, or input numbers on keypad, press Accept. Scan Strip Vial container bar code, then Iden'fy pa'ent using two pa7ent iden7fiers. Scan barcode on pa'ent ID band, verify & press Accept. Or If necessary, enter Pa'ent Financial Account Number (7 digits) into the Meter. 13
Pa7ent Tes7ng Troubleshoo7ng When the StatStrip Meter displays a message that a pa'ent s financial number is Invalid, New or Not In the System, you must: Stop Inves'gate and.. Correct the entry or registra'on issue. You may not override the meter. You must input the correct pa'ent financial numbers into the meter prior to tes'ng. 14
Non-Registered Pa7ents ED, NICU, L&D, & Cath Lab areas are the ONLY areas that MAY USE Non-Registered Pa7ent procedure. All other areas must use the pa'ent s Financial Number. Procedure for Non-Registered Pa7ent: Operator must manually input the appropriate pa'ent informa'on into the meter (Last Name). Operator must enter the appropriate informa'on in the Non-Registered Pa7ent Log. Submit completed Non-Registered Pa7ent Log to POC Lab within 48 hours of the test. 15
Invalid, New or Not In System Patient Message STOP, INVESTIGATE and CORRECT BEFORE TESTING Con7nued.. 16
Invalid, New or Not In System Pa7ent Message STOP, INVESTIGATE and CORRECT BEFORE TESTING 17
Pa7ent Tes7ng -2- Obtaining Blood Specimen from Finger Allow pa'ent s hand to hang lower than heart for a few minutes. Gently, squeeze the finger 1 or 2 'mes- do not milk the finger. Clean pa'ent s finger with alcohol wipe. Dry finger with gauze. Lance side of pa'ent s finger (outside edge of finger, not on the center pads which is more painful and has less blood). Wipe off first drop of blood; use second 2nd drop of blood to place on strip. Dispose lancet in sharps container. 18
Pa7ent Tes7ng -3- Applying Blood Sample to Strip Maintain meter in a horizontal posi'on to keep blood out of the meter. Allow drop of blood to touch the 'p of the strip; the strip must fill completely. No re-applica'on of blood will be accepted once the tes'ng has started. Do not remove finger from strip un'l meter countdown begins. Enter Comments: When the results appear, select & enter appropriate Comment indica7ng the blood specimen type: If capillary blood was used, choose capillary If using arterial or venous blood, choose arterial/venous Arterial or venous blood must be obtained with a lithium heparin syringe (blood gas syringe) If Results are Outside Unit Specific Ac7on Range: Enter Comment Repeat test & repeat test to confirm result. ACer confirmed repeat, follow appropriate protocol & enter appropriate comment(s), e.g. Caregiver no'fied, Hypoglycemia Protocol, etc. Can enter up to 3 comments. Then press Accept in order for results to be saved. 19
Clean & Disinfect Meter With Hospital Approved Disinfectant- A&er Each Pa/ent Test Clean AND Wear protec've gloves. Make sure test strip is removed from meter. Lay meter on flat surface. Obtain a fresh germicidal wipe (hospital approved) from container. Wipe external surface of meter thoroughly with the fresh wipe. Discard used wipe & gloves into appropriate container. Disinfect Use a new, fresh germicidal wipe, & thoroughly wipe the surface of the meter (top, bodom, lec & right sides) for a minimum of 3 'mes horizontally followed by 3 'mes ver'cally. Avoid the bar code scanner & electrical connector when wiping. Discard used wipe into appropriate container. Ensure meter surfaces stay wet for a minimum of 3 minutes. Allow Surfaces to air dry for an addi7onal 1 minute. Dispose gloves into appropriate container. Con'nued.. 20
Ager Cleaning & Disinfec7ng The Meter.. Add the Comment Cleaning/Disinfect. Sani'ze hands. Put on a fresh set of protec've gloves before proceeding to perform tes'ng on the next pa'ent. 21
Finger S7ck Glucose Documenta7on Results & interven7ons are documented in HealthBridge Flowsheet /Point of Care Tes7ng 22
Isola7on Precau7ons Use Universal Precau'ons. Clean & disinfect as stated previously. Use separate monitor based on clinical situa'ons (e.g. Hemodialysis). 23
Test Results Review & Logging Off Click on Review Highlight QC or Pa'ent. If Pa'ent, highlight that par'cular pa'ent and press view for history. Logging Off several op'ons: Press Log Off in meter. Dock Meter. Meter will shut off in 5 minutes when not used (It is not advised to log off in this way.) 24
Cri7cally Ill Pa7ents For the Purposes of Glucose Point of Care Tes7ng cri7cally ill pa7ents are those with: Unstable hemodynamics low perfusion index, use of vasopressor, presence of edema & low mean arterial pressure. Decompensated heart failure NYHA class IV. Severe dehydra7on as a result of diabe'c ketoacidosis or hyperglycemic hyperosmolar non-keno'c syndrome. Arterial occlusive disease. *Capillary tes7ng (via fingers7ck blood) should NOT be used in pa7ents who are cri7cally ill. 25
Two Op7ons to Check Glucose in the Cri7cally Ill Pa7ent Op7on One: Using the Nova StatStrip Meter: obtain arterial or venous blood and place blood sample on the Nova StatStrip. Procedure: Clear the arterial or venous line before drawing a blood sample by drawing appropriate discard. Blood must be collected in a lithium heparin collec'on device (ABG syringe) use sample within 30 minutes. Place blood sample on Nova strip and use according to procedure; remember to add comment arterial/venous for specimen type. Con7nued 26
Two Ways to Check Glucose in the Cri7cally Ill Pa7ent Op7on Two: Send a whole blood specimen to the Lab Procedure: Clear the arterial or venous line before drawing a blood sample by drawing appropriate discard. Obtain blood sample in a grey top tube or add on a glucose test to any arterial or venous blood gas sent to lab. 27
Fingers7ck Glucose: When to Check? Morning fingers'ck glucose is checked at or acer 7:00 AM, unless clinically indicated or per unit policy or prescriber s order (Rehabilita'on, OB, Cri'cal Care, etc.). Fingers7ck glucose must be checked: Within 1 hour prior to administering prandial or correc'on insulin. If it is more than 1 hour since the 'me of the test and insulin administra'on, test again. 28
Hypoglycemia: 3 Protocols in UHB 1. Adult Hypoglycemia Treatment Protocol (Inpa'ent & Procedural Areas) 2. Pediatric Hypoglycemia Protocol 3. Outpa'ent Hypoglycemia Treatment Protocol UHB Suites & Satellites 29
Highlights Hypoglycemia Protocol (Inpa7ent/ Procedural Areas- Adult) <70 mg/dl Repeat, if s'll < 70 mg/dl, ini'ate Hypoglycemia Protocol Treat with 15 grams carbohydrate (apple juice or glucose gel) Repeat in 15 minutes If <70, repeat treatment Goal: 2 fingers7ck values of >70 mg/dl, 15 minutes apart If NPO or not able to treat orally follow Protocol for treatment Intravenous Dextrose 50% if no IV access - administer Glucagon intramuscularly Cri7cal Low - <50 mg/dl repeat to confirm results treat as per protocol Draw serum sample to send for glucose in grey top tube Remember: If pa7ent is cri7cally ill, obtain blood via arterial or venous line; clear line before drawing a blood sample by drawing appropriate discard. No7fy Provider for all Hypoglycemia Document in HealthBridge 30
Cri7cal Hyperglycemia 599 mg/dl and above (Adult Med/Surg) Repeat fingers'ck to confirm result If s7ll above 599 mg/dl: Draw a blood specimen in a grey top tube and send to laboratory No'fy provider for further treatment 31
Meters Assigned to Specific Units Nova StatStrip Meters are assigned to nursing units by the Point of Care Lab. Meters may not be moved by the nursing staff. If a meter is needed in a par'cular unit, contact the Point of Care Lab immediately. 32
Unit Specific Ac7on Ranges All Ac/on Ranges require a repeat test to confirm results. Pediatrics: less than 70 mg/dl more than 200 mg/dl NICU: less than 45 mg/dl more than 150 mg/dl L&D and Mother Baby Unit Newborns' less than 25mg/dl: birth to the 1st 4 hours of age less than 35 mg/dl: 4 to 24 hours of age Ambulatory: less than 70mg/dL more than 599 mg/dl CTICU: less than 60 mg/dl more than 120 mg/dl Adult Medical/Surgical: less than 70 mg/dl 599 mg/dl 33
Visitors/Employees Use of the Meter is Not for Screening. Using the Meter to check an employee or visitor s blood glucose is Not acceptable. If an employee or visitor is ill, they are immediately referred to the ED. Reference: Policy LAB 23-A; Point of Care Nova Stat Strip Glucose Meter 34
Thank you. Proceed with exam. 35