Roche ACCU-CHEK Inform II User`s guide
Contents
1. NORTHERN ARIZONA HEALTHCARE ACCU CHEK Inform II Competency 2013 Aa Northern Arizona Healthcare Sponsored by the Education Department DIRECTIONS FOR COMPLETING THE 2013 ACCU CHEK INFORM II COMPETENCY There is one module for all sites This module contains the ACCU CHEK INFORM II policy for VVMC and FMC Please be sure to read the policy for the facility where you will be completing your clinicals You are responsible for understanding the information for your site Review the information presented in the policy for the facility where you will be completing your clinicals 2 Complete the Post Test and use the Answer Sheet provided to record your responses to the Post Test Print out the answer sheet and sign the statement showing that you have read the Guidelines of Practice for Point of Care ACCU CHEK Inform II Blood Glucose Monitoring System Policy You should give this answer sheet to your instructor A minimum score of 84 must be attained for successful completion of the module 3 You should also print out the Hands On Competency check list for the facility where you will be completing your clinicals This will be completed with your instructor and handed in to the hospital Number 200 02 fu Verde Valley Medical Center NURSING Northern Arizona Healthcare Page 1of7 POINT OF CARE ACCU CHEK INFORM Il BLOOD GLUCOSE MONITORING SYSTEM POLICY The ACCU CHEK Inform Il system quanti2. ooo NOCO O0 O O0 Of VVMC ACCU CHEK Inform II Skills Checklist Demonstrates knowledge of Accu chek Inform II meter and the dock station Demonstrates knowledge of proper equipment used soap water gauze pads Demonstrates knowledge and importance of proper lot number verification Demonstrates knowledge of proper test strip application Properly doses the test strip Enters Operator ID and Patient ID according to policy Scan own badge and wristband Understands why meter needs to be docked after use charges battery Quality Control States when controls are routinely run once every 24 hrs or every use day States when to discard control solution at exp date or 90 days after opening States what to do when control result fails to fall within the acceptable range repeat the test and document remedial action with a comment Demonstrates correct procedure for Hi amp Lo solution testing Hospital Critical Limits Documentation and Follow up States critical values 60 or 2450 mg DI notify provider of critical results 0 6 months 40 or 2200 mg dL Demonstrates importance of comments notify provider or notify RN and repeat criteria States when venous sample is sent to central laboratory for confirmation 30 or 2500 mg dL 6 months to Adult 30 or gt 500mg dL 0 6months States emergency ID when patient is unidentified 0911911 Verbalizes how to enter a custom comment patient s name Cleaning States proper
3. and disinfect as necessary following your hospital s policy Document cleaning electronically in the meter Discard the strip in the normal waste and discard the lancet in a sharps container The meter should always be placed in the docking station when not in use This will serve to charge the battery Kx ge 11 Interpretation of Results a f the glucose value is out of the normal low range 70 mg dL adult or 40 mg dl 0 months treat per the hypoglycemia guideline of care b If the glucose value is gt 180 mg dL treat per licensed medical provider orders c If the value falls outside of critical range 60 or 2450 or 40 or gt 200 in the NICU the meter will prompt an action comment requiring the operator to contact the patient care provider i The date time name of person contacted must be documented in the computer in the significant events form including documentation that read back verify RBV was done d If the glucose is outside of the ACCU CHEK Inform Il reportable range 30 or gt 500 the result is flagged with RR LO or HR HI i The meter will prompt for an action comment requiring the operator to contact the patient care provider Page 5 of 7 200 02 Point of Care ACCU CHEK Inform II Blood Glucose Monitoring System a The date time name of person contacted must be documented in the computer in the significant events form including documentation that read back verify RBV was done ii In addition t
4. infection control and safety practices States cleaning techniques for the meter wipe ACCU CHEK Inform II meter with Asepti wipes States the importance of not getting liquid into the strip port If liquid does get into the test strip port immediately dry the components with a dry cloth or gauze pad State cleaning frequency after each patient use at time of quality control once every 24 hours States how to document cleaning electronically in the meter States cleaning precautions After cleaning wait until the meter is completely dry before docking Employee I have read the Guidelines of Practice for Point of Care Accu Chek Inform II Blood Glucose Monitoring System I feel competent to perform above skills I understand that the use of another person s ID or a false patient identification in the ACCU CHECK Inform II meter is considered falsification of a document and may result in disciplinary action Signature Lawson No Date Trainers The above skills have been successfully demonstrated and stated correctly By signing this competency check list Signature Date FMC ACCU CHEK Inform II Skills Checklist oar e Deum Demonstrates knowledge of Accu chek Inform Il meter and the dock station Demonstrates knowledge of proper equipment used soap water gauze pads Demonstrates knowledge and importance of proper lot number verification Demonstrates knowledge of proper test strip application P
5. number or scan patient s hospital ID band as the identification in the ACCU CHEK Inform II system In the event the patient is a trauma and is not registered at the time glucose testing is needed 0911911 may be used as an alternate patient ID number Confirm that the meter is coded calibrated to the same test strip code that is printed on the test strip vial by scanning the test strip vial Contact the laboratory if you are unable to confirm the correct test strip code A picture of a test strip with a downward flashing arrow on the screen indicates a test strip may be inserted into the meter Remove a test strip from the vial and immediately recap the vial Insert the test strip into the meter in the direction of the arrows and with the ACCU CHEK lettering facing upward The meter will display a flashing drop above the test strip icon when the test strip is properly inserted indicating that you are ready to apply a blood sample Collect an acceptable blood sample according to your facility s established procedures a lf using a capillary sample wipe the first drop away when testing capillary samples this is advantageous because it ensures that the cleansing agent is dry it stimulates blood flow and clears interstitial fluid from the sample Apply blood to the front edge of the test strip The sample will fill the yellow sample chamber by capillary action Do not apply sample to the top of the test strip Once sufficient sample h
6. transfer new data when a wireless connection is available even if the meter is powered off This connection gives the meter the most up to date settings and ADT information when available Wired Data Transfer Results are transferred into Cerner by placing the meter into a base unit that is connected to the hospital network through an RJ45 connection connected to the hospital network When properly docked the meter will automatically transfer test results The following series of screen displays will appear to confirm that data transfer is occurring Critical limits for adult patient tests are lt 45 mg dL and 2450 mg dL and for newborns 30 mg dL and 2300 mg dL Patient test results that exceed critical limits must be called to the patient s provider and then documented in the patient electronic medical records Reportable limits for patient testing are 30 mg dL and 2500 mg dL Results that exceed the reportable limits of the system will be displayed as RR HI RR LO or HI LO the measurement range default Patient test results that exceed reportable limits must have follow up testing performed in the laboratory ATTACHMENTS N A REFERENCES ACCU CHEK Inform Il Users Guide Retrieved from www poc roche com and www accu checkinformii com websites 2012 2013 Roche Diagnostics All rights reserved Mosby s Nursing Skills 2013 e Blood Glucose Monitoring Retrieved from http mns elsevierperformancemanager com NursingSkills ContentPla
7. will cause overestimation of blood glucose results e Intravenous administration of ascorbic acid which results in blood concentrations of ascorbic acid gt 3 mg dL will cause overestimation of blood glucose results e f peripheral circulation is impaired collection of capillary blood from the approved sample sites is not advised as the results might not be a true reflection of the physiological blood glucose level This may apply in the following circumstances severe dehydration as a result of diabetic ketoacidosis or due to hyperglycemic hyperosmolar non ketotic syndrome hypotension shock decompensated heart failure NYHA Class IV or peripheral arterial occlusive disease NOTE The performance of this system has not been evaluated in the critically ill Take the meter and testing supplies to the patient location Wash hands and don personal protective equipment gloves gowns etc as required by infection control and isolation policies and procedures Greet and identify the patient Explain the procedure to the patient Turn on the ACCU CHEK Inform Il meter and enter your operator ID by means of scanning the barcode on your identification badge NOTE If the operator ID you enter is not accepted attempt to re enter it If it is still rejected contact your supervisor or Point of Care Coordinator DO NOT attempt to perform tests under another operator s ID From the Main Menu touch Patient Test Enter the patient s FIN
8. 010 7 2012 2 2013 4 13 NUMBER HP 300 121 Page 1 of 5 Flagstaff Medical Center HOSPITAL Northern Arizona Healthcare EFFECTIVE DATE GUIDELINES OF PRACTICE E June 12 1991 TITLE ACCU CHECK INFORM II BLOOD GLUCOSE MONITORING SYSTEM PRINCIPLE The ACCU CHEK Inform II system quantitatively measures glucose in whole blood The enzyme on the test strip mutant variant of quinoprotein glucose dehydrogenase from Acinetobacter calcoaceticus recombinant in E coli converts the glucose in the blood sample to gluconolactone This reaction creates a harmless electrical DC current that the meter interprets for a glucose result The sample and environmental conditions are also evaluated using a small AC signal The system is calibrated with venous blood containing various glucose concentrations and is calibrated to deliver plasma like results The reference values are obtained using a validated test method This test method is referenced to the hexokinase method and is traceable to an NIST standard SPECIMEN Proper blood sample collection is an essential and integral part of bedside blood glucose testing Acceptable Samples 1 The following fresh whole blood sample types may be used all line draws must be used within 30 minutes of collection a Venous whole blood b Arterial whole blood c Capillary non neonate finger stick and neonate heel stick whole blood test immediately 2 The following anticoagulants are acceptable do not us
9. anning the barcode on the identification band NOTE If the operator ID you enter is not accepted attempt to re enter it If it is still rejected contact the laboratory DO NOT attempt to perform tests under another operator s ID From the Main Menu touch Control Test Select the level of control that you wish to test Confirm that the meter is coded calibrated to the same test strip code that is printed on the test strip vial by scanning the test strip vial s barcode Contact the laboratory if unable to confirm the correct test strip code The meter will display a picture of a test strip with a downward flashing arrow on the meter indicating that you are ready to insert a test strip into the meter Remove a test strip from the vial and immediately recap the vial Insert the test strip into the meter in the direction of the arrows and with the ACCU CHEK lettering facing upward The meter will display a flashing drop above the test strip icon when the test strip is properly inserted indicating that you are ready to apply control solution Apply control solution to the front edge of the test strip The solution will fill the yellow sample chamber by capillary action Do not apply sample to the top of the test strip Once sufficient sample has been detected the measurement begins An hourglass icon indicates that the measurement is in progress You will get an error message if the sample is insufficient If this occurs you will need to repea
10. as been detected the measurement begins An hourglass icon indicates that the measurement is in progress Reviewed Revised 06 26 13 15 16 17 18 19 20 21 22 23 HP 300 121 Page 4 of 5 After the sample has been obtained apply gentle pressure to the puncture with a clean gauze square or cotton ball site for several minutes The measurement is complete when the result is displayed on the screen Depending upon how high or low the result is it may appear in a numeric or non numeric format See Reporting Results section below for interpretation of each result format Remove the test strip and dispose of it in plain trash CC Touch to enter up to three appropriate comment s as required in the General Policies section of this manual Touch the Y button to confirm the result and send the result from the meter wirelessly or place the meter in the base unit to send the result and record the result into the electronic data management System The base unit also charges the meter Documentation of the result in the patient s electronic medical record occurs automatically as long as the patient s FIN number is entered correctly Follow up on any results that exceed critical or reportable limits according to policy Clean and disinfect as necessary with Clorox wipes Error messages e If the error message Strip Defect Error appears on the display the test strip may be defective or the blood gluc
11. blood or control solution to the test strip before inserting it into the meter If a result appears before applying blood or control solution do not act on that result Once sufficient sample has been detected the measurement begins An hourglass icon indicates that the measurement is in progress n After the sample has been obtained apply gentle pressure to the puncture with a clean gauze square on the site for several minutes If the patient is conscious and capable enlist the patient s assistance with applying pressure o The measurement is complete when the result is displayed on the screen Depending upon how high or low the result is it may appear in a numeric or non numeric format See Interpretation of Results section below for interpretation of each result format p Remove the test strip and dispose of it in plain trash q Touch e to enter up to three appropriate comment s as required in the General Policies section of this manual f N r Touch the Y button to confirm the result and send the result from the meter wirelessly or place the meter in the base unit to send the result and record the result into the electronic data management system The base unit also charges the meter s Documentation of the result in the patient s electronic medical record occurs automatically as long as the patient s FIN number is entered correctly Follow up on any results that exceed critical or reportable limits according to policy Clean
12. c The glucose is less than 10 d Sample was applied before the drop symbol appeared on the screen e All of the above 4 What number is used as the patient identifier a The patient s Social Security number b The patient s Medical Record number C The patient s financial FIN number d The operator s Lawson ID number 5 n what situation is it appropriate to use 0911911 as the patient identifier a The patient comes in as a trauma and isn t registered yet b Youare a diabetic and wish to test yourself c You are having a busy night d aandb 6 How long are quality control solutions good after opening a 15 days b 30 days c 45 days d 90 days 7 Ifthe meter is not working properly you should a Try toreset the meter by unplugging the dock system Place a red out of service tag on the meter and take the meter to the lab Borrow a meter from another unit Submit a work order to BIOMED ec 8 If the meter reads patient results outside the Critical or reportable ranges a Notify patient care provider and then document in Cerner b Do nothing patients have critical glucose results all the time c Test the patients five more times to be sure d None of the above 9 Whatis true of test strip handling a Teststrips do not have an expiration date b Remove the test strip from the vial and immediately recap the vial c Unopened test strips are kept in the lab d Opened vials of test strips are stored in the refrigerator t
13. diately recap the vial Insert the test strip into the meter in the direction of the arrows and with the ACCU CHEK lettering facing upward The Page 4 of 7 200 02 Point of Care ACCU CHEK Inform Il Blood Glucose Monitoring System meter will display a flashing drop above the test strip icon when the test strip is properly inserted indicating that you are ready to apply a blood sample Perform the finger stick with the Safe T Pro Plus lancet i Twist off the purple sterility cap ii Set lancet depth at 1 3 1 8 or 2 3 by turning depth adjuster iii Hold lancet against the side of fingertip or heel and activate by pressing the purple trigger button on the lancet 1 A venous or arterial sample may also be used for testing a Use fresh sample from the end of the syringe b If the blood is collected in a heparinized or EDTA tube testing must be completed within 30 minutes of being drawn 2 Fingerstick or neonate heelstick samples a Testimmediately as the sample is collected 3 Venous arterial or line draw samples a Test as soon as possible and no later than 30 minutes following collection Be sure they are well mixed and that line draw samples have been thoroughly cleared of line fluids Do not allow bubbles to enter the test strip sampling chamber m Apply blood to the front edge of the test strip The sample will fill the yellow sample chamber by capillary action Do not apply sample to the top of the test strip Do not apply
14. e Main Menu touch Control Test Select the level of control that you wish to test Confirm that the meter is coded calibrated to the same test strip code that is printed on the test strip vial by scanning the test strip vial s barcode Contact the laboratory if unable to confirm the correct test strip code The meter will display a picture of a test strip with a downward flashing arrow on the meter indicating that you are ready to insert a test strip into the meter Remove a test strip from the vial and immediately recap the vial Insert the test strip into the meter in the direction of the arrows and with the ACCU CHEK lettering facing upward The meter will display a flashing drop above the test strip icon when the test strip is properly inserted indicating that you are ready to apply control solution Apply control solution to the front edge of the test strip The solution will fill the yellow sample chamber by capillary action Do not apply sample to the top of the test strip Once sufficient sample has been detected the measurement begins An hourglass icon indicates that the measurement is in progress You will get an error message if the sample is insufficient If this occurs you will need to repeat the test The measurement is complete when the result is displayed on the meter screen See the Interpretation of Results and Troubleshooting sections below for guidance on what to do if your result is Fail or shows an out of range
15. e any other anticoagulants for meter testing a Lithium or Sodium Heparin EDTA 3 Referto Mosby s Nursing Skills for detailed instructions on how to perform a finger or heel stick MATERIALS Accu Chek Inform Il meter Accu Check Inform II glucose strips Accu Chek Inform II Quality Control solutions Accu Chek Inform II Linearity Kit Accu Check Inform Il base unit Lancet devices Gloves Sharps container gt Alcohol wipe REAGENT STORAGE HANDLING AND STABILITY Meters system components and reagents are stored maintained and handled according to manufacturer s instructions and in compliance with all established safety and infection control policies and regulatory guidelines Test Strip Storage and Handling Use the test strips at temperatures between 61 95 F 16 35 C and between 10 80 relative humidity Store the test strips at temperatures between 36 86 F 2 30 C Do not freeze Store unused test strips in the original container with the cap closed Do not remove test strips from the test strip container and put them into another container such as a plastic bag or pocket etc to protect from humidity Use the test strip immediately after removing it from the container Discard the test strips that are past the expiration date printed on the test strip container If the expiration date is missing or illegible do not use the test strips Do not apply blood or control solution to the test strip before inserting it into the meter I
16. e cleaned after each patient test and every twenty four hours if when the quality control is done c Care should be taken not to get any liquid into the ports at the bottom and top of the meter as this can damage the meter d The cleaning will be documented electronically in the meter e Gloves should always be worn during testing events hand hygiene performed and gloves changed between patients according to Standard Precautions f Only auto disabling single use fingerstick devices are used for assisting monitoring of blood glucose g Base Unit and Accessory box cleaning and disinfecting Base units are cleaned and disinfected with an approved germicidal wipe h Cleaning and disinfecting are companion procedures that are generally performed together at the same time Do not clean or disinfect the meter while performing any type of test Do not allow pooling of liquid on the touchscreen Do not spray anything onto the meter or base unit Do not immerse the meter or base unit in liquid E A I Page 2 of 7 200 02 Point of Care ACCU CHEK Inform Il Blood Glucose Monitoring System m Do not get liquid into the strip port If liquid does get into the test strip port immediately dry the components with a dry cloth or gauze pad If solution is allowed to collect in any meter opening severe damage to the system can occur If you suspect that moisture may have entered the strip perform glucose control testing Do not wipe the electrical connecto
17. f a result appears before applying blood or control solution do not act on that result APPROVED BY TITLE DATE REVIEWED UT PEE DATE REVISED 06 26 13 te HP 300 121 Page 2 of 5 Cleaning and Disinfecting the ACCU CHEK Inform Il System Components Meter and Base Unit Cleaning and Disinfecting Cleaning and disinfecting the exterior surface of the meter with either Clorox Bleach Wipes is at minimum recommended daily for dedicated patient devices Meters used with multiple patients may require more frequent cleaning and disinfecting NOTE Follow all facility safety and infection control policies when handling cleaning and disinfecting ACCU CHEK Inform I meters QUALITY CONTROL Quality control testing is performed as a primary means of ensuring ongoing proper performance of the ACCU CHEK Inform Il system Low and high quality control testing is performed on the following occasions 1 a fF oO DN Every 24 hour period of patient testing When a new test strip vial is opened and placed into service With unexpected patient results of any kind Acceptable quality control results are defined as results that are within manufacturer s posted limits Quality control testing results must be acceptable prior to performing patient testing according to the nterpretation of Results section of the procedure below Procedure 1 2 10 11 Turn on the ACCU CHEK Inform II meter Enter the operator ID by means of sc
18. glucose results e If peripheral circulation is impaired collection of capillary blood from the approved sample sites is not advised as the results might not be a true reflection of the physiological blood glucose level This may apply in the following circumstances severe dehydration as a result of diabetic ketoacidosis or due to hyperglycemic hyperosmolar non ketotic syndrome hypotension shock decompensated heart failure NYHA Class IV or peripheral arterial occlusive disease f Hematocrit the acceptable range for the ACCU CHEK INFORM II test strips is 20 65 for values below 200 mg dL and 20 55 for values above 200 mg dL g Patients in Isolation 1 The meter can be placed in a plastic bag 2 Asmall hole can be punctured in the bag 3 The strip can be placed in the meter through the hole and the meter programmed as usual 4 After the testing is done the plastic bag is discarded and the meter will be wiped down 10 Procedure for Patient Testing a eo Wash hands and don personal protective equipment gloves gowns etc as required by infection control and isolation policies and procedures Assemble the finger stick equipment the meter and the test strips at the patient bedside Identify the patient by armband and explain the procedure Wash and dry patient s hands heel with soap and water before obtaining a blood sample Alcohol wipes are not recommended for use Turn on the meter Scan your operator barcode or en
19. he operator should send a specimen to the laboratory for further quantification iii The operator should always follow the protocol for hypoglycemia or hyperglycemia that is in place for the patient type The operator should not wait for the lab confirmation before starting treatment 12 Documentation a Alicensed medical provider must order all patient testing b Glucose results are documented in Powerchart i Labor and postpartum patients ACCU CHEK INFORM LL Inform Il results must be charted under Maternal Vital Signs in QS ii Well newborns in QS ACCU CHEK INFORM LL Inform II results must be charted on the newborn flow sheet under glucose c f patients choose to recheck results with their own glucose meter these results cannot be used for diagnostic purposes or be documented in the patient s medical record d lf a patient is on an insulin pump it may be used by the patient if the licensed medical provider writes an order for the pump to be used In this instance the patient s own glucose meter may be used for glucose testing and insulin bolusing via the patient s insulin pump e Once results are verified the test will automatically charge in computer f If the value is outside for the reportable range 30 or gt 500 the value entered in computer will be 30 or 2500 with a comment added to indicate the actions taken g The glucose value of the patient will be stored in the meter and may be retrieved at a later date h W
20. henever the patient result obtained by the ACCU CHEK Inform Il does not appear to fit the clinical picture repeat the QC and patient specimen A You must use the comment Repeat will not post on the repeat test The patient will not be charged for two tests Only the repeat test will chart 13 Troubleshooting a Troubleshooting and technical assistance with the ACCU CHEK Inform Il is handled by the Point of Care Coordinator POCC the Education office the CRC superuser or the superuser on the unit that is responsible for point of care glucose testing c Document the problem with the red out of service tags attached to the meter and bring the meter to the Laboratory d Loaner meters are available E Help with corrective action is available from the laboratory in the ACCU Check Inform Il manual and within the meter using the Comment Codes 13 Storage of Testing Materials a Test strips should be stored at room temperature from 36 86 F b Unopened test strips are good until the expiration date printed on the label c When you take a test strip out of the container put the cap back on tightly immediately D Control material is good 90 days after opened if kept at 39 86 F 4 30 C 14 Supplies a Strips and auto disabling single use fingerstick lancets are stocked in Supply Chain Management and stored in the PYXIS b Do not use the test strips if there is loose desiccant in the test strip vial c Controls will be kept in
21. hours States how to document cleaning electronically in the meter States cleaning precautions After cleaning wait until the meter is completely dry before docking Employee feel competent to perform above skills understand that the use of another person s ID or a false patient identification in the ACCU CHECK Inform II meter is considered falsification of a document and may result in disciplinary action Signature Lawson No Date Trainers The above skills have been successfully demonstrated and stated correctly By signing this competency check list The employee listed above agrees to take the on line quiz within 2 days of completion of this skills lab Signature Date
22. message associated with the result Remove the test strip and dispose of it in plain trash Touch the comment button 2 to enter an appropriate comment s as required in the General Policies section of this manual f Touch the Y button to confirm the result and send the result from the meter wirelessly or place the meter in the base unit to send the result and record the result into the electronic data management system The base unit also charges the meter Page 3 of 7 200 02 Point of Care ACCU CHEK Inform Il Blood Glucose Monitoring System h Interpretation of Quality Control Results a Results are displayed on the screen as a number Any result that shows an out of range message or Fail is an indication that the system may not be performing correctly for patient testing b Patient testing may not be performed if quality control testing results are not within acceptable limits and the meter will not display the patient testing option if scheduled quality control results exceed acceptable limits 9 Special considerations for Patient Testing a Hematocrit should be between 10 65 96 b Lipemic samples triglycerides in excess of 1800 mg dL may produce elevated results c Blood concentrations of galactose gt 15 mg dL will cause overestimation of blood glucose results d Intravenous administration of ascorbic acid which results in blood concentrations of ascorbic acid gt 3 mg dL will cause overestimation of blood
23. nications and is ready to use The meter can be removed and used at any time during the transfer of information Any information not completed will be transferred the next time the meter is docked When properly docked the meter will communicate every 10 minutes even if the meter is off This connection gives the meter the most up to date settings and ADT information when available This transfer can occur also when a wireless meter is docked in a connected base unit REFERENCES ACCU CHEK INFORM LL Inform II User s Guide Retrieved from www poc roche com and www accu checkinformii com websites 2012 2013 Roche Diagnostics All rights reserved Clinical Laboratory Improvement Act of 1988 CLIA 88 Standards College of American Pathologists CAP Point of Care testing checklist 9 25 2012 McClatchey Kenneth ed 2002 Clinical Laboratory Medicine Second Edition Philadelphia Lippincott Williams amp Wilkins The Diabetes Educator Vol 31 No 6 849 857 2005 Page 7 of 7 200 02 Point of Care ACCU CHEK Inform Il Blood Glucose Monitoring System Prepared by Title Date D Danielson MT ASCP 7 12 Karen McMullin Director 7 12 4 13 Approved by Title Date Susanne Maiden CNO VP 6 13 Committee Approval Date Policy amp Procedure 10 06 5 18 07 Nursing Practice 8 25 10 GOP 9 21 10 7 17 12 4 16 13 6 18 13 Dates Reviewed Revised 12 99 11 00 12 01 10 03 12 05 10 06 5 07 10 07 7 2
24. o limit exposure to humidity 10 You confirm the meter is coded calibrated by scanning the test strip vial a True b False 11 The meter should be cleaned when a The meter is visibly soiled At least daily After running a test on a patient in isolation After each patient use All of the above Dopo 12 If the operator s ID is not accepted the operator would a Call the laboratory Attempt to re enter his her ID Borrow another operators badge All of the above aandb popo 13 You should touch and hold the drop of blood to the front edge of the Accu chek Inform Il test strip a True b False 14 Only capillary whole blood samples should be used when testing the Accu chek Inform Il meter and the Accu chek Inform ll test strips a True b False ANSWER SHEET FOR 2013 ACCU CHEK INFORM II TEST COMPETENCY Directions Circle the best answer l abececd e 2 a b 3 a nN 5 c c c c c c c e a en Qa en e en Qa 10 a b ll abcdee 12 a b c d e 13 a b 14 a b Instructor s Name LawsonID _ J The undersigned certifies as follows I have read the Guidelines of Practice for Point of Care ACCU CHEK Inform II Blood Glucose Monitoring System Policy I understand this test in of itself does not test competency This test in conjunction with a hands on demonstration is needed to certify competency and allowing the use of the ACCU CHEK system Student Signature
25. o the test strip Strip Defect Error 17 Reporting Results a Datais transferred from the meter into Cerner as follows i Wireless Data Transfer Results will automatically transfer wirelessly into Cerner if a wireless connection is currently available upon completion of a test A wireless vo 3 connection is activated when the testing operator touches upon completing a 3 test An available wireless connection is confirmed by the presence of I at the ep bottom of the screen If I is not present a wireless connection is not currently available If a wireless connection is not currently available the meter will automatically send results as soon as a wireless connection is established The meter will connect to Cerner every 10 minutes and transfer new data when a wireless connection is available even if the meter is powered off This connection gives the meter the most up to date settings and ADT information when available ii Wired Data Transfer Results are transferred into Cerner by placing the meter into a base unit that is connected to the hospital network through an RJ45 connection connected to the hospital network When properly docked the meter will automatically transfer test results The following series of screen displays will appear to confirm that data transfer is occurring 1 Connecting meter is establishing connection 2 Transferring meter is transferring information 3 Idle meter has finished commu
26. ose result may be extremely low and below the meters measurement range Refer to the test strip package insert perform a quality control test using a new test strip review proper testing procedure and repeat the blood glucose test or follow your facility s testing policy e If the meter displays Type Bad Dose there may be insufficient amount of blood on the test strip Repeat the test using a new test strip ensuring proper sample application or refer to the test strip package insert e Guidance for Interpreting On Screen Message and Error Codes All error messages displayed by the system have a letter identifying the message type a number and a description of the error to help the operator take action to resolve the problem The different message types are in the table below E Identifies the notification as an Error The information notifies the operator that an error has occurred W Identifies the notification as a Warning The information does not block the operator from continuing but rather gives the operator information that may suggest an alternate workflow is required Identifies the notification as Informational only Informational notifications present the operator with contextual information and allow the operator to proceed after confirming the notification D Identifies a Decision point Decision notifications provide the operator with a choice based on contextual information Linearit
27. roperly doses the test strip Enters Operator ID and Patient ID according to policy Scan own badge and wristband Understands why meter needs to be docked after use charges battery Quality Control States when controls are routinely run once every 24 hrs or every use day States when to discard control solution at exp date or 90 days after opening States what to do when control result fails to fall within the acceptable range repeat the test and document remedial action with a comment Demonstrates correct procedure for Hi amp Lo solution testing Hospital Critical Limits Documentation and Follow up States critical values 45 or 2450 mg dL notify provider of critical results newborns 30 or 2300 mg dL Demonstrates importance of comments notify provider or notify RN and repeat criteria States when venous sample is sent to central laboratory for confirmation lt 30 or 2500 mg States emergency ID when patient is unidentified 0911911 Verbalizes how to enter a custom comment patient s name Cleaning States proper infection control and safety practices States cleaning techniques for the meter wipe ACCU CHEK Inform Il meter with Chlorox Bleach Wipes States the importance of not getting liquid into the strip port If liquid does get into the test strip port immediately dry the components with a dry cloth or gauze pad State cleaning frequency after each patient use at time of quality control once every 24
28. rs on the back of the base unit Do not use any cleaning and disinfecting product other than that which is recommended by the manufacturer identified in this procedure and provided through normal procurement policies and procedures f Quality Control Testing a b C Two levels of quality control material Low and High with known values must be performed every use day If a facility is closed quality control will be done when the facility opens prior to testing of the first patient Results of both levels of quality control must be within the acceptable ranges before patient testing is done Failure to successfully run quality control within the 24 hour window will result in the ACCU CHEK Inform Il locking out all patient testing Quality control must also be performed in the following circumstances i When a new vial of test strips is opened ii If the cap has been left off a vial of test strips iii If the meter has been dropped iv When questioning patient results or the performance of the meter g Procedure for Quality Control Testing a b a9 Turn the meter on by pressing the ON OFF button located below the center of the touch screen Enter the operator ID by means of scanning the barcode on the identification band NOTE If the operator ID you enter is not accepted attempt to re enter it If it is still rejected contact the laboratory DO NOT attempt to perform tests under another operators ID From th
29. t the test The measurement is complete when the result is displayed on the meter screen See the Interpretation of Results and Troubleshooting sections below for guidance on what to do if your result is Fail or shows an out of range message associated with the result Remove the test strip and dispose of it in plain trash p O N Touch the comment button L to enter an appropriate comment s as required in the General Policies section of this manual i Touch the Y button to confirm the result and send the result from the meter wirelessly or place the meter in the base unit to send the result and record the result into the electronic data management System The base unit also charges the meter Interpretation of Quality Control Reviewed Revised 06 26 13 1 HP 300 121 Page 3 of 5 Results are displayed on the screen as a number Any result that shows an out of range message or Fail is an indication that the system may not be performing correctly for patient testing PROCEDURE Patient Testing Procedure Ts 10 11 12 13 14 Carefully assess the patient for any indication that bedside glucose testing may not be appropriate Consider the following potential interferences and compromising conditions e Hematocrit should be between 10 65 e Lipemic samples triglycerides in excess of 1800 mg dL may produce elevated results e Blood concentrations of galactose gt 15 mg dL
30. tatively measures glucose in whole blood It is used to monitor and treat abnormal glucose levels This test is definitive for glucose levels but requires laboratory verification of any result outside of the meter s reportable range as outlined in the procedure below Only certified or licensed personnel that have successfully completed training on the meter at VVMC can perform this test Point of care glucose monitoring must be done on Verde Valley Medical Centers ACCU CHEK Inform I meters PROCEDURE a Normal Ranges a 12years and up 70 110 mg dL b 6 months to 12 years pediatric range 60 115 mg dL c Oto 6 months 40 125 mg dL d Pregnancy 60 110 mg dL b Critical Ranges a 6 months to adults 60 mg dL and gt 450 mg dL b 0 6 months 40 mg dL and gt 200 mg dL c Reportable Ranges a 30 500 mg dL b Outside this range needs a laboratory verification sample d Specimen Collection and Handling a The following fresh whole blood sample types may be used i Venous whole blood ii Arterial whole blood iii Capillary non neonate fingerstick and neonate heelstick whole blood b The following anticoagulants are acceptable do not use any other anticoagulants for meter testing i Lithium or Sodium Heparin EDTA c Sufficient sample size is required for accurate results e Safety and Maintenance a Itis important to keep the meters clean and disinfected with an approved germicidal wipe b The ACCU CHEK Inform Il meter should b
31. ter your 5 digit Lawson ID You must enter a leading zero if you have a 4 digit Lawson number If your ID is not on record in the laboratory you will be locked out of the instrument NOTE If the operator ID you enter is not accepted attempt to re enter it If it is still rejected contact your supervisor or Point of Care Coordinator DO NOT attempt to perform tests under another operator s ID From the Main Menu touch Patient Test Scan the patient s financial number from the bar coded wristband for the patient ID i In any situation where a patient has not been registered the number 0911911 should be used as the patient identification number ii A custom comment should be entered in the ACCU Check Inform Il system with the patient s name at the time of testing This will allow for charting and billing when a financial number is assigned in the future iii In certain situations an employee may need to have a glucose test done If this occurs the number 0123456 should be used This will not be documented as a patient test Confirm that the meter is coded calibrated to the same test strip code that is printed on the test strip vial by scanning the test strip vial Contact the laboratory if you are unable to confirm the correct test strip code You will now see a picture of a test strip with a downward flashing arrow on the screen indicating that you are ready to insert a test strip into the meter Remove a test strip from the vial and imme
32. the Laboratory and replaced every three months by the POCC 15 Training and Proficiency a New operators need to show proficiency initially at six months and yearly thereafter This will be incorporated initially at orientation at six months with the assistance of superusers and at the annual nursing competency review b Glucose proficiency testing a CAP requirement will be performed according to the scheduled distribution c The testing material directions and data sheets will be provided by the laboratory Page 6 of 7 200 02 Point of Care ACCU CHEK Inform II Blood Glucose Monitoring System D The use of another person s ID in the ACCU CHEK Inform II meter is considered falsification of a document and may be subject to disciplinary action 16 Notes a In any situation where a patient has not been registered the number 0911911 should be used as the patient identification number A custom comment should be entered in the ACCU Check with the patient s name at the time of testing This will allow for charting and billing when a financial number is assigned in the future b In special situations an employee may need to have a glucose test done If this occurs the number 0123456 should be used This will not be documented as a patient test c You may get an error code if e Strip is under filled Type bad dose e Strip defective or previously used glucose is 10 or end user did not wait for drop symbol to appear before applying sample t
33. y Testing Procedure Linearity testing also known as calibration verification is a means of testing the ACCU CHEK Inform II system s ability to give correct readings through a broad range of glucose levels It is used as a periodic check on system performance Linearity testing is performed on 1096 of meters during new instrument implementation then on all subsequent meters or as part of troubleshooting related to questionable meter performance Proficiency Testing Procedure Participation in proficiency testing is part of the quality assurance program to ensure proper on going performance of the ACCU CHEK Inform Il system and the competence of staff performing tests At least 1096 of meters are tested during each proficiency cycle by staff routinely using the device Results are submitted to CAP without consulting with any other survey subscribers The survey report is reviewed by Reviewed Revised 06 26 13 HP 300 121 Page 5 of 5 the Laboratory Director Medical Director or Designee Appropriate corrective action is taken in the event of survey failures REPORTING RESULTS Data is transferred from the meter into Cerner as follows 1 Wireless Data Transfer Results will automatically transfer wirelessly into Cerner if a wireless connection is currently available upon completion of a test A wireless connection is activated when the testing operator touches ce upon completing a test The meter will connect to Cerner every 10 minutes and
34. yer Skill ContentPlayerlFrame aspx Keyld 430 amp ld GN 43 12 amp Section 1 amp bcp Sear chOp 0 glucose False amp lsConnect False e Blood Glucose Monitoring Pediatric Retrieved from http mns elsevierperformancemanager com NursingSkills ContentPlayer Skill ContentPlayerlFrame aspx Keyld 855 amp ld CCP_133 amp Section 1 amp bcp Searc hOp 0 glucose False amp lsConnect False e Heel Stick Neonatal Retrieved from http mns elsevierperformancemanager com NursingSkills ContentPlayer Skill ContentPlayerlFrame aspx Keyld 1233 amp Id NN_003 amp Section 1 amp bcp Searc hOp 0 heelstick False amp lsConnect False Reviewed Revised 06 26 13 Name Lawson Date ACCU CHEK INFORM II TEST COMPETENCY Please read the Guidelines of Practice for Point of Care ACCU CHEK Inform II Blood Glucose Monitoring System and answer the following questions Questions 1 When does a specimen need to be sent to the lab for verification a When the meter reads RR HI When the meter reads RR LO When results are questionable All of the above None of the above oop oo 2 The measurement testing will start when the appropriate amount of sample is applied to the Accu chek Inform Il test strip If it is not the correct amount it will give an error code a True b False 3 After applying the sample to the test strip and the measurement begins an error message occur this means a The sample is insufficient b The strip was previously used
Download Pdf Manuals
Related Search