Inform II Initial Training Module. ACCU-CHEK Inform II Training

Transcription

1 Inform II Initial Training Module ACCU-CHEK Inform II Training

2 Course Objectives This course will cover the following information about the Accu Chek Inform II glucose meter: Overview of System Features Features of the Accu Chek Inform II glucose meter, base unit and test strips Charging and downloading the meter Inform II test strip vial requirements Control vial requirements and how to perform control testing Meter Screens Operation Operator ID requirements Patient ID requirements and how to perform patient testing Proper technique for fingerstick and use of Safe T Pro Lancet Adding Comments Actions required when patient test results fall into critical range and/or HI or LO Specimen Requirements and Regulations Meter Limitations Hospital Policy requirements Infection Control requirements ACCU CHEK Inform II Training

3 Meter Features Test strip port Bar code scanner Sealed screen Rechargeable battery with stainless steel contacts Backlit touchscreen display Infrared window for communicating with the recharger/downloader base units. On/Off button FRONT BACK Rubber Feet ACCU-CHEK Inform II Training

4 Recharger/Downloader Base Unit Design Battery charging contacts Infrared communication for the meter (if base unit is a downloading unit) Base unit status light green means connected to the network The meter should always be in a base unit when not testing patients so that battery stays charged and meter errors do not occur. Some base units download results and recharge the battery Some base units only recharge the battery. ACCU-CHEK Inform II Training

5 Downloading the Meter There are two methods for downloading information from a meter to a patient s EMR. One or both of these methods may be used at any HFHS glucose meter testing location. 1. Wired base unit connected to a computer or an intranet jack by cable 2. Wireless network this symbol will appear on the bottom of the meter screen at sites where the wireless download function is enabled Glucose meter download screens Wired Base Download Wireless Download This red circle means the meter has information to transmit. It s important to LEAVE THE METER DOCKED in the base until the red circle disappears. Sometimes, it may say Synchronizing Database for up to 10 minutes. Do not remove meter from base unit until red circle is gone and screen says Idle. If the lightning bolt symbol does not appear after this cycle, pick up the meter and dock it again. Repeat until the lightning bolt appears. If it won t appear after several tries, call the Point of Care Coordinator or STAT referral lab assigned to your clinic or unit. Note: Wireless Icon visible on meters that download data via wireless network ACCU CHEK Inform II Training

6 Charging the Meter Wireless Communication Icon Visible only at sites with wireless connectivity Battery icon If the meter flashes this symbol then goes dark, the battery is critically low. Dock the meter. It may be several minutes before it gathers enough charge to display the regular lightning bolt charge symbol. The meter may flash and beep during this time. ACCU CHEK Inform II Training

7 Test Strip Vial Requirements Expiration date is the manufacturer expiration date printed on vial Inform II strips Do not date the strip vial Store at room temperature Make sure vial is tightly closed at all times. Discard code key when opening a new box of test strips. Center edge dosed strip Re-closable flip top lid ACCU-CHEK Inform II Training

8 Control Bottle Requirements Label control bottle with open date and expiration (discard) date. Controls expire three months after opening or at manufacturer s expiration date if it is sooner. Include the full date on the bottle for discard date: mm/dd/yy. Store at room temperature. ACCU-CHEK Inform II Training

9 Meter Screens Power Up Hours until quality control is due Wireless not connected 5C2 Location where the meter is assigned Press Forward Arrow Icon to continue Battery gauge All meters attempt to download every 10 mins ( see below ) last attempt to communicate to the data management system was successful last attempt to communicate to the data management system was unsuccessful or was unintentionally terminated (may need to dock the meter) ACCU-CHEK Inform II Training

10 Meter Screens Icons Menu Icon To display menu on the screen Barcode Icon Scan barcodes Eraser Icon Deletes entire entry Comment Icon To enter Comments Check Mark Icon Use to forward to next screen or confirm information entered in meter ACCU-CHEK Inform II Training

11 Meter Screens Input Operator ID and Menu Operator ID displayed Press and release the barcode button to scan operator ID To backspace To scan, position meter a few inches away from bar code on employee ID badge Main Menu Screen To perform a patient test, press the Patient Test menu item Operator name displayed here To perform a control test, press the Control Test menu item ACCU CHEK Inform II Training

12 Operator ID Operator ID is the Employee Badge Number Operators may scan the barcode on back of employee badge, or manually enter badge number. If barcode on badge is damaged, it may not scan. Obtain a new employee badge. If employee ID badge is replaced, notify Point of Care with new employee badge number. It is a violation of Hospital Policy to share operator IDs! System Wide Confidentiality and Information Security HR Policy No: 5.18 ACCU CHEK Inform II Training

13 Preparing to Run Controls Press the barcode icon and scan the barcode on the control bottle REQUIRED indicates QC is due now. REMEMBER: Two levels of control must be run on each strip vial in use at least once every 24 hours, when opening a new vial of strips, or new lot # of strips. QC should also be run a if a meter is dropped or damaged in any way, or if there is any question regarding the accuracy of meter results. Press the barcode icon to scan the barcode on the test strip vial. ACCU-CHEK Inform II Training

14 Screens While Running Controls Do not add sample until this drop appears. Wipe tip of control vial before and after use. Code Key Checks Insert Strip Apply Sample Apply to the front edge of the yellow target area and fill the yellow window DO NOT PLACE SAMPLE ON THE TOP OF THE STRIP. Squeeze small drop of QC solution; keep the meter level to prevent solution from entering the test strip port area. ACCU-CHEK Inform II Training

15 Control Results If QC passes, PASS displays on screen. Press the check mark icon and continue. If QC fails, enter a comment. The comment icon will flash. Testing cannot proceed until a comment is entered. Repeat QC test. Comments are required for QC that FAIL Both levels of QC must pass before patient testing is allowed. ACCU-CHEK Inform II Training

16 Patient Identification Verify patient s identification prior to testing using two patient identifiers. A medical record number (MRN) is required for all patient testing. Enter the MRN by scanning the patient s wristband at the bedside. If the wristband is damaged, get a new wristband and then proceed with testing. If meter is unable to scan the barcode, enter the MRN using the keypad on the meter screen. Enter carefully and verify! If scanner doesn t work please contact site POC Coordinator If the MRN is entered incorrectly, the patient s glucose result will not appear on the patient s EPIC chart. If no wristband is available, which may be the case in Outpatient Clinics, the EPIC stickers may be used for scanning the medical record number. ACCU CHEK Inform II Training

17 How to Collect a Proper Fingerstick Sample 1. SELECT THE FINGER SITE Select the side of the fingertip that has not been lanced recently. Each test should be performed from a new skin puncture. The middle or ring finger is preferred. Do not use an old puncture site. 2. ACCESS THE PUNCTURE SITE To help ensure that an adequate sample is obtained, have the patient hold his or her hand in a downward position. Applying gentle pressure, massage the inside of the patient s hand from the palm to the base of the finger to be lanced and up to the tip of the finger. 3. DISINFECT THE PUNCTURE SITE Cleanse the puncture site. Scrub using acceptable cleansing wipe. Let the solutions dry before puncturing. It is very important to make sure the puncture site is dry. Alcohol or other skin preparation ingredients may interfere with the glucose test chemistry and cause an inaccurate reading. 4. OBTAIN ADEQUATE BLOOD FROM THE PUNCTURE SITE Wipe away the first drop of blood with a gauze pad. Hold the puncture site downward and gently apply intermittent pressure to the surrounding tissue. Strong repetitive pressure (milking) should not be applied; it may cause tissue fluid contamination. ACCU-CHEK Inform II Training

18 How to Use the ACCU CHEK Safe T Pro Lancet Single-Use Twist and Press Hold the lancet and twist off the protective cap. DO NOT use if cap has previously been removed. Place lancet against the side of the fingertip and press the blue button. AFTER USE, DISPOSE IN SHARPS CONTAINER. ACCU-CHEK Inform II Training

19 To Run a Patient Test Press Patient Test on the Main Menu. Input the patient s medical record number (MRN): Scan the barcode on the patient s wristband. (Operators may also manually enter using the numeric keys Enter carefully & verify!) ACCU-CHEK Inform II Training

20 Screens While Running a Patient Test Do not add sample until this drop appears. Code Key Checks Insert Strip Apply Sample If the comment icon is flashing, a comment entry is required. Press Range icon to display appropriate reference range for the result. Press the check mark icon to continue. ACCU-CHEK Inform II Training

21 Screens Used For Adding Comments To A Test Select up to 3 pre defined comments. To de select a comment, press it again. Site Specific: Custom icon to add a custom comment. Use Down Arrow icon to scroll for more comments. Press check mark icon to go to summary screen. Comments selected display Summary Screen ALWAYS press check mark icon when finished. Meter will transmit result and comments when placed in a recharger/downloader base unit. Wireless meters will transmit result immediately. ACCU-CHEK Inform II Training

22 Critical Glucose Meter Results and Repeat Testing Critical Glucose Meter Results for patients: A glucose meter result in the critical range can have life threatening consequences if left untreated or treated improperly. It is important to confirm critical values to ensure proper treatment. Adult Critical Range: less than 40mg/dL or greater than 400mg/dL Neonatal Critical Range: less than 45mg/dL or greater than 125mg/dL To successfully confirm a critical result, repeat results must agree within specific limits. Adult Critical Values less than 40 mg/dl: Repeat result must be within 15mg/dL of first result. For example: Acceptable repeat: 1 st result = 35 mg/dl; 2 nd result = 20 mg/dl Unacceptable repeat: 1 st result = 35 mg/dl; 2 nd result = 15 mg/dl Adult Critical Values greater than 400 mg/dl: Repeat result must be within 20% of first result. For example: Acceptable repeat: 1 st result = 450 mg/dl; 2 nd result = 525 mg/dl Unacceptable repeat: 1 st result = 450 mg/dl; 2 nd result = 580 mg/dl ACCU-CHEK Inform II Training

23 Action Steps for Critical Glucose Results When a patient result falls into a critical range: 1. Meter screen will display a message indicating that the patient result is critical. A comment will be required before proceeding to next step. Enter appropriate comment; such as Will repeat test. 2. The same operator should perform another test on the same meter within 5 minutes, or send a patient sample to the lab immediately for Stat Glucose. 3. Evaluate the two results to determine if they meet acceptability criteria. 1. If the two results meet acceptability criteria, the result is successfully confirmed 2. If the two results do not meet acceptability criteria, perform a third test or send a patient sample to the lab immediately for Stat Glucose 4. Notify RN or physician of critical result. 5. Do not withhold treatment if clinical symptoms warrant immediate intervention. Proceed with repeat testing, as soon as possible, after treatment has been administered. ACCU CHEK Inform II Training

24 Action Steps LO and HI LO <10 mg/dl HI >600 mg/dl 1. Repeat to verify result is LO or HI. 2. If LO repeats on meter Send specimen to Lab STAT after treatment of patient, as necessary. 3. If HI repeats on meter Send specimen to Lab STAT ACCU-CHEK Inform II Training

25 Specimens Requirements Approved for capillary, venous, arterial and neonate samples. No Cord Blood! Only acceptable sites for obtaining capillary whole blood: Finger or neonatal heel stick. If peripheral circulation is impaired, collection of capillary blood is not advised as the results might not be a true reflection of the blood glucose level. This may apply in the following circumstances: Dehydration as a result of diabetic ketoacidosis or due to hyperglycemic hyperosmolar non ketotic syndrome Hypotension (Adult systolic blood pressure less than 75 mmhg) Shock Decompensated heart failure NYHA Class IV Peripheral arterial occlusive disease Collect a venous or arterial sample and send to clinical lab. Caution should be taken to clear arterial lines before blood is drawn. Do not use gray top tubes for testing. ACCU-CHEK Inform II Training

26 Meter Limitations Acceptable Hematocrit Range: 10 65%. Triglycerides greater than 1800 mg/dl may produce elevated glucose results. Ascorbic acid administered intravenously resulting in blood concentrations of greater than 3 mg/dl will cause falsely elevated glucose results. Galactose concentrations of greater than 15 mg/dl in the patient s blood will cause falsely elevated glucose results. Neonates with suspected galactosemia should have their glucose readings confirmed by send a specimen to the laboratory for testing. ACCU-CHEK Inform II Training

27 Hospital Policy Requirements All operators are responsible for knowing how to locate the Inform II Glucose Meter procedure on POC testing web page. PRC PALM 5.82 pro1: WHOLE BLOOD GLUCOSE ROCHE INFORM II SYSTEM PROCEDURE Results obtained on patient s personal meters should not be used to make treatment decisions. Do not use Hospital meters for self testing, testing other employees or visitors. Use of Accu Chek Inform II glucose meters is limited to patients currently receiving care under a Henry Ford Health System provider. It is a violation of Hospital policy to use the operator ID of another employee, or to loan out your operator ID. ACCU-CHEK Inform II Training

28 Infection Control Requirements Perform Hand Hygiene before and after wearing gloves. Always wear a new pair of clean gloves for each patient. Use appropriate PPE when performing testing on isolation patients. Clean the meter with the approved Infection Control approved disinfectant wipes after each patient use: Super Sani Cloth wipe after use on each patient. Squeeze excess solution from the wipe before using on meter. Contact Time: 2 minutes Clorox Germicidal wipe after use on patient s in Contact Plus Isolation. Squeeze excess solution from the wipe before using on meter. Contact time: 3 minutes. Remove bleach residue by wiping with damp gauze; dry. Note: Avoid getting liquid into the test strip port when disinfecting the meter. Do not allow liquid to pool on the touch screen as severe damage to the system may occur. ACCU-CHEK Inform II Training

29 Author Henry Ford Macomb Point of Care Testing November 2013 Henry Ford Macomb Point of Care Testing Revised: August 2014 Henry Ford POC Technical Team June 2015 ACCU-CHEK Inform II Training

30 You have completed the Inform II Initial Training Module ACCU CHEK Inform II Training