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Glucose POCT

  • 1.  Glucose POCT

    Posted 07-18-2019 10:04
    Good morning,

    Are nurses required to repeat glucose results >300 mg/dL on a POCT? Our current procedure states that results >300 mg/dL should be repeated by the nurse before administering treatment and results >600 mg/dL should be confirmed by the laboratory. We're currently using Accu Chek Inform II and in the process of updating the manual so I wanted to know if anyone had any thoughts. 


    Thank you.


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    Rose Hanna, MS, MLS (ASCP)CM
    --
    Bayonne NJ
    (201) 484-9044
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  • 2.  RE: Glucose POCT

    Posted 07-19-2019 11:18
    Our current nursing protocol states: " Results of Accu-Chek® glucoses should always be correlated with the patient's clinical picture. If the Accu-Chek® Inform II meter reading is less than 50 mg/dl or greater than 500 mg/dl, assess the clinical condition and consult with the provider as appropriate. A blood glucose level may need to be drawn and sent to the laboratory for verification."

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    [Rebecca] [Dill-Devor]
    [MLS Supervisor]
    [UIHealthcare Iowa River Landing][Coralville] [IA]
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  • 3.  RE: Glucose POCT

    Posted 07-22-2019 00:03
    Thank you, Rebecca!

    Rose

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    Rose Hanna, MS, MLS(ASCP)CM
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  • 4.  RE: Glucose POCT

    Posted 07-23-2019 12:03
    As a recently retired CLIA surveyor of over 30 years - please be aware that most glucometers in the market are not intended for hospital use, or for critically ill patients. Most glucometers went through the FDA process utilizing the waived ruling and for the screening of known diabetic patients. So if a surveyor were to show up at your door and you were using a glucometer not intended for the diagnosis of diabetes, or screening of a patient that does not have a diagnosis of diabetes you put your facility at the risk of an "Immediate Jeopardy " situation. So look closely at your Operators Manuals and package inserts to see if your glucometer is approved for the diagnosis of diabetes and for the use of critically ill patients. If not then that test system becomes highly complex/LDT and you would need all validation studies for high complex/LDT and also have personnel qualified to perform high complexity testing.

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    Francis Vickery
    Laboratory Compliance Officer
    Reliapath
    LAFAYETTE LA
    337-233-1898
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  • 5.  RE: Glucose POCT

    Posted 08-06-2019 20:43
    Hello!
    Rose your follow up question is great. Did anyone have a response? It seems to me that if a glucose was needed to be confirmed and was either < or > values stated for the confirmation, then for patient safety, venipuncture and lab testing should be utilized until glucose was back down (or up) to safe values and only then should fingerstick or capillary glucose be tested no? Would love to hear what happens elsewhere. I manage a small clinic with typically healthy students, but glucose is usually one of those tests providers and nursing staff want as POC so this is a great forum to read.

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    Tina Dihle
    Laboratory Manager
    --Colorado State University Health Network
    Fort Collins CO
    (970) 443-6261
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  • 6.  RE: Glucose POCT

    Posted 07-22-2019 18:01
    With all respect, patients have died because the results from a glucose POC monitor were falsely elevated and insulin that the patient did not need was administered.  So unless the POC instrument is an i-Stat (I know that some of the glucose monitors have been approved or are being approved to be used on critically ill patients but...), the best protocol that protects patients should state that POCT glucose >300 or <50 must be verified by a laboratory professional.  And then your institution should have someone from the lab available to either draw the specimen and run it to the lab or use an i-Stat to check the result.

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    Elissa Passiment
    Adjunct Assistant Professor
    Rutgers University School of Health Professions
    Bluffton SC
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  • 7.  RE: Glucose POCT

    Posted 07-23-2019 07:33
    I agree with Elissa.  When I was POC coordinator, the protocol stated that values >300 or <50 had to be verified with a lab draw.  Of course, at that time the POC monitors were not as advanced as they are today, but the bottom line is the patient safety.

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    Mary Gourley
    --
    Pittsburgh PA
    (412) 398-9567
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  • 8.  RE: Glucose POCT

    Posted 07-25-2019 11:50
    Thank you for your feedback. I do have a follow-up question. If the results were verified by the laboratory how often do we need to confirm the results if they remain >300 or <50 on the subsequent draws? I notice physicians will request a POCT glucose every 2-3 hrs, so does that mean every 2-3 hrs we run a confirmation on every value that is >300 or <50?


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    Rose Hanna, MS, MLS(ASCP)CM
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  • 9.  RE: Glucose POCT

    Posted 08-06-2019 21:34
    Rose,

    Currently our policy states any time that the value is <45 or >475 for adults, (<30 or >300 for neonates), a lab draw must be ordered.  HOWEVER, if the physician documents that they are actively monitoring the patient, they can chart No Lab Confirmation since it may be that the patient remains elevated above 475 for a few rounds of beside testing, which is understandable since you may have just drawn the patient 30 minutes prior and the bedside is still elevated.  However, if the patient falls under 475 / goes above 45 and then rises / drops again, a lab must be ordered.

    When I am checking the POC values and I find one that should have had a lab confirm but didn't, I send a letter to the nurse / PCT who performed the test asking for an explanation of why they did not follow policy and order a lab draw.  They document that the physician did not want a lab confirm and I keep this with the POC documentation.

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    Alesia Wallin
    Lead Chemistry/POC
    CHI Memorial Hospital Georgia
    Rising Fawn GA
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  • 10.  RE: Glucose POCT

    Posted 07-23-2019 18:03

    Per our POC Manager:

    The reportable range of our glucometers is 10-600.  We suggest a repeat and main lab testing if they get a result outside of this range.

     

    We also suggest a repeat and main lab testing if the result is a critical value or anytime the nurse suspects that the result is not consistent with the patient's clinical picture.

     

    Critical values:

    0 - 3 months: <40 mg/dL or >200 mg/dL

    3 mos. – 1 yr: <40 mg/dL or >500 mg/dl

    1yr. – 150 yrs: <50 mg/dL or >500 mg/dL



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    Kristina Martin
    Clinical Pathology Operations Director
    University of Michigan
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  • 11.  RE: Glucose POCT

    Posted 07-25-2019 07:55
    In our organization at HealthPartners, our system-wide Point of Care Technical team has landed on the following policy for bedside glucose testing.

    It is left up to the provider to request a recheck.
    Our linearity is 20-600 so anything less than 20 or greater than 600 must be sent for a blood collection and recheck in the laboratory.

    Rick Panning



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    Rick Panning
    Senior Administrative Director
    HealthPartners
    Bloomington MN
    6512805909
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  • 12.  RE: Glucose POCT

    Posted 07-25-2019 12:52
    We also use the Accucheck Inform II and our current policy is any POCT value <45 or >475 must have a lab draw confirmation. However, we are in the process of preparing to change to Nova STAT in November and our policy will also change to be if the value is <50 or >600 a lab confirmation is required. No further confirmations required UNLESS the patient falls into normal range and then goes outside normal range and the process starts over.

    ---------------------------------
    Alesia Wallin
    Lead Chemistry/POC
    CHI Memorial Hospital Georgia
    Rising Fawn GA
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  • 13.  RE: Glucose POCT

    Posted 07-25-2019 15:32
    Please keep in mind that there are many settings where glucose meters are used that do not offer immediate clinical lab confirmation, so lab verification prior to nursing action/intervention is not feasible.  This may include nursing homes, behavioral health care facilities, medical offices, prisons, daycare centers...

    CLSI has a document, POCT 13 Glucose Monitoring in Settings Without Laboratory Support, that addresses the appropriate response to abnormal blood glucose concentrations.

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    Jennifer Hayes
    Laboratory Director
    Oregon State Hospital
    Salem OR
    503-507-2614
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