Transcript Point of Care St. Luke’s Rehabilitation Institute For Nursing Students Created by Beata Zawadzka RN, BSN Revised December 2010

Point of Care
St. Luke’s Rehabilitation Institute
For Nursing Students
Created by Beata Zawadzka RN, BSN
Revised December 2010
Welcome to St. Luke’s
• Please review this presentation on your
own.
• When performing your first Point of Care
tests to ensure competency, you should do
it under the direct supervision of your
instructor and/or nurse preceptor.
• If you have any questions related to Point
of Care testing, ask the nurse you are
working with or Beata at 570-4699.
Introduction to Point of Care
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•
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•
What is Point of Care Testing (POCT)?
What are the goals of POCT?
What procedures fall under POCT?
Policies and Procedures
What are the goals of POC?
• To assure the safety of the patients
• To maintain the regulatory compliance
• To monitor and maintain competency of all
individuals performing tests
• To assist nursing with any issues,
questions, and/or concerns with all
aspects of POCT
What is Point of Care Testing?
• Point of Care is any laboratory test
performed outside the laboratory
• It allows for a quick decision making at
patient’s bedside
• It is utilized as a screening,
not a diagnostic tool
Where is POC performed?
• Blood glucose readings are performed at
the patient’s bedside
• Other tests should be performed in an
area designated for POC testing, located
on each unit in the Dirty Utility Room
Who can perform POC testing?
• Glucose testing may be performed by a
licensed nurse (RN/LPN), Nursing
Assistant Certified (NAC) who has a
current Health Care Assistant license
(HCA), and Nursing Students
• Other POC tests may be performed by any
nursing staff who is compliant with POC
training
POC training and proficiency
requirements
• Initial hire/clinicals
• Annually
• New equipment
Policies and Procedures
What is an operator ID?
• It is used to identify you as
the person performing a test.
• Each nursing student will be
assigned a unique operator
ID, which is different from
St.Luke’s employees.
• Please use the ID number
assigned to you; do not use
the precepting nurse’s or
NAC’s ID if you are
performing the test.
• You should always wear
your badge in an easily
visible place
Would you let someone borrow your
credit card or Social Security
number?
Why you must never allow anyone to use your
ID number or borrow someone else’s:
• Remember you are legally responsible for all tests
performed using your ID
• Your name is tied to every glucose test performed
using your ID
• This may be considered a work standard violation
Always identify your patient!
• Per St. Luke’s policy, all patients must be
identified with two identifiers:
• In an inpatient setting – “The patient will be
asked for his/her first and last name, and date of
birth by the individual collecting the sample. This
will be compared to the patient’s ID band and/or
laboratory generated label.”
• In an outpatient setting - “Patient’s name will
be checked against the name on the specimen.
The name on the tube is then rechecked with the
name on the laboratory labels.”
Only attached armbands should be
used!
• NEVER USE ARMBANDS…
- Found lying in the patient’s
bed or somewhere else in
patient’s room
- Taped to the bed
To whom does the armband
belong?
Testing visitors and/or coworkers
during an emergency situation
• For the purpose of identification and
record keeping, the above individuals will
be assigned number 855000000
What tests fall under POCT?
POCT Tests include:
• ACCU-CHEK® Inform
Glucose Meter
• Hemoccult
• Urine Dipstick – visual
method
• Gastroccult
Hemoccult Testing (Guiac testing)
• Check Hemoccult slide’s expiration
date
• Using the applicator, collect a small
fecal sample
Hemoccult
Testing
• Stool sample should not be mixed
with other fluid (urine, water) as it will
dilute sample
• Apply a thin smear covering Box A
• Reuse the applicator to obtain a
second sample from a different part of
the stool. Apply a thin smear covering
Box B
• Close the cover flap. Dispose of
applicator in a waste container
• Wait 3 to 5 minutes before developing
Identify the patient
• Open the back of the slide, apply two
drops of Hemoccult developer to quiac
paper directly over each smear
• Read results within 60 seconds. Any
trace of blue on or at the edge of the
smear is positive for occult blood
• Also, blue and green indicates positive
result
• Green alone indicates presence of bile in
the sample and is considered a negative
result
Hemoccult
• Apply one drop of
Hemoccult developer
between the positive and
negative performance
monitor areas
• Read results within 10
seconds
• Neither the intensity nor the
shade of the blue from the
positive performance
monitor should be used as
a reference for the
appearance of positive test
results
Quality Control
The Performance Monitor areas
must be developed on every slide
Factors Affecting Results
• Ideally, patients should follow the special
Diagnostic Diet for at least 48 prior to
Giuac testing
• Foods to avoid (red meat, raw vegetables
and fruits)
• Vitamins and medications to avoid (Vit. C,
iron, and/or Aspirin/NSAIDS)
Visual Urine Testing
Visual Urine Testing
• It is a SLRI policy that urine dipstick will be
performed on all newly admitted patients who
are not undergoing an antibiotic treatment
• In addition, it may be done at nurse’s discretion
at any time during patient’s stay
• Collect urine in a sterile
container. Pour off small amount
of urine into a second sterile
container (1st container is saved
for a UA if indicated)
• Completely immerse reagent
strip in a urine sample for no
longer than 1 second
• Compare reagent areas to a
corresponding color chart on a
bottle
• Read nitrite and leukocytes at 60
seconds
• If leucocytes indicate trace, read
again in another 60 seconds
• Notify MD if dipstick positive for
nitrites and/or leucocytes
Urine Dipstick
Positive for
nitrites
Urine Quality Control
• Done with each new
bottle of urine strips or if
the integrity of strips is
in question
• Documented in the QC log
in the POCT manual
Year____
Unit______
Quality Control Log (Testing Strips)
Date
Lot # of
test strips
Reason for Testing
(new bottle of
strips,
integrity issue)
Bottle #
QC Solution
Normal Exp. Date
Abnormal Exp. date
Normal Exp. date
Abnormal Exp. date
SLRI Urine Dipstick Quality Control Log
Nitrites
Leukocytes
Is QC within
expected range?
(If no, must take
corrective action)
Initial of the
nursing staff
member who
performed
QC
Glucose Testing
Quality control (QC) for Accu-Chek
Inform meter
• Is done to ensure the machine and test strips are
functioning properly, and operator’s technique is correct
• Two levels need to be performed to stay compliant with
the requirements
• QC should be performed every 24hrs (done by night shift
after midnight) of patient testing
• Meters do have QC lockout and will notify you when QC
needs to be done
• In addition, QC should be performed: with every new
bottle of strips; when machine comes back from being
repaired; if meter gets dropped; and/or if patient’s test
results contradict clinical symptoms
Quality Control
How many hours until
quality control is due
NICU
• Quality control
solution expires 90
days from the date
opened or the
manufacture’s expiration
date, whichever comes
first.
• Don’t forget to label the
bottle with the open
date, the expiration date,
and your initials.
• Glucose Strips are
•
•
•
•
NOTE : The meter must be turned
off when replacing the Code Key
good until manufacturer's
expiration date
Bottle should be kept
tightly closed
Strips should not be out
of the closed bottle for
longer than 5 minutes
If accidentally fallen on
the floor, strips should be
discarded
The code key should be
changed with every new
bottle of strips (lot
number on the bottle has
to match the code key)
40033341
If entering employee ID number manually, remember to place
40 (SLRI staff), 42 (agency/travelers) before your five digit
employee number, followed by number 1
Example: barcode number 40033341, the employee
number is actually 03334
Touch “Control Test”
and follow the prompts
SMITH JOHN
Scan the barcode
on the control vial
REQUIRED label showing
that a Level is due now
Required
Required
Scan the barcode
on the glucose strip vial
QC procedure continues
• Remove strip from the
vial.
• Recap the vial
immediately.
• With yellow target area
facing up, gently insert
the strip into the meter.
QC procedure continues
• Gently mix the control
by inverting vial 5-10
times or by rolling
between the palms.
• Touch and hold a drop
of the control solution
to the curved edge of
the yellow target area.
Screens While Running Controls
Pass
•“PASS” indicates the control
is within range and is
successful.
What if QC is out of range? Troubleshooting!
• If “FAIL” appears, touch “COMMENT.” You may enter up to 3
comments.
- Check the QC solution bottles for expiration dates
(if expired, get new solutions)
- Run controls again
• Still out of range. Perform the following interventions in this order
- Change strips and run another QC
- Still “FAIL”
- Label glucometer as not working and notify the “house
supervisor/manager”
When the screen freezes…
• If the meter does not turn
on, perform the following:
1. Place meter in the
charging base.
2. Verify the green light is
ON at the base unit.
3. If meter display remains
blank or the screen
freezes, perform a “soft
reset” by inserting paper
clip as shown.
Glucose Testing – major points:
• Wash your hands and ask the
patient to wash his/hers
• Put on gloves
• Do not milk the finger (other
fluid, serum/tissue fluids, may
enter the sample and dilute it)
• The Accu-chek Inform machine
accepts capillary, venous, and
arterial blood
• Use of alternate sample sites
such as ear lobe, arms, is not
allowed
Lance the side of the finger,
wipe off the first drop of blood
with dry gauze/cotton swab. Use the second
drop for testing.
Patient testing
procedure
• Scan your ID barcode (you
will receive it when you
arrive to St. Luke’s)
• Select “Patient Test” on the
screen.
• Scan the patient’s armband.
• The patient’s name will
appear for you to verify if
he/she is in the hospital
computer system. Carefully
confirm by touching “YES”.
SMITH JOHN
Invalid Patient ID –
what should you do?
• The following message
will show on the
glucometer’s screen “ID
ACZ222711 was not found
in the patient list. Do you
want to run a test for this
ID?”
• Choose “No”
• Correct the situation
(wrong armband?, wrong
patient?)
Patient testing procedure
• Scan the barcode on the
strip vial.
• Remove the strip from the
vial and replace cap tightly.
Note: Strip must be used within 5
minutes after removing it from the
vial.
• Insert strip with yellow
target area facing up.
• Touch and hold second
drop of blood to the curved
edge of strip.
Correct application of blood
sample
• Verify sufficient sample has
been applied to glucose strip
• Important: If there is any
yellow color in the target area or
test strip window, a second drop
of blood may be applied to the
strip within 15 seconds of the
first drop
• Over or under saturation of
blood on a strip can alter results
incorrect
Values
60 – 100 Normal Values
100 – 400 Abnormal Values
208
Out of Normal Range
The “Range” button below the
result will remind you whether
the result is within “Range”
(normal), “Out of Normal Range”
or “Out of Critical Range”.
Critical Values
< 60 or > 400
The result for this test is
outside the hospital’s
“Critical Range” (greater
than 400 mg/dl)
505
Out of Critical Range
The “Range” button
will be flashing “Out of
Critical Range”
(to alert you)
Comments
The “Comments” button
will also be flashing to
alert you a comment is
required for this result.
Press the “Comments”
button to add a comment.
Accu-Check Inform Meter
Comment List
Comment Code
Comment Order
Chartable
Flag for Review
Will Repeat Test
1
YES
NO
Procedure Error
2
NO
YES
Critical to RN
3
YES
NO
Critical to MD
4
YES
NO
Confirm HI in Lab
5
NO
YES
Confirm LO in Lab
6
NO
YES
Will Order Lab Draw
7
YES
NO
AC Meal
8
YES
NO
Post Prandial
9
YES
NO
Eating
10
YES
NO
Training Test
12
NO
YES
Protocol Initiated
13
YES
NO
Arterial Sample
15
YES
NO
Venous Sample
16
YES
NO
High and Low Readings
• “HI” - the blood glucose result may be higher than
>600mg/dL.
• “LO” - the blood glucose result may be lower than
<10mg/dL.
NOTE: Repeat the test immediately, using a fresh sample from new
stick. If Lo and patient is symptomatic, immediately treat the
patient according to the standing orders for hypoglycemia. If patient
is asymptomatic and you are questioning the result, confirm with
blood draw.
Any Hi result should be confirmed by a venous draw sent to clinical
laboratory prior to any treatment.
If you question patient’s blood sugar
results!
• Please follow the instructions for trouble
shooting
• Do not test patient’s cs with three different
machines and compare results
• Doing so, may give you three very
different values and does not help you
identify the “malfunctioning” machine.
How do you know which cs result is
correct?
Return the meter to the
docking station
Note: Meter must remain
in the docking station
when not in use to allow
patient data transmission
and to maintain a fully
charged battery.
Self Medication Program
• Patients for whom glucose monitoring is a
part of their self medication program will
have blood glucose results from their own
meter confirmed by the Accu-chek Inform
Meter.
• The results from the Accu-chek Inform
Meter will be documented and used for
treatment.
Meter Maintenance
Meter, Base Unit, and Carrying Case
Cleaning Procedure:
•
•
•
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•
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ACCU-CHEK® Inform Glucose Meter
must be cleaned as frequently as stated in
the Infection Disease Policy.
Meter must be turned off prior to
cleaning.
Meter, Base Unit and Carrying case must
be cleaned anytime there is apparent
contamination of body fluids or dirty from
use.
Base unit must be unplugged prior to
cleaning.
Carefully wipe the surfaces with a soft
cloth slightly dampened (NOT WET)
with a hepacide or an antimicrobial
solution with sodium hydrochlorite as the
active ingredient.
Dry thoroughly after cleaning making sure
no streaks remain on the touch screen.
•
•
If cleaning solution does get on the
connector, DRY thoroughly with a cloth
or gauze pad before returning the meter
to the base unit.
Note:To prevent severe damage, DO
NOT allow cleaning solution to get
into the connector at the bottom of
the meter or the base unit. Visually verify
that no solution is seen at the completion of
cleaning.
Scanner Window Cleaning Procedure:
• The scanner window on the bottom side
of the meter must be cleaned if scanning
becomes a problem or there are visible
smudges.
• Use a clean, dry cloth to wipe the scanner
window.
Gastroccult Testing
supplies located in supervisor’s office
1. Apply specimen to the
pH area, and in 30 sec.
compare color to the pH
table below. Always
perform first.
2. To check for blood, apply
gastric sample to test
area, apply gastroccult
developer, look for any
blue = positive
3. Perform QC. Apply
gastroccult developer to
Performance Area and
read within 10 seconds
- Positive should turn
blue
- Negative should remain
unchanged
Documentation
• Blood sugar results are
downloaded into patient’s record
when the meter is docked.
• Urine dipstick, gastroccult, and
hemoccult results should be
documented in patient’s
computerized record in the
Intake and Output section.
• All results display in MediLinks
under flow sheets – bedside
testing tab.
• Also, gastroccult can be viewed
under GI tab and urine dipstick
under GU tab.