Transcript MEMS GLUCOMETER TRAINING MEMS Education Committee 2008

MEMS GLUCOMETER
TRAINING
MEMS Education Committee
2008
NOTE
Information within this presentation
should be tailored to the Blood Glucose
Measuring Device used by the service and
should include a review of the
manufacturer’s instructions.
Purpose
~To prepare currently certified and future
EMT-Basics to utilize a Blood Glucose
Measuring Device under current MEMS
Protocol Standards.
Objectives
At the conclusion of this program participants will
be able to:
• State when blood glucose measuring is indicated
• Describe the importance of a full patient
assessment in conjunction with test results
• Demonstrate accurate calibration
• Demonstrate appropriate procedures for measuring
blood glucose
• Explain proper maintenance, care & storage
• Understand the need for a CLIA Waiver
Indications for BG Measuring
Signs and Symptoms consistent with
• Acute Stroke
• Altered Mental Status
• Known Diabetic Patient
• Trauma with potential for Head/Spinal Injury
• Combative Patient
• Seizures
• Overdose
• ETC…
Altered Mental Status
(Common Causes)
AEIOU-TIPS
Alcoholism
Epilepsy
Insulin
Overdose
Underdose
Trauma
Infection
Psychiatric
Stroke
Pre-Hospital Care
(FOLLOW THE PROTOCOLS)
1. Scene Safety/Survey
2. Perform initial assessment
Considering/Treating ABC’s
3. Ensure cervical spine immobilization as indicated
4. Activate ALS-ALS must be activated when using the
glucometer.
Pre-Hospital Care
5. Perform focused history and physical exam
(a). SAMPLE history
1. Signs/Symptoms (when did they start?; how long did
they last?)
2. Allergies
3. Medications (When last taken?)
4. Prior Medical History (diabetes?, seizure disorder?)
5. Last oral intake (When did patient last eat)?
6. Events leading to illness/injury
Pre-Hospital Care
5. Focused history & physical exam, cont.
(b). Take base line vital signs
(c). Determine blood glucose level
(d). Evidence of hypothermia/hyperthermia?
(e). Can the patient swallow normally?
Pre-Hospital Care
• Do not administer anything orally if the
patient does not have a reasonable level of
consciousness and normal gag reflex.
• Contact medical control prior to
administering glucose to patients suspected
of Acute Stroke/Head/Spinal Injury.
Pre-Hospital Care
6. If patient is unconscious or seizing,
transport on left side.
7. If patient’s BP drops below 100 systolic;
treat for shock
8. Monitor VS every 5 minutes if unstable;
every 15 minutes if stable.
9. Notify intercepting ALS service/provider
Glucose Measuring Devices
• Used to Check Blood Sugar Levels
• Many different types and models
Procedures
•
•
•
•
Careful attention to BSI & safety
Select Finger
Massage blood into distal end
Clean finger with appropriate aseptic technique
(if using alcohol, let dry or wipe dry with sterile gauze)
• Use lancet or Auto-lancet device
• Apply drop of blood onto test strip and follow
individual glucometer instructions
• Dispose of sharps and soiled supplies in
appropriate container
Device & Accessories
Test Strips
Glucometer
Lancet
Glucose Measuring Steps
Step #1
Step #2
Step #3
Locate Glucometer
Open Up Case
Turn Power On
Device Variations
Some glucometers turn on automatically.
Know the features of the glucometer your service uses.
Glucose Measuring Steps, cont.
Step #4
Confirm Codes
Glucose Measuring Steps, cont.
Step #5
Insert Test Strip
Glucose Measuring Steps, cont.
Step #6
Obtain Blood Sample
Glucose Measuring Steps, cont.
Step #7
Apply Drop of Blood
If inadequate up to 15 secs., add additional blood
Glucose Measuring Steps, cont.
Step #8
Document Results
Results
• Measured in milligrams per deciliter
• Normal blood glucose range is typically
80-120 mg/dl (fasting)
• Treat the patient, not the numbers
Maintenance & Calibration
• FOLLOW MANUFACTURER’S
RECOMMENDATIONS:
• Techniques
• Frequency
• Batteries
• Care & Storage
– Device
– test strips
• Temperature Can Affect Machine Accuracy!!!!
Documentation
•
•
•
•
•
Reasons for procedure
Time of procedure
Results of procedure
Response to treatments
Changes in signs/symptoms
BSI & Cleansing Issues
• Dispose of all sharps and blood contaminated
materials properly
• Cleanse only outside of monitor with general
disinfectant (manufacturer approved)
• Do not immerse/ inject/spray any liquid into
device
CLIA WAIVERS
• Required for all services using a glucometer
• The Centers for Medicare & Medicaid Services
(CMS) regulates all laboratory testing (except
research) performed on humans in the U.S.
through the Clinical Laboratory Improvement
Amendments (CLIA).
• The objective of the CLIA program is to ensure
quality laboratory testing.
CLIA WAIVERS
• There is a Biennial Fee of $150.00 for this
waiver
• An application for a CLIA Waiver can be
obtained by going to:
– http://www.cms.hhs.gov/clia/
• This must be filled out by all services intending to
use glucometers, whether they are volunteer or paid.
– Or call Margaret Naas, Bureau of Health, and
request application, 287-9339
Summary
• Indications for blood glucose measuring
• Importance of a full patient assessment in
conjunction with test results
• Accurate calibration procedures
• Appropriate blood glucose measuring procedures
• Proper maintenance, care & storage procedures
• CLIA Waiver Compliance
Practice Session
• Students should complete a calibration
procedure and test sequence under the direct
supervision of an instructor
• Demonstrate proper technique for obtaining
a Blood Sugar correctly.
– Showing proper aseptic technique
– Sharps disposal
Questions?