AccuChek Inform II Training Presentation Created by POC

Accu-Chek Inform II ® Training Presentation Created by POC Laboratory Services December 2012

Directions for Initial Certification *This competency requires two parts. 1. Review the information in this module with your trainer 2. Demonstrate the correct procedure for performing quality control testing and complete the accompanying post-test for the Accu. Chek Inform II 2

Accu. Chek I vs Accu. Chek IIWhat’s different? • Wireless transfer of patient data (vs having to dock the meter in a base unit) • Results in 5 seconds (vs 26 seconds) • 0. 6 μL sample • Under-dose detection- meter will not give a result if the test window is not full • Easy-to-clean, durable housing • No maltose interference • Discard the Code Key! *Do NOT place the Code Key in the meter as there is no space available for it 3

Accu. Chek II Meter Barcode scanner (laser)The integrated barcode scanner can be used to read operator, patient IDs, and reagents Test Strip Port Insert test strip here. This is the only opening on the meter, helping to simplify cleaning and protecting internal components. On/Off Button Press to turn the meter on or off. Base Unit Status Display As long as the light is on, the meter is in ‘charge mode’. (The color will change when transmitting results, connecting wirelessly, etc). 4

Base Unit and *Wireless* Connectivity • The glucose meter should reside in the base unit when not in use • Press the on/off button to turn off the meter, after a few seconds, place the meter in the base unit and the battery will charge • The information in the meter will be transmitted to the patient’s chart via wireless connectivity after the test is performed which means the results will be uploaded immediately after the test is performed. YOU must press the button to confirm the result. *ALL meters are wireless. -See the laboratory/POC dept for further information on connectivity. 5

ACCU-CHEK Inform II Test Strip • Doses from the END and uses capillary action to pull sample into strip; result available in 5 seconds. • The sample fills with in the yellow window- between the 2 pieces of plastic. • The test strip must be used immediately after being taken out of the vial - This means that you must be ready to apply the blood sample as soon as you take a test strip from the vial. 6

Test Strip Handling/Storage • Use the test strips at temperatures between 61 -95 °F and between 10 -80 % relative humidity • Use the test strip immediately after removing it from the container • Discard 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 • 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 • Test strips are good until the expiration on the vial; good laboratory practice states that the open date should be also be written on the vial. 7

Test Strip Code Key. NO LONGER NEEDED! The coding/calibrating needed for the glucometers is performed by the POC Department. Each box of test strips will contain a code key, however, when opening a lot of test strips, you do NOT have to place the new Code Key in the meter as there is no space available for it. Discard the Code Key! 8

QC (Quality Control) Storage and Handling Record Expiration date on control vials; discard 3 months after opening. 9

QC Storage and Handling con’t. • Controls must be stored at room temperature • Both levels (level 1 and 2) of controls must be run and “PASSED” every 24 hrs. The meter will count down the time until QC is due. *Quality Control testing is also required with each of the following situations: ü With the opening of each new vial of test strips ü If the Accu-Check meter has been dropped ü When test results contradict clinical symptoms 10

Steps for performing QC- Quality Control Testing 1. Turn on the ACCU-CHEK Inform II meter. 2. Scan your operator ID when prompted; DO NOT attempt 3. 4. 5. to perform tests under another operator’s ID. This takes you to the Main Menu. From the Main Menu, touch Control Test. Select the level of control that you wish to run. Scan the lot number on the control vial by pressing the scan button. Step 2 Step 3 Step 4 Step 5 11

Steps for performing QC cont. . 6. Confirm that the meter is coded (calibrated) to the same test strip code that is printed on the test strip vial by scanning the lot number of test strips that you are using. 12

Steps for performing QC cont. . 7. The meter will display a picture of 8. 9. Step 7 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 uphill 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. Step that you are ready to apply control solution. 9 13

Steps for performing QC Testing Cont. . 10. MIX CONTROLS WELL and 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. 11. When the result displays on the meter screen the measurement is complete. See failed QC test below and the troubleshooting section for more information. 12. Remove the test strip and discard. 13. Touch the button to confirm the result. The result is sent from the meter wirelessly into the medical record. 14. Run the next level of control or proceed with patient testing after both controls have passed. If necessary, touch the comment button to enter an appropriate comment(s) if there are issues when testing QC material. 14

!! Failed QC Test – What do I do? - Any control results that are not within the acceptable range must have a comment code selected indicating the action taken to resolve the problem (repeat test, opened new controls, used expired controls/repeated test, operator error, opened new test strip bottle, etc. ) - Press the comment button for all failed QC results and choose from the defined list. *A control that fails may be repeated a second time, but if the control fails again after troubleshooting steps, contact the Lab POC department for further instruction. 15

Stop Here and Perform QC Test 16

Steps for Performing PATIENT Test -Proper Patient ID • The patient must be identified with 2 patient identifiers prior to performing blood glucose collection. The only acceptable patient identifiers are: -Patient name -medical record -social security number -date of birth -account number • When the patient’s barcoded account number/armband is scanned, you should see and confirm the patient’s information by pressing yes/checkmark. *NOTE: On occasion, the patient’s information will not be available in the glucometer. You may override this by choosing to continue to test, but note when doing so, the scanned barcode number on the armband MUST match what is on the meter’s screen!! 17

Steps for Performing Patient Testing 1. Carefully assess the patient for any indication that bedside glucose testing may not be appropriate (See limitations section and patient assessment). Step 3 2. Turn on the ACCU-CHEK Inform II meter. 3. Enter your operator ID by means of scanning your ID badge. DO NOT attempt to perform tests under another operator’s ID. Step 4 4. From the Main Menu, touch Patient Test. 5. Enter the patient identification in the ACCUCHEK Inform II system by scanning the patient’s account number on his/her armband. Step 5 18

Steps for Performing Patient Testing cont. 6. Confirm that the meter is coded (calibrated) to the same test strip code that is printed on the test strip vial by scanning the lot number of test strips that you are using. Contact your Point-of. Care Department if you are unable to confirm the correct test strip code. 7. 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. Step 6 Step 7 19

Steps for Performing Patient Testing cont. . 8. 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. 9. Perform finger stick and wipe away the 1 st drop of blood. Use 2 nd drop for patient sample. 10. Apply blood to the front edge of the test strip. The sample will fill the yellow sample chamber by capillary action. 20

Steps for Performing Patient Testing (Cont’d) 10. When the result appears touch the button to confirm the result and the result will be sent wirelessly to the medical record. (See Nursing downtime procedure for other information). 11. Discard dirty test strip into trash can. 21

Stop here and Perform Finger stick (Patient) Test 1. Choose site on the side of the pad of the finger 2. 3. 4. 5. (not in center of pad). Cleanse finger with alcohol. Set lancet to preferred depth, press against site and trigger lancet with thumb. Wipe away the 1 st drop of blood with gauze. Use 2 nd drop of blood for specimen; this is mandatory because it ensures that the sample is flowing well and free from interstitial fluid from the sample. 22

How Do I enter a comment with a patient result? 23

Entering a comment with a CRITICAL result *critical values are <40 or >500 mg/dl) 1. When a critical value appears, press the comment button to move to a list of predefined comments. *The critical value message Critical Value!! Notify Provider or Nurse will flash in BLACK ! 520 mg/dl Critical Value!! Notify Provider or Nurse *The Joint Commission (regulatory agency) requires that we DOCUMENT the NAME of who was notified for all critical values (the provider and/or nurse’s name). 24

Entering a comment with a CRITICAL result con’t. 2. From the next screen choose 3. 4. Provider Notified. Then press the custom comment button and type in the provider that was notified - and any other information necessary. Treat the patient according to nursing protocols and repeat with a Lab glucose if needed. Provider Notified Order a lab glucose test if the result is not consistent with clinical evaluation. 25

CNA/PCT staff entering a comment with a CRITICAL result 1. When a critical value appears, press the comment button to move to a list of predefined comments and choose RN Notified 2. Then press the 3. comment button Type in the RN that was notified 26

What do I do when the meter displays LO or HI - which is also a Critical Result <40 or >500 mg/dl? • If a patient’s glucose • value is <10 mg/d. L, the meter will read LO. If a patient’s glucose value is >600 mg/d. L, the meter will read HI. LO Critical Value!! Notify Provider or Nurse * Regulation states that you must DOCUMENT the provider/nurse’s NAME with the comment on all critical values! 27

NOTE ! • If additional insulin is ordered, it should be based on the most recent finger stick result and not the STAT glucose done as much as 1 -2 hours ago. *You would expect the finger stick result to be lower since the first dose of insulin is doing its job. Giving a dose of insulin based on the STAT glucose could result in hypoglycemia within a few hours. 28

Cleaning the meter • Always use Clorox Germicidal • • Wipes to clean and disinfect the meter. Take meter out of the base unit and turn the on/off button to OFF. Clean the outside of the meter with Clorox Germicidal Wipes. Do not use any other cleaning agent. Clean the meter if there is visible contamination or if exposed to infectious agents. Do not get the test strip port wet! *FDA, CDC, and CMS state that we must clean the meters between each patient test. 29

Limitations for Testing- Do NOT use the glucometer in these scenarios • Hematocrit should be between 10– 65 % • Lipemic samples (triglycerides) in excess of 1800 mg/d. L may produce • • elevated results Blood concentrations of galactose >15 mg/d. L IV administration of ascorbic acid (concentration of >3 mg/d. L) Fresh capillary, arterial, or neonatal whole blood can be used; Cord blood samples cannot be used. If severe peripheral circulation is impaired, do not use the glucometer. This may apply in the following circumstances: Ø severe dehydration - as a result of diabetic ketoacidosis or due to hyperglycemic hyperosmolar non-ketotic syndrome Ø Hypotension Ø Shock Ø Decompensated heart failure NYHA Class IV peripheral arterial occlusive disease 30

Important ! • DO NOT use a blood sample from an IV site (from needle or the skin) • DO NOT use a blood drop from a collection tube 31

IMPORTANT: The performance of this meter has not been evaluated on critically ill patients, therefore, order a laboratory glucose test if result is not consistent with clinical evaluation. 32

Final Notes • • • - Do not treat a patient based on a glucose finger stick result obtained from any other glucometer, including the patient’s own meter. For patients who are on Isolation Precautions - use a biohazard bag to protect the Accu-Chek Inform II glucometer. (This process is/was demonstrated to you in the Accu-Chek I Training Class. ) Notify the Point of Care Department in the Clinical Laboratory of any problems or concerns at the following extensions: 7393, Danialle Kenney 4968, Patty Nuttall 6398, Lisa Owens Questions? 33