Critical Result Communication - Glucose Testing performed by non licensed staff - CAP.30100

Hi Kelly,
Periodically we have the question, "Why can't nursing assistants perform Glu testing?"  It is for the very reason you are describing.  They cannot chart a critical result, nor act upon the results.  I am at a VA Medical Center and since prior to my arrival in 2008 we have not permitted non-licensed individuals to perform glucose testing.  We have a required procedure that we monitor for QA purposes and critical glucoses get reported to the Patient Safety Committee.  Failure to follow the protocol results in a JPSR which also goes to upper management.  I have, to date, had the backing of management on this issue and, once we state it is the institutions policy, I do not hear anything further issues.  Hope this helps.

Thank You. 

Hi Kelly,
At our facility, each operator using the point of care glucose meter becomes a Certified Operator through a specific training program taught by a Certified Instructor, who is any designated individual trained in the use of the point of care glucose meter. This includes any Rn and CNAs. Training is performed initially at employee orientation, at six months and annually thereafter. Skills labs are held every six (6) months and competency updates should be completed at that time.
A record of Certified Operators is maintained in the UniPOC™ system.  The Point of Care Coordinator or Designee is to be informed any time a new operator is trained by providing them with the completed competency test and skills check off.  The Point of Care Coordinator will maintain current records in UniPOC with hard copies forwarded to Human Resources.  
 Critical values will be visually marked on the meter screen .   When this occurs, the operator is to follow proper protocols for critical values.  Nursing Administrative Directors will receive a weekly report of all out of range results (this will include critical values as well as results out of the meters’ readable range).  Nursing leaders or their designee will verify that proper protocols were followed for these results as part of their quality management plan.

Thank You. We train all our staff in a similar fashion. Our criticals are also displayed on the meter screen and in EPIC. My concern is the communicating critical results to the appropriate staff and documenting that communication. Would you mind sharing what your protocols are for that situation? 
Thanks Again, 
Kelly

This is information from our Nursing Policy STAT.

RESULT REPORTING

All results from POCT become part of the EMR. Critical values are called to the physician according to established policies.

Whole blood glucose, POC Creatinine and POC Troponin results upload to the electronic medical record wirelessly or as each meter is docked.

It is critical that the following information be documented:

This is the information from the Whole Blood Glucose Procedure (Nursing Version).

Reporting of Test Results

Point of Care blood glucose results are transmitted wirelessly to UniPOC™ then to the EMR.  In addition to the glucose result, UniPOC™ also records:

Date / Time of test

Meter name and serial number

Operator Name and ID number

Patient Name and FIN number

Reagent Lot

 
 When a patient is found to have a glucose level that is outside of the reportable range of the meter, you will get a result of either ≤20mg/dl or ≥500mg/dl.  When this occurs it is hospital policy to confirm the results with a peripheral blood test. 

This is information in the Point of Care Policy Procedure
DEFINITION OF “CRITICAL” AS IT RELATES TO POC GLUCOSE TESTING

The definition of “critical” as it relates to POC glucose testing will be patients who require:

§  admission to the critical care area

§  Vasopressors to maintain Systolic BP of 90

§  Vasopressors to maintain MAP below 60

A detailed list of the limitations of the POC whole blood glucose testing is listed in the procedure for this test.  Providers and Staff should acquaint themselves with these limitations and not rely on the POC glucometer results for patient care and treatment when these conditions apply.

RESULT REPORTING

All results from POCT become part of the EMR.  Critical values are called to the physician according to established policies.

Whole blood glucose, POC Creatinine and POC Troponin results upload to the electronic medical record wirelessly or as each meter is docked. 

 

It is critical that the following information be documented:

·         Date and time specimen was collected and test performed.

·         The result of the test with units of measurement

·         Expected ranges for the test performed. 



This report is generated weekly, sorted by location and sent to all Nursing ADs
 | Report:   Out of Range / Critical Results
| Purpose:  Since we do not have access to the section where nursing documents follow-up on critical and out of range results, all out of range and critical results are sent back to the nursing leaders of areas using glucometers to allow them to verify & document protocol compliance.
This report is emailed to all Nursing ADs with the note "Please check this report and document as part of your quality plan to ensure that the appropriate action was taken when an out of reportable range or critical range was obtained."


I hope this helps.

Thank You!

Hi Kelly,
We have the nursing assistants give the results to either the physician or the nurse in charge of the patient.  They are documented in EPIC under the Shift Assessment flowsheet that is set up so they only have to enter the required info. The ID of the person that completes the section is captured along with the date and time.  This information also pulls to the Critical Lab Notification tab in EPIC so you don't have to search for it.  It is a hospital nursing policy that all critical labs be given to the physician so that helps some.
 
I had to come up with a creative way in QML to indicate operators that were not nurses, like MA's, NA's, ED techs etc.  I added a middle initial to 
operators that corresponded with their title such as N or M so it made it easier to audit.