repeat POCT glucose testing.

We also use the AccuChek Inform II meters and RALS as our DM system. Our repeats flag if they are run within 5 minutes of each other. I was told that tests run within 5 minutes will not be reimbursed, so I believe that is why it was set that way. I'd be interested to know if anyone else knows that for a fact? (I also inherited the procedure!) The policy recommends RNs retest a hypoglycemic result 15 minutes after treatment per their Hypoglycemia Protocol.

Good call on updating your procedure. I don't use the ACCU-CHEJ, but I would only use limits that the manufacturer has stated or items from hospital policy in a procedure.  Repeats for our purposes are defined as within 10 minutes. 

Erika

Word of caution - this becomes a slippery slope, and I'll share why.  As most of us have a lab background, we are focused on what is a "reportable" result before we release it - a single result.  When testing is performed at point-of-care that model is imperfect, because we are not present during the testing, and each time the patient is tested, it is in fact a different sample, rather than a single, stable sample as we have in the lab.  Point being, you may want to err on the side of caution when it comes to manipulating results after the clinical staff have already had access to, and treated the patient based on.  Put another way, we can "guess" what is logically to be considered a repeat based on timing, but the truth is we were not there at the time and don't know what all was done.
  Years ago (>15 years), we also had a repeat protocol in place, where the second result was deleted or held based on a % or mg/dl match and a time window.  I then learned of a legal case where the hospital was faulted for having deleted a result from the hospital medical record as a result of an interface repeat protocol, when in fact the patient was treated based on that result, but it was not part of the formal record, as the operator intended.  We then went to releasing all tests POC glucose tests performed and dropped the interface rule.  We do have a means whereby the operator can flag a result as unsuitable for charting based on their assessment, but then the responsibility is at least on someone that was present during the testing and can speak to what was done.

Thank you for all of this! 

Right now- all of the results, whether they are repeats or not, are all uploaded to the chart- I don’t remove any of the results from the chart, I just check that a lab confirmation was also run.
So I believe that covers us for the potential legal issue James brought up. 
With that being the case, it’s just a question of when a lab confirmation is required in regards to “repeat” testing based on the time between tests if they’re >10% different

Following....are there facilities that don't repeat glucoses at all?
Manufact. insert says to follow your hospital policy...and to  repeat the test if you get "Lo" or "Hi" for Nova Stat Strips.  Our facility procedure states to repeat all critical values within a 10 minute timeframe and that if you get a "Hi" (>600) you would have to draw a stat glucose and send to the lab within 15 minutes.   All results are uploaded to the chart.  I wish there was a way to simplify this for the nursing staff.

Can you tell me how those that have the AccuChek are handling the use with the critically ill?  Our process has been that once they are deemed critically ill they must send it to the lab.  What we have found on the onset of getting a vasopressor they perform one on the AccuChek but send one to the lab at the same time. Then the rest are sent to the lab. We were cited for this process and I am curious how other hospitals avoid this.

Hello
Analyzer: Nova StatStrip glucometers  Middleware:  RALS
I too am working on updating our glucometer policy specifically repeating high glucoses on the meter AND requiring a lab draw.

 Most glucometer makers have precision and accuracy values that can be utilized so the repeatability values aren't an arbitrary number or percentage.  10% seems really tight.
To: Janet Royal - We came up with policies/procedures based on a combination of nursing (TJC), laboratory (CAP-CLIA), current ADA guidelines, and hospitalist input - Group meets formally once a month to discuss all things Diabetes - Diabetes Champions!
Good Luck...

We currently have the Accuchek Inform II meters but will be switching to Nova hopefully by the end of the year.  

Our current practice for glucose testing: 

I too inherited the procedures.  I was hoping with the switch to Nova to change the process and remove any required comments.  I want to change procedure to just suggest repeating if result doesn't match patients condition, but not require comment.  And to also not require a blood draw for any results above or below the reportable range of meter but only suggest that they send to the lab.  I feel like they are with the patient and they should follow whatever protocol they have for patient.  We always tell them that the lab is the backup and if they ever question a result they should send sample there.  

If I make the changes, we would only require a comment for failed QC.  

For Nova, do they have to repeat of they receive a result lower or above reportable range?   I don't see that information in the Information for Use Manual.  

Nova doesn't require repeats unless it reads "lo" or "hi" (out of its reportable range).  I feel like maybe we need to rethink our reasons for doing repeats as Sherilyn stated above.