Repeat Critical BGM tests
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What dictates policy for the repeating of critical BGMs?
Our long-standing (way before I landed in POC land..) policy states that every critical BGM, high or low, must be repeated on the meter within 5 minutes to rule out technical error, before taking action- action being either treating with the hypoglycemic protocol if low, ordering a lab confirmation on the initial pair of critically high BGMs, or continuing treatment on the patient if this is subsequent critically high BGMs after the first pair has been confirmed.
We sometimes get push-back about repeating critically high results when it is a known patient on an insulin drip or if they have been continually running high.
I'd like to hear what others do about this situation. What's your policy for repeating critical BGMs?
Thanks in advance for your feedback!
Our long-standing (way before I landed in POC land..) policy states that every critical BGM, high or low, must be repeated on the meter within 5 minutes to rule out technical error, before taking action- action being either treating with the hypoglycemic protocol if low, ordering a lab confirmation on the initial pair of critically high BGMs, or continuing treatment on the patient if this is subsequent critically high BGMs after the first pair has been confirmed.
We sometimes get push-back about repeating critically high results when it is a known patient on an insulin drip or if they have been continually running high.
I'd like to hear what others do about this situation. What's your policy for repeating critical BGMs?
Thanks in advance for your feedback!
3 Replies
Our policy does not require repeat testing. Repeat testing can be performed if needed and rejection of a test result is an option at time of test. We do require a comment (pre made list) for any test that is not within the normal range. I suppose there are a lot of considerations to your ask: IT, charging, charting... just to name a few.
Our policy states that all critical results need to be repeated immediately and we give them a time frame of 10 minutes to do so. Only on the high end, if the glucose is critical, they must repeat and have a lab confirmation test performed within an hour. That lab confirmation is good for 24 hours. So if the patient is treated and the glucose is no longer critical but still high and 4 hours later it's critical again, a repeat is not necessary due to the "previous lab confirmation". If the glucose becomes critically high again 26 hours later, then yes, they will have to repeat and get another lab confirmation test. I hope this makes sense.
Repeat testing can be performed if needed, but is not required by policy. When results are repeated, we ask that they be within 10 minutes. This is because the middleware program is set to report only one result and the patient doesn't get charged for the extra. Lab confirmation is performed when result is questionable - doesn't fit patient presentation or outside meter linearity.
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