critical POC glucose lab confirmation

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Does your facility confirm critical POC glucose  results with a lab draw? In what circumstances? 
We’re in the process of reevaluating our procedure- which right now requires all critical results to be repeated and then confirmed with a lab draw no matter how consistent it is with the patient’s history/presentation. 
I inherited this policy so I don’t know what the full logic was behind it.

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We require an immediate repeat on the meter for the first critical result. If the patient stays critical, no consecutive repeats are required.  A lab draw is only required if the meter result repeats out of meter AMR (<10 or >600).

Hi
I also inherited similar policies and procedures!
Current:
Critical low <40 mg/dL - repeat with glucometer if result is suspect.  
  • Previously a lab draw was required but the fact that treatment should be immediate we changed to if the result is suspect.
  • ADA recommendation is to treat and repeat fingerstick 15 minutes after intervention which is our policy.

Critical high >400 mg/dL
  • Previously our policy was to repeat with the meter then a lab draw - We just changed this to reflect the fact none of these results where being repeated on the meter unless the results were inconsistent with patient's history.
  • Now our policy states to repeat with meter if result is suspect
  • Follow-up lab draw or Charted decline by provider/patient both of which have inconsistently followed.

In the ideal world...
  • Keep the current low policy.
  • >400 mg/dL -repeat with meter if result inconsistent with patient's history/presentation & a lab draw
  • Lab draws greater than 550 (linearity of our meter) only
We use the NOVA glucometers - patient history access, QC reviewed daily and monthly, CAP surveys - I believe there are enough quality monitors in place to ensure the proper functioning of the meter that would preclude repeating ever critical ever time...

I will be following this thread very closely as I am trying to institute the "ideal" world process!

For our facility, criticals do not need to be repeated unless they are outside of the AMR (<10 or >600). If the repeat has the same result (outside the AMR), then a STAT Lab glucose is ordered for confirmation. 

Our facility follows almost the same protocol as Cristina's - if it's outside of AMR it has to be followed up with a stat lab glucose.  We do recommend repeats of critical values, especially if suspect.

In our facility, a glucose <40 mg/dL is considered critical low. If the patient is a neonate than a glucose verification lab draw is required. If it is not a neonate than nurse will repeat the test before treatment. For high results (ours is > or = 500), it is up to the individual testing to repeat if they decide it is a questionable result or inconsistent with the patient history/presentation. However, we have our system set up to where a critical high result automatically reflexes (orders) a lab glucose verification draw. We changed to this because our rate of lab glucose verification tests after a critical high fingerstick were very low. Now they are great- the only slight issue now is that I have to cancel some glucose verification tests at times if the patient has a BMP or CMP at the same time. 

We just recently changed our policy.

Critical values require a repeat on the glucometer before any patient intervention (Once every 24 hours). Confirmation labs are up to the physician.

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McKenna Chandler
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