The ACCU-CHEK Inform system Training Guide Daphne Connolly Denise Delorey Liz Farrell April 27 2011

The ACCU-CHEK Inform system comprises three unique components: meter Base Unit Connector Electrical connection to base unit for charging battery and for data exchange. accessory box

Front and back View

Parts of meter 1. Power On/Off Button Use this button to power the meter on or off. 2. Forward Arrow Button Use this button to go to the next screen. 3. Touchscreen Use this area to enter data, answer prompts, and observe results from a test or review. 4. Strip Port Use this port to insert a test strip when performing a test. 5. Menu Button Use this button to go to the Main Menu screen at any time. 6.Backlight On/Off Button Use this button to turn the back light for the display on or off. ?delete

8. Code Key Slot The area where the code key from a test strip vial is inserted. The code is unique to the lot of test strips. The code key must be changed each time a new vial of test strips is opened. 9. Scanner Window The area from which the laser beam is emitted during bar code scanning. 10. Battery Compartment The area where the rechargeable battery is installed. 11. Soft Reset Button The button used to reset the meter.

How to perform patient testing Press the On/Off button to power on the meter. Once the ACCU-CHEK Inform meter Startup screen appears, Wait for the Operator ID screen

Enter operator ID( scan or manually enter-NSHIS user ID name) Enter 4 digit password by pressing the number and letter keys on the touchscreen using your fingertip.

Once the password has been verified by the system, the Main Menu screen will appear.

Identify the patient: To identify the patient use one of the following three methods: 1) Select Patient Test from the menu on the glucometer to display an alphabetical list of patients on your unit. Select your patient and confirm that the patient’s ID band and the information on the glucometer screen match. ** To keep the patient list current, the meter must be placed on the docking station when not in use!

2) Scan the barcode on the patient’s ID band 2) Scan the barcode on the patient’s ID band. (Hold the barcode flat for easier scanning.) 3) Scan the barcode on the patient’s MAR and compare very carefully to the patient’s ID band and to the name displayed in the meter. Note: Always scan a barcode or select from the patient lists - Never use the keyboard to manually enter the patient’s account number as even the slightest error typing the number will prevent the glucometer results from transferring to the EMR!! Do not randomly type in a number (ie: FT0000) in order to use the glucometer! If an invalid account number is used – the Lab will file an Incident Report, as this number cannot be traced to a known patient, therefore the information will not appear in the patient’s EMR.

Verify Strip Lot Compare the code number from the test strip vial with the number on the screen. If correct, press Yes If incorrect, press No When Yes is pressed, the insert Strip screen appears Gently insert the strip into the meter with the electrodes facing up and toward the test strip port. When No is pressed, insert the correct code key. (see later slide) Then press to display the Insert Strip screen.

Once the strip has been inserted, the Apply Sample screen appears. Once the flashing drop appears, add the patient sample to the edge of the ACCU-CHEK Comfort Curve test strip. The meter may beep after the sample is recognized Screen with an hourglass is displayed while the meter completes the test.

Obtain a Blood Sample Ensure patients hands are Warm, Clean and Dry Let the arm hang down to allow blood to go to the fingertips Massage the finger before pricking The best target is the side of the fingertip Wipe away the first drop. Use second drop. Obtain a small drop of blood resting on the finger. Touch the edge of the yellow window to the drop. Make sure the yellow window is completely filled. You have 15 seconds to apply a second drop if required.

Once the test is completed, an audible beep is heard and the Patient Result screen is displayed. Critical Range is <2.5 - >25.0 for adults. Any result outside this range must be repeated and validated by sending a sample to the lab. If the patient result is out of normal or critical range, there will be a warning message under the result. A comment is required for all out of range results. Add about yellow box and the 15 seconds to fill it.

A text of Preprogrammed Comments is displayed in large buttons. Up to 3 preprogrammed comments can be selected. Press the appropriate comment(s) using your fingertip.

The display will return to the Main Menu screen. Press the large button or the Menu button under the touchscreen to complete the test and record the result. The display will return to the Main Menu screen. Remove the test strip and discard according to your institution’s infection control policy. Add to download and clean meter

Strips can be used until the expiry date stated on the vial Strips can be used until the expiry date stated on the vial. Strips and controls are stored at room temperature. Always put the top on the vial of strips. Moisture/humidity may affect the accuracy of the strips. STAT testing can be performed even though QC testing is required. Press STAT and proceed with prompts. Maintenance of meter: wipe with a slightly damp cloth. Alcohol, soap and water or wiper (Virox) can be used. Isolation Precautions: Isolation sleeves available. Safe T Pro Plus (lancet device) – Three depths 1.3mm, 1.8mm, and 2.3mm

Recording Glucometer results Dock the glucometer when you are finished testing all of your patients to record the glucometer results in each patient’s EMR. Once on the docking station the meter will cycle through Connecting → Transmitting → Idle. Transmission of the results is not completed until there is a square box around Idle . You will see a message on the screen indicating the number of results transmitted at this time. Always check to be sure the meter displays Idle before removing it from the docking station for further use! If the meter does not cycle through to Idle after an appropriate amount of time: Try to re-dock the meter as it might not be correctly connected to the base. Check the two cord connections to be sure they are tight. Restart the computer

What to Do If: Wrong Patient: If the wrong patient is selected, the test completed, the meter docked and the results transferred to the EMR → call the Glucometer Point of Care Coordinator in the Lab (Dale Melanson # 4143 GASHA only). Give her the following data: The USER ID of the staff member who performed the test. The Account number of the wrong patient. The date, time and glucometer result of the incorrect entry. The lab tech will add a comment to the result indicating that it is on the wrong patient and should be disregarded. Right Patient but wrong account (visit): If the wrong account (visit) is selected, the test completed, the meter docked and the results transferred to the EMR → call the Glucometer Point of Care Coordinator in the Lab (Dale Melanson # 4143 GASHA only). Give her the following data: The USER ID of the staff member who performed the test. The Account number of the patient where the results were recorded.

Viewing glucometer results in the EMR Click the Laboratory panel in the EMR Click Chemistry Results appear with the test name Glucometer Results will be displayed in a table, organized by Date & Time When applicable a Comment bubble will appear next to the result. To view a Comment click “Glucometer” to view a history of all results, including the comments. Or to view a single result click the Date/Time at the top of any column for the snapshot of that specific result. As usual for all lab results, the letter H appears beside the value if it is a high reading and the letter L will appear beside the value if it is low. Abnormal results are highlighted in yellow. Critical High or Low glucometer results do not have an asterisk or pink highlighting.

Out of Range (High or Low) Results If the meter reading is HIGH or LOW, as the value is too High or too LOW for the meter to capture, it will appear as follows in the EMR:

Documenting in PCS that you have done the glucometer test The results will flow directly to the EMR from the Accu-Chek meter, therefore it will be unnecessary to document the results in PCS on the “Blood Glucose Assessment”. However the results in the Lab panel of the EMR do not include the user’s name. To record the name of the user who did the glucometer test, document on the “Monitor Bedside Glucose” intervention on your intervention list, at least once on your shift. This is a statement intervention (no assessment screen) that will record in the EMR who performed the glucometer test.

In the EMR this data is displayed in the Care Activity → Interventions panel

TROUBLE SHOOTING If a patient does not appear on the unit list in the glucometer: Re-dock the meter to update the patient list. If you cannot find a patient’s glucose result in the EMR Try docking again as the data transfer may have not been completed. Place the meter back on the docking station; the green light on the docking station must be lit. Once on the docking station the meter will go to connecting, transmitting, then idle, results will not be transmitted until there is a square box around the idle. The computer that the Glucometer is connected to must always be on, no results will transmit if computer is turned off. Check to see if an Unregistered Emergency Glucometer Account Number was used for the patient, there will be a delay in these results flowing to the EMR because they have to be manually released by the Lab. If there is a downtime there will be a delay in results flowing to the EMR. Remember: All results can always be viewed on the handheld meter in the Review Results Menu.

How to Replace the Code Key Replace the existing code key with the code key packaged with the vial of test strips that are to be used. After inserting the new code key, press arrow, verify strip lot. • If correct, press Yes • If incorrect, press No Follow any additional instructions on the meter screen.

Quality Control (QC) Hospital policy requires controls to be run as follows: Every 24 hours the meter will prompt the user to run controls. Both level 1 (low) and Level 2 (high) must be run Controls are stable for 3 months after opening. Date all vials with the expiry date. Mix the control before testing and clean the tip with a tissue before replacing the cover

How to Perform Control Testing Press the On/Off button to power on the meter. Once the ACCU-CHEK Inform meter Startup screen appears, wait for the Operator ID screen.

How to Perform Control Testing Enter or scan the operator ID, enter password, then press arrow to display the Main Menu screen. Press Control Test to display the Control Test screen. Press the control level to be run.

Verify the control solution lot number. • If correct, press Yes • If incorrect, press No When No is pressed, enter the new control solution information. Then press yes to display the Verify Strip Lot screen. Verify strip lot on vial. If incorrect, press No When No is pressed, insert the correct code key. Then press yes to display the Insert Strip screen.

Insert test stripe Apply control solution when prompted Hour glass will appear while test being completed When the test is completed, pass or fail will appear on the screen If FAIL appears: Add a comment from the comment menu. Retest with a new strip and confirm proper control solutions. If controls remain unacceptable return the meter to the Chemistry Lab Department with all the materials and a description of the problem

Keeping your Access 2 sets of level 1 and level 2 must be done every 12 months AND 2 patient test must be completed every 12months. If you do not comply, your access to use the glucomters will be automatically inactivated and you will have to contact the Lab to be recertified before you can use the glucometer again.

Note: Your user ID and Password is only for access in GASHA. If you go to another facility you will need to make arrangements with that facility to gain access. ( For Coop or consolidated)