Nova Stat Strip Update

Welcome to your Statstrip update Point of Care Testing (POCT) is the analysis of patient specimens outside of the laboratory by non-laboratory staff. The success of POCT depends crucially on the effectiveness of the training of non-laboratory staff. Training is required for Care Quality Commission: Outcome11 Safe Use of Medical Devices Explain that POCT is the performance of analytical tests on patient specimens outside of the laboratory by non-laboratory staff. Blood glucose is an example of POCT, as is urine dipstick analysis and pregnancy testing. It is a significant Risk Management Issue for the Trust as incorrect results have the same medico-legal implications regardless whether the test was performed in the lab or on a ward or unit. Why is update training is necessary? POCT is a clinical risk and significant harm can come to patients if a point of care test is not done correctly. Training and update training is key to safe practice and therefore it is mandatory and required by Trust policy and by a range of statutory bodies such as CQC and  MHRA.  Staff must not sharing barcodes as all activity is recorded and can be audited.

Contact Information For any technical or training issues with the meters please contact Helen Hobba or Kate Tregunna in Clinical Chemistry via ext 2556 / 2837, or poct.poct@rcht.cornwall.nhs.uk For any Clinical advice please contact the Diabetic Inpatient Specialist Team on 3104 (RCHT) or 4151 (WCH / SMH) Explain that is there are any issues with the system then staff must contact Helen Hobba or Kate Tregunna in Clin Chem.. (I have put this slide at the beginning rather than at the end to try and deflect complaints away from the L+D trainers as ward staff are prone to venting their dislike of the meters!)

Equipment Required on the wards Stat Strip Connectivity Meter and Docking Station Plus Work Station containing: Owen Mumford Unistix lancets Gauze for wiping finger after obtaining sample. Stat Strip Glucose Test Strips, 50 strips per vial – stable for 6 months after opening, please date the vial. Stat Strip Glucose Control Solution, Level 1(low) and Level 3 (high) - stable for 3 months, please date the bottle. Test strips and lancets are available from Pharmacy at Treliske QC and replacement meters are available via Clinical Chemistry QC and test strips are only stable for a certain time period, they should not be used after this date as they could give incorrect results. Please store meter and workstation between 15° C and 40°C and away from moisture. Our glucose monitoring system is audited every 6 months by the manufacturer; the latest audit showed that 60% of strip pots in use were NOT dated. The auditor discarded the all of the undated vials of strips. The cost of a pot of strips is £13 so this was a waste of £780 to the Trust. The next time you pick up a pot of strips please make sure that it has a date on the label – there is a blank area on the label for the expiry date. Ditto QC bottles. Just to recap, the expiry date pre-printed on the bottle is unopened shelf life. The expiry date that you need to fill in on the test strips is 6 months from the day the pot is first opened.

Contraindications to use of the Statstrip Meter When patient has peripheral vascular disease or a condition that impairs circulation to the periphery Patient is dehydrated Patient is in shock Patient has severe odema Patient is hypotensive Send a venous sample to the lab to check the result There are certain conditions where capilliary glucose may not be representative of central glucose levels – the result obtained on the meter could be falsely LOW. In these circumstances, it is essential to send a venous sample to Clinical Chemistry to check the patient’s glucose. It is worth noting that you should always send a sample to the lab for checking any time the meter result is not in keeping with the clinical picture.

Sample Collection Children < 1 year Collect from the lateral areas of the sole. During blood collection, the child must held with foot facing towards the floor. A site which has all ready been punctured must not be punctured a second time. To improve blood flow you can warm heel prior to sample collection by wrapping in a warm, moist cloth. The heel must be disinfected and then dried completely.

Children >1yr and Adults Collect capillary blood from the side of the fingertips. Thumb and index finger should be avoided for the puncture. Wash patient’s hands with warm soapy water or water and a damp gauze. Alcohol wipes / gel should not be used. Massage finger to stimulate blood flow. 1. Twist the sterility cap, remove and dispose. 2. Hold the device between index finger, middle finger and thumb. 3. Press device firmly against chosen puncture site 4. Using your thumb, press down trigger completely. 5. Remove device from puncture site and dispose in sharps bin as per Trust sharps policy Please note: the lancets are single-use, disposable devices Washing the patient’s hands is crucial in order to avoid common contaminants such as sugar from fizzy drinks, fruit juice and sweets. Newspaper ink and some perfumed soaps and handcreams are also said to interfere with the test result. We recommend using the last three digits of the hand so that the thumb and forefingers are not continually used. The sides of the fingers should be used not the tips to lessen pain.

Spare battery at rear of docking station. Charging Light: Amber = Charging Green = Charged Green light on when connected to the network The meter should always be located in the docking station, clean and ready to use. One of the most common problems with the meters is when the docking station and the network do not communicate. If you have problems with your barcode not being recognised it could be that the system has not uploaded your details – please check the status of the green lights on the front of the docking station to see if there is an issue with the network and ring the lab if the light on the left hand side is not green. Another reason for your barcode not being recognised is that is has ‘expired’ – certification is required once every two years for the reasons given at the start of the presentation Please doublecheck that all of your docking stations have spare batteries in the rear of the docking station and that the charging light is showing amber or green (ie the battery has been inserted the right way around). Sometimes the cause of ‘faulty’ meter is simply a flat battery with no charged spare for replacement. Always call the lab as soon as there is a problem. Replacement meters are available from the lab (please bleep after 5.30 or at weekends). Charging Light: Amber = Charging Green = Charged Green light on when data is flowing

Running Quality Control 1) 2) 3) 5) 4) 6) Level 1 and Level 3 quality control solutions must be run once every 24 hours. This has always been Trust policy (even with the previous simpler version of meters, running qc every day was mandatory). The meter will lock out if QC is not run for more than 24 hours. The reasons for running a quality control is to check that the meter and the strips are working correctly. All tests done in the lab have quality control checks at least once a day and any testing done outside of the lab must be done still be performed to the same standard. (After logging in) Step 1: Press the QC button Step 2: Scan the test strip lot barcode on the strip vial Step3: Scan the qc lot barcode on the qc bottle. (It doesn’t matter which order you run the levels, the barcode tells the meter if it is level 1 or 3.) Step 4: Insert strip Step 5: Apply a drop of qc fluid onto the end of the test strip. IMPORTANT – please ensure that the meter is held horizontally, or the strip port is facing downwards, to avoid getting the blue qc fluid running down into the strip port. The most common reason for meters being returned to the lab for fixing, is contamination of the strip port with QC which crystallises and means that the meter cannot recognise when a strip has been inserted. Step 6: The meter will display the qc result – will say Pass if result is within acceptable range, or Fail if the results are not within the acceptable range. If the meter fails qc please run the qc again, if it still fails try a new pot of strips and/or QC bottle, if it still fails then contact the lab)

Running a Patient Sample 2) 8636 1) 3) 4) 5) 6) Before taking a patient sample observe the clinical presentation of the patient, explain the procedure and obtain consent if possible. Wash own hands and put on gloves as Trust policy. Wash patient’s finger (as explained in prev slide 7) Step 1: Scan your operator ID barcode, ideally this should be the barcode on the front of the newer format of Trust staff ID badges. It is essential that you use your own ID for audit purposes. Do not lend your ID to anyone as you will be responsible for that result and any subsequent action taken due to that result. If the barcode on the front of your Trust ID badge is not activated for glucose monitoring (and you have previously attended a ‘new user’ Nova session), then please contact the lab using the email address on slide 3 (poct.poct@...) and give details of your name and Novell log in username as this is the information encoded in the barcode. Step 2: If the qc has been run within the previous 24 hours, the meter will automatically default to ‘patient test’ Step 3: Scan test strip lot number barcode Step 4: Enter the patient’s NHS Number – this is essential information. During a recent investigation of a potential ‘never event’, results could not be found for a particular patient due to users entering 0000000000 or using the generic ‘unknown999’ barcode which was supplied for use in emergencies-only. Step 5: Insert test strip Step 6: Apply drop if blood to the end of the test strip After you have finished running the test: Discard the test strip and used lancet safely into the sharps bin, clean the meter (details on next slide) and return the meter to the docking station. Write the result into the patient notes and inform staff in charge of patient, if required (Please note this slide will need updating when we switch to scanning patient wristbands and have further discussion about the use of the generic patient id code)

Screen Comments StatStrip glucose meter reads between 0.6 - 33.3 mmol/L Glucose: < 4mmol/l - Diabetic - HYPO – Treat Glucose: <4 mmol/l - Not Diabetic – Review Glucose: 4 - 9 mmol/l -"Normal - No Action" Glucose: > 9 mmol/l - "Review needed" Glucose: > 15mmol/l " Review Ketone Test If result is greater than 33.3mmol/L, meter displays HI If result is less than 0.6 mmol/L, meter displays LO The result must be entered in the patient’s notes, along with any appropriate action taken.

Report abnormal or unexpected results to nurse in charge or doctor Any sample giving a meter result below 2.8 mmol / L or above 25 mmol / L and any unexpected result not in keeping with the clinical picture or a sample which gives more than one error message MUST be confirmed by sending an urgent venous blood sample to Clinical Chemistry. Any result less than 4 mmol /l or greater than 9mmol/l consistently or 15mmol/l at any one time should be reported to a trained member of the nursing or medical staff.

Cleaning the Meter Clean and disinfect the meter after each use using a sani-cloth disinfectant wipe (yellow top), blot with a dry paper towel and then follow with a water dampened cloth to remove any residue of cleaning solution Please take care to keep moisture out of the test strip area. The lastest audit results were poor for meter cleanliness – approx 50% of meters that were found in the docking stations (ie should be ready for use on a new patient) had blood and qc fluid on the body of the meter and sometimes the touch screen. In line with the Trust Decontamination Policy each device must receive appropriate decontamination before being transferred between patients, departments, or laboratory. Any equipment that has been decontaminated must be labelled as such. POCT users must recognise the potential hazards of handling and disposing of body fluids and sharps outside of the laboratory setting and be reminded of the importance of: • Universal infection control precautions • The wearing of gloves and other protective clothing • Safe handling and disposal of healthcare waste, including sharps

Troubleshooing Low battery – replace with spare from back of docking station. Contact Clinical Chemistry if you do not have a spare Transfer failed – check the lights on the front of the docking station. Contact Clinical Chemistry if the left hand and/or middle light is not showing green as this indicates there is a problem with your meter not connecting to the network. Bad strip – try a new one, if you get another error please try a new pot of strips and inform Pharmacy or Clinical Chemistry of the lot number of the potentially faulty strips Temperature error, meter and strips need to be stored within 15-40 oC. (Unlikely to be a problem) Bad sample – sample may contain bubbles or clots, please repeat. If error happens again, please send a venous sample to the lab for checking Flow error – the yellow sample area in the test strip must be filled in one touch, double dosing ie pressing the finger to the end of the test strip again if the first attempt was insufficient will result in a flow error. Faulty meters must be returned to Clinical Chemistry with details of the fault. Often meters are returned to Medical Physics for repair, this is understandable as Medical Physics deal with most of the Trust’s other medical devices, but this does build in a delay by the time the meter is re-routed to Clinical Chemistry, fixed/replaced and returned to you. Please note that meters must be clean and decontaminated before being sent to the lab.