1. Nova StatStrip Glucose Meter Training for glucometer operators
A Self-Study Packet for The Johns Hopkins Hospital Point-of-Care Testing Program
©copyright 2015
Johns Hopkins Hospital
All rights reserved

2. Overview and Objectives
This module provides an introduction to the JHH policy for performing bedside blood glucose monitoring.
At the conclusion of the module the learner will be able to:
State training and maintenance of competency requirements with point of care testing ( POCT ) for blood glucose
Define indications for blood glucose monitoring
Identify how to perform a blood glucose test using the Nova StatStrip Glucose meter
State procedure for obtaining capillary, venous, neonatal, and arterial blood specimen for glucose POCT
Identify limitations of POCT
Define operator responsibilities with POCT

3. Training and Competency
Only those operators who have completed training and have demonstrated competency may perform POCT blood glucose testing.
The Training program will consist of:
Attending a defined in-service session on the glucose meter.
Passing a written examination
Demonstrating competence through the proper performance and interpretation of quality control.
Maintaining competency:
Annual online education
Perform 2 levels of QC once a year

4. Reasons for Point of Care Blood Glucose Monitoring
On-going management of blood glucose in patients with diabetes
Rapid detection of extreme blood glucose concentrations in patients who:
are in a coma
have symptoms that suggest hypoglycemia or hyperglycemia

5. Monitoring of patients:
who have diabetes
who are receiving Parenteral Hyperalimentation
who are receiving medications which affect blood glucose concentration
after liver or pancreas operative procedures
with post-op or post procedure elevations in glucose secondary to stress
with infection
undergoing renal dialysis
hyperglycemia

6. Point-of-Care Glucose analysis IS NOT used to diagnose Diabetes Mellitus
Bedside whole blood glucose monitoring is used to supplement laboratory analysis of blood glucose
Patients will still require periodic laboratory testing of blood glucose levels.

7. Factors Influencing Accuracy of Test Results Patient Medical Conditions
Problem
Potential Impact
Recommendation
Patient has peripheral vascular disease or a condition that impairs/decreases circulation to the periphery
False low glucose
Fingerstick collection not recommended
Patient is dehydrated
Patient is in shock
Patient has severe edema
Patient is hypotensive

8. Operator Performance
The operator ID used for the glucose meter is the employee’s JHED ID.
For legal reasons, Operator’s should NOT share their JHED IDs with other users.
Operators that fail to perform quality control (QC) or fail to take their yearly quiz, will be removed from the meter and unable to perform testing
Operators that are removed from the meters will need to repeat the training program.
NOTE: If your QC is due within 28 days, when you scan your JHED ID barcode, the meter will give you a message that your QC is due.

9. Specimen Collection
Capillary, venous, neonatal and arterial whole blood specimens may be used.
Remember to use Standard Precautions when obtaining blood samples and performing patient testing.

10. Quality Control (QC) All glucose meters require QC every 24 hours
Patient testing will not be allowed until the QC has been performed satisfactorily
All test strips and control bottles must be dated when opened with the opened date and expiration date.
This is a Laboratory Regulatory Requirement!
Example: O: 3/11/11 X: 6/11/11 NN
O=opened X= expired NN= Nancy Nurse (your initials)

11. Nova Statstrips®
Once opened, test strips are good for 180 days or manufacturer’s expiration date
Store at room temperature and tightly capped
No interference from medications, oxygen, uric acid, acetaminophen, bilirubin, maltose, galactose, xylose or hematocrit

12. Control Solutions
Once opened, solutions are good for 90 days or until expiration date on the vial.

13. QC Procedure Log-in by scanning your user barcode Choose QC
Each operator will have a barcode with their JHED ID
Choose QC
Scan the vial of test strips
Scan Control solution, level 1
Place the test strip into the meter
Gently mix control solution, discard the first drop then apply drop to strip
After 6 seconds, view results (PASS/FAIL)
FAIL requires a comment
Discard test strip
Repeat procedure with Level 3 control solution

14. QC Procedure
If QC fails, the following troubleshooting steps should be taken:
Repeat control test, record comment on meter
Open new set of controls and repeat test
Open new test strips and repeat test
If QC continues to fail after these steps….. STOP TESTING.
Contact the POCT Office for assistance

15. Patient Testing

16. Capillary Blood Collection (Fingerstick/Heel Stick)
Verify the patient’s ID with 2 unique identifiers:
Inpatient: Name & Medical Record Number
Outpatient: Name & Birthday
ALWAYS scan the csn number into the glucose
meter (WE NO LONGER USE MRNs for the meter)
Select an appropriate sampling site:
Palm side of the finger tip
Lateral or medial plantar surface of the infant heel
Warm the site if needed.
Clean site with 70% alcohol and ALLOW TO AIR DRY.
Perform the puncture just off-center of the fingertip or infant heel.

17. Capillary Blood Collection (cont’d)
Wipe off the first drop of blood, using a gauze.
Allow a small drop of blood to form by gently applying intermittent pressure.
Do Not Milk the site.
Touch the end of the test strip to the drop of blood.
Capillary action will cause the blood to flow in the 4 wells on the test strip.
The strip must fill completely upon touching the blood droplet.
Do not touch the test strip to the blood droplet a second time.
Discard the test strip and repeat with a new strip.
Discard all contaminated patient materials in appropriate biohazard containers. 
Dispose of used lancets into sharps container.

18. Blood Collection from Arterial or Central Lines
Verify the patient’s ID with 2 unique identifiers.
Ensure the line is clear before obtaining the sample.
Discard appropriate volume of blood in a waste syringe.
Attach a lithium heparin blood gas syringe to the line and draw the sample.
Cap the syringe and gently mix by inverting the syringe 10 times.
This allows the anticoagulant to properly mix with the blood sample.
Uncap the syringe and discard a small amount of the blood sample before dosing the test strip.

19. Blood Collection from Arterial or Central Lines (cont’d)
Gently push on the syringe plunger to allow a drop of blood to form on the end of the syringe.
Touch the blood drop to the end of the test strip.
The strip must fill completely upon touching the blood droplet.
Do not touch the test strip to the blood droplet a second time.
Discard the test strip and repeat with a new strip.
Flush the line, when test is completed.
Discard all contaminated patient materials in an approved biohazard container.
Dispose of used syringes in sharps container.

20. Blood Glucose Reference Ranges (* Diabetes Care,2003;26:3160)
Normal Fasting
60-99 mg/dL
Newborn (0-7days) mg/dL
Glucose values of mg/dL indicate impaired fasting
glucose

21. Remember…
Nova Stat Strip glucometer machine will only read from ( ) ( ) mg/dL.
If the result is >600 or <10, retest using a new strip. If the same HI or LO reading is obtained, run a QC.
The RN is authorized to send a STAT blood glucose specimen to the critical care lab to confirm accuracy of the glucometer when the result is > 400, inconsistent with the patient current physical status or previous glucose values.

22. Reporting of Values
UAPs (Clinical Associates, Clinical Technicians and Clinical Nursing Externs) will notify the patient’s Registered Nurse of ALL Point-of-Care blood glucose results.
Registered Nurses and Licensed Practical Nurses will notify the provider immediately for blood glucose levels greater or less than the parameters specified in the written orders.
Document in the patient’s record:
Name of the provider that was notified
A read-back of the Critical Action value has occurred and been verified.

23. Factors Influencing Accuracy of Test Results Improper Fingerstick Collection
Problem
Potential Impact
Recommendation
Using a previously punctured site
Accumulated fluid will contaminate the blood specimen (decreases glucose)
Obtain blood specimen from a fresh, non-punctured site
Improperly cleaning the puncture site with alcohol
Residual alcohol causes rapid hemolysis and adversely affects glucose results ( increases glucose)
Allow puncture site to air dry after cleansing with alcohol
Not wiping away the first drop of blood
Excess tissue fluid in blood specimen (decreases glucose)
Wipe away first drop of blood after the puncture is performed
Milking the puncture site to obtain the blood drop
Hemolysis and /or contamination of blood with tissue fluids
Hold the puncture site downward and apply gentle, intermittent pressure proximal to the puncture site
Edema at the puncture site
May give a falsely low glucose result
Fingerstick collection not recommended

24. Factors Influencing Accuracy of Test Results User-based Problems
Recommendation
Not enough blood applied to the test strip
If the test strip does not fill completely:
Discard the test strip
Repeat the test with a new strip.
Test strip not fully inserted into the meter
Strip must be fully inserted into the meter before dosing with a sample
Test strips/Controls stored at temperature extremes
Test strip and controls must be stored according to manufacturer’s instructions
Test strips left uncapped
Use test strips immediately after removal from vial.
Recap vial immediately after removing strip.
Vials found uncapped should be discarded.

25. Documentation of Glucose Results
Test results will automatically upload to the electronic medical record.
If required by your unit or if results do not transmit, document test results, the Meter ID number, date, time and operator initials in the electronic medical record. 
Specific interventions will be documented on the MAR and/or in the Notes section under Response to Intervention.

26. Operator Responsibilities
Clean the meter after each patient use!
Record open dates on test strips and control solutions.
Dispose of outdated test strips and control solutions.
Perform QC with the appropriate control solutions (Discard the first drop).
Document any failed QC results and corrective actions.
Enter/scan the correct patient history number into the meter. It is ALWAYS better to scan the CSN number
and override if necessary than to manually
enter the CSN number. Please don’t enter the
MRN number!
Properly collect the patient sample.
Document test results, meter ID, date, time,
operator initials and care actions.

27. Cleaning of the Meter Wipe meter with a Sani-Cloth® wipe
Squeeze out any excess liquid
If meter screen develops a light film, wipe with alcohol wipe or a gauze moistened with water.
Do not spray solutions on the meter!
This could damage the internal electronics

28. Battery Replacement Replace battery when “battery low” message appears
The battery is a rechargeable lithium battery
Press Power button to enter Sleep Mode
Push down on 2 cover latches on the back of the meter
Push up on the battery latch to release the battery
Remove old battery and replace with charged battery
Insert new battery into the bottom first
Replace cover
Place drained battery into docking station to recharge
The light on the charger station should be red, if you don’t see the light, the battery is in backwards.

29. Batteries…. The rechargeable battery life expectancy is 18-24 months.
Batteries should be removed from use and properly disposed of if they exhibit any of the following conditions
Has exceeded its expiration date
Swelling, cracking or damage to battery case
Leakage
Failure to hold a charge

30. Common Nova StatStrip Glucose Meter Error Codes/Alerts
Error Code/Alerts
Possible Cause
Solutions
Battery Low
Has not been recharged
Charge/Replace Battery
QC Due: xx:xx hrs
Run QC after time has lapsed
LOCKED
QC not run
Perform QC before Patient Testing
Test Strip Was Removed
Test cancel, insert new test strip
Temperature
Meter outside temperature range of 59°F-104°F or (15°C-40°C)
Move meter to correct temperature range and run QC
Bad Sample
Insert a new strip and rerun the test
Replace Strip
Insert another strip
Flow Error
Insufficient sample or sample applied incorrectly
Rerun test with a new strip
Transfer Failed
Connection to server broken
Contact POCT Office (52645)
Meter removed from dock before data transfer was complete
Re-dock the meter

31. Transmission of Results
The Nova Stat Strip glucometer utilizes wireless technology for the transmission of glucose results.
Eliminates the need to return the meter to the docking station for uploading patient restults.
However, the meter must be returned to the docking station for battery recharging and to download operator and reagent updates.

32. Radio and Network Connection Status
The Radio and Network Connection Status is displayed via icons on the Screen Title Bar.

33. Summary
The Nova Stat Strip glucometer utilizes wireless technology for the transmission of blood glucose results.
The procedure for QC and patient testing using POCT testing may be found in HPO
Blood Glucose testing
Nova Stat Strip Blood Glucose meter

34. Resources The Point-of-Care Testing Program Office
is located in CMSC SB-201
Phone:
Hours: Monday –Friday,
8am-4pm
POCT Website: