1. Accu-Chek® Performa and Accu-Chek® Inform II Blood Glucose Meter Training
28 November page 1 © 2009 Roche

2. Why Training? Medicines & Healthcare products Regulatory Agency
Nursing & Midwifery Council
Hospital Trust
RCN
Department of Health:
“The use of blood glucose meters by untrained staff, without adequate management supervision of the equipment and without the use of quality control procedures, can lead to misleading results, adversely affecting the treatment of patients” MHRA 1996
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3. Refer to strip pack insert for limitations for use
Contra-indications For Use Of Blood Glucose Meters As indicated by the M.H.R.A
If peripheral circulation is impaired collection of capillary blood is not advised as there is a risk that the result obtained may be unreliable. Preferably a venous sample should be sent to the lab, however it is also possible to measure glucose POCT on a venous sample.
Examples of condition where peripheral circulation may be impaired include;
Severe Dehydration due to Diabetic Ketoacidosis
Hypotension
Shock
Hyperosmolar, Hyper glycaemic State (known previously as H.O.N.K )
Decompensated heart failure NHYA Class IV
Refer to strip pack insert for limitations for use
We acknowledge that staff are required to perform POCT capillary blood glucose determination as part of national protocol in some of the conditions listed above. In these circumstances we recommend caution in the interpretation of results obtained from capillary blood glucose instruments. Result should be reviewed in the knowledge that capillary results have the potential to be misleading in the conditions listed above.
28 November page 3 © 2009 Roche

4. Accu-Chek Performa Meter
On/Off button
Display Screen
QC Buttons
On/Off Button – Press and hold down to display screen contents. Check that screen is full of icons and the segments that form the “8”s are intact.
Ensure all areas of the screen are clearly visible. Screen should be checked each time meter is switched on , minimum daily.
(meter may have been dropped and the screen may have been damaged / not display figures clearly e.g may display a 3 but should be an 8 – this could have implications to the treatment given)
Memory Buttons – Do not use memory function in clinical setting as not able to input patient identification into meter. This should NEVER be used in a professional setting.
Storage – The meter and all associated consumables should be stored at room temperature. Avoid extremes of heat/cold.
Replacement Meter – Ask staff where a new meter should be obtained.
Test Strip Slot
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5. CR2032 battery – Only order from Lab!
Insertion of Battery
CR2032 battery – Only order from Lab!
Inserting a battery:
Push the recessed plastic tab of the battery compartment forward (towards the arrow) to flip open the battery door.
Insert the battery into the compartment with “+” side facing you.
Snap battery cover into place.
When a battery symbol appears on the screen or error code E-9 appears on the screen, change the battery immediately.
The performa meter has a back up battery inside the meter which maintains the time & date. This enables the meter to determine the code chip expiration date, preventing the use of expired test strips.
Give staff opportunity to change the battery if necessary.
New battery obtained from?
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6. How to Calibrate the Performa Meter
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7. Accu-Chek Inform II Test Strip
Golden End (electrodes)
Yellow Window
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8. Patient Testing Consent Infection Control Patient preparation
Obtaining a sample
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9. Patient test - Application of Blood to Strip
Explain this is how you apply the blood to the test strip.
All results must be documented in accordance with Trust policy.
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10. Quality Control Testing
Why Quality Control?
How often is Quality Control performed?
When are extra Quality Controls required ?
3 month shelf life once opened
20/6/16
28 November page © 2009 Roche

11. Quality Control Testing
Why Quality Control? This is the only way to ensure meter is working accurately.
When to Quality Control? QC expires 3 months after opening – write 3 month expiry date on QC bottle. Mix QC before using (main reason QC fails) – wipe off any crystalising of QC solution from top of QC bottle onto tissue.
If meter is used daily – QC should be performed every 24 hours. (refer to Trust Policy) The Inform II will Automatically QC lock out and no patient testing can be performed.
If used infrequently – QC should be performed weekly and on day of test.
QC should also be performed in the following situations:
New Test Strips
New QC Solution
If meter is dropped
New Battery
Unexplained result versus clinical appearance
How to QC the Inform Meter – Demonstrate how to perform QC Staff being trained must demonstrate how to do a QC test.
Documentation of Results: Explain that because the staff log in into the system with User Id’s and scanning all barcodes they are effectively filling out the logbook electronically therefore there is no paper based log book to fill out or retain for the 10 / 25 years.
External Quality Assurance: Explain this is a sample sent to all wards from Biochemistry, it tests the accuracy of the meter and also that the user is following procedures (result only known by lab). Explain It is processed like a patient sample, how to complete paperwork & return to laboratory. Everyone’s responsibility to perform EQA samples. Hospital is audited on numbers of tests returned and accuracy.
28 November page © 2009 Roche

12. Good Data Recoding - N.M.C
“Good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care. It is not an optional extra to be fitted in if circumstances allow.”
To safeguard both patients and staff
10 years for adults , 25 years for children , to be kept on the ward or sometimes by the biochemistry dept.
N.M.C – Record keeping – Guidance for nurses and midwives
28 November page © 2009 Roche

13. Failed Quality Control Test What should you do?
Check
Expiry dates, mix solutions & repeat the test.
Change
Solutions & Test Strips
Contact
POC team, Biochemistry Laboratory
Remember
If the meter continues to fail – cannot use it!
28 November page © 2009 Roche

14. Accu-Chek Inform II
Inform II Blood Glucose Meter is connected to your hospital laboratory system when in the docking station.
Central database within the laboratory
Enables complete audit trail for each test
Protects Patient
Protects Hospital
Protects You
Patient ID Mandatory
Scan or manually enter patient HC number for each test

15. Accu-Chek Inform II Strip Port Touch Screen Barcode Scanner
On / Off Button
Base Unit
The base unit:
The meter should always be placed in this when not in use.
The Silver charging points charge the meter
The IR Data transfer window allows the upload and down load of information (Not WI-FI)
LED status should be Green , if RED or RED and Flashing not communicating unplug wait a few seconds and re-insert plug. If LED is Blue then the meter is Wi-Fi and it’s just a charging station.
The Meter
The On / Off button will turn the meter on or off.
The Touch screen is a Light Sensitive touch screen and looks for changes in light. For effective use touch screen and release.
The Test-strip port. The system has been ergonomically designed to encourage hygienic strip handling in the horizontal plane.
The Barcode scanner is used to Scan the Patient identification and the barcodes on the Strips for Lot Verification and that of the Qc .
Charging Points
Data Transfer
LED Status Display

16. Know your base unit…. Green Light – Ready
Flashing Red Light – Communication Error
Red Light – Power connected & starting up
Blue Light – Wifi / Configuration mode

17. Accu-Chek Inform II (reverse side)
Battery Pack:
(powers the meter)
Reset Button:
Use this button to reset the device
(reset will not alter configuration
Charging Contacts:
(These are used to charge the meter when it’s in the base unit
28 November page © 2009 Roche

18. Accu-Chek Inform II Blood Glucose Meter
OLD VERSION
NEW VERSION
No Reset button on reverse.
Hold on/off button down for 15 seconds to reset
Old version reset button
RF Slot

19. General Meter Operation (Scan a barcode)
28 November page © 2009 Roche

20. Calibration of the Accu-Chek Inform II Meter Coding is done Centrally
Throw away the code chip that comes in every box of test strips
The code chip information is loaded by the Point of Care Co-ordinator (POCC)
Automatically downloaded into every Accu-Chek Inform II.
This calibrates the meter to the strips.

21. Accu-Chek Inform II Test Strip Container
Hinged lid
Expiry Date
Strip Code Number
28 November page © 2009 Roche

22. Accu-Chek Inform II Test Strip
Golden End (electrodes)
Test Strip – Is robust and can be handled as long as hands are clean, dry & free from alcohol gel. They are dosed at the tip of the strip. (End dosing strip).
Under Dosed – The Inform II meter will report a “Type Bad Dose” if the test strip is under filled
The Inform II strip also compensates for temperature, humidity & Haematocrit – gives error messages if unable to compensate.
The Inform II strip also detects sample type: blood /QC
Blood or QC must be placed at the leading edge of the test strip.
New strips obtained from?
Yellow Window
28 November page © 2009 Roche

23. Patient Testing Consent Infection Control Patient preparation
Obtaining a sample
28 November page © 2009 Roche

24. How To Perform A Patient Test Switch on Inform & enter your operator ID. Main Menu appears.
Confirm the current strip lot is being used by scanning in the test strip barcode.
Scan your unique Operator barcode.
Test Processing
Result displayed – Document as per trust policy.
Insert a strip when prompted
Touch Patient Test
Type the patient ID or scan patient barcode.
Apply patient blood only when prompted

25. Results Normal Range = 4. 1 mmol/L – 6
Results Normal Range = 4.1 mmol/L – 6.5 mmol/L Critical Range = < 2.8 mmol/L - >20.0 mmol/L – Laboratory sample MUST be sent If outside Normal/Critical Range - meter prompts “Out of Range”
What does this mean?
Blood Glucose lower than 0.6mmol.
Potentially very high glucose – above 33.3 mmol.
28 November page © 2009 Roche

26. Cleaning the Meter 70% Alcohol may be used
Follow hospital policy for decontamination

27. Quality Control Testing
Why Quality Control?
How often is Quality Control performed?
When are extra Quality Controls required ?
3 month shelf life once opened
20/6/16
28 November page © 2009 Roche

28. How To Perform A Quality Control Test Switch on Inform & enter your operator ID. Main Menu appears.
Insert a strip when prompted
Touch Control Test
Select Glucose Control test
Select your level and scan the QC barcode on the side of the bottle
Apply correct Control Solution only when prompted
The Inform automatically downloads the QC result into the database Remember to add a comment if the QC fails.
Confirm the current strip lot is being used, by scanning the test strip barcode

29. Failed Quality Control Test What should you do?
Check
Expiry dates, mix solutions & repeat the test.
Change
Solutions & Test Strips
Contact
POC team, Biochemistry Laboratory
Remember
If the meter continues to fail – cannot use it!
28 November page © 2009 Roche

30. Review Results Only Selected Patients results displayed.
Press the Review Results button in the Main Menu.
Select specific results to view details (e.g. comments, flags, date & time)
Scroll the list using the arrow buttons on the right side of the screen.
View all results for a specific patient by pressing Patient in the main list,

31. poct@southerntrust.hscni.net Or Tel: 02838360651
SHSCT - Point Of Care Team Derek McKillop, Dorinda O’Neill or Garerth Prideaux, Biochemistry Laboratory, Craigavon Area Hospital. Contact via
Or Tel:
All Performa stock (Log books, batteries, replacement meters) and replacement Inform II bar codes are requested via above POC team.

32. Remember!
Always dock the meter after use and/or on return to your base station.
Always enter the correct Patient HC number
Never share your barcode
Never leave the lid of the strip container open

33. Thank you for your attention.
Roche Diagnostics Ltd. Charles Avenue
Burgess Hill
RH15 9RY
COBAS and LIFE NEEDS ANSWERS are trademarks of Roche
This presentation is our intellectual property. Without our written consent, it shall neither be copied in any manner, nor used for manufacturing, nor communicated to third parties.
28 November page © 2009 Roche