2. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20041 Roche ACCU-CHEK® Inform Blood Glucose Meter with the ACCU-CHEK® Comfort Curve™Test Strip and the Roche Safe-T-Pro™ Lancets Sarasota Memorial Hospital

3. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20042 Required to run 2 levels (HI and LO) of quality control once per 24 hours. Regulatory requirements (Joint Commission and CAP) mandate an “audit trail” or “tracer” for each test (including patient/operator ID, reagent lot, day/date/time). Most of this information will be “scanned” in the meter. Draw a STAT lab draw for values outside SHM’s “Critical Values”. Required to write the open/discard dates on all control bottles (3 month expiration after opened). Comments are required for QC that “fails” or patient results that are outside “critical values”. The meter will remind you of this requirement. Hospital Policy Requirements System Features ANY sample can be used (capillary, venous, arterial, neonatal and cord) on the ACCU-CHEK® Inform meter. The ACCU-CHEK® Inform is programmed with SMH’s “critical values” (below 40 mg/dl and greater than 400 mg/dl). Strips packaged in 50 test strip vials and expire the date on the vial. Bar code scanner for quickly scanning strip vials, control bottles, patient and operator IDs.

4. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20043 Other System Features Comments are easily added to each test result, are unlimited and customized by nursing and the laboratory. There are separate comments for QC results and Patient results. Communicate through touchscreen buttons, that in most cases, action will not occur until after you release the button. Feel free to use any soft plastic point, fingernail or your finger (do not use a ballpoint pen with the ballpoint exposed or anything that may scratch/mark the screen). The ACCU-CHEK® Inform is automatically calibrated with the code key in each vial of 50 strips (assures accuracy and should be replaced with each vial of strips). Touch-screen display that allows you also to manually input ALPHA characters (A,B,C …). The meter uses a 5 YEAR rechargeable battery and a docking station for EACH meter (where it should be stored when not in use). The ACCU-CHEK® Inform valid readable range is 10 to 600 mg/dl. Results below 10 mg/dl will report “LO”. Results above 600 mg/dl will report “HI” (see next slide).

5. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20044 Test Ranges and Critical Values (with messages displayed under each patient test result) RANGE: Normal “within” range values seen for healthy adult population. “Range” “Out of Normal Range” “Out of Normal Range” “Out of Critical Range” “Out of Critical Range” OUT OF NORMAL RANGE: Values seen for outside healthy adult population. OUT OF CRITICAL RANGE: Lab back-up must be drawn. SMH’s range selected is below 40 mg/dl and above 400 mg/dl. This message will be flashing at you to remind you that this an “Out of Critical Range” patient test result. ACCU-CHEK® Inform READABLE RANGE Values that the ACCU-CHEK® Inform will report a result (10 mg/dl to 600 mg/dl). A result below 10 mg/dl will report a “LO” and a result above 600 mg/dl will report a “HI”. >400>600<40<10 “HI” “LO”

6. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20045 Roche Safe-T-Pro™ Lancets “TWIST, PULL AND SHOOT ” 1. Hold the lancet and twist off the protective lancet cap. (DO NOT use if cap has previously been removed.) 2. Firmly place the lancet against the fingertip and press the blue button. AFTER USE, PLEASE DISPOSE IN SHARPS CONTAINER.

7. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20046 How to Dose the ACCU-CHEK® Comfort Curve™ Test Strip Lance the side of the finger, wipe off the first drop of blood with dry gauze. Then obtain a small drop of blood. With the strip is inserted into the meter, touch and hold the edge of the yellow window and blood should totally fill the yellow window AFTER THE INFORM BEEPS THE REACTION HAS STARTED and you have up to 15 seconds to apply more blood to the strip, if the yellow window is not totally filled. Not Acceptable Acceptable

8. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20047 How to Hold the ACCU-CHEK® Inform Meter While Dosing a Strip Not Acceptable Always hold the meter in the middle, bottom or sides while dosing (see above). It is not acceptable to hold the meter at the top (see below).

9. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20048 How to Use the Barcode Scanner Do not stare directly into the laser. Aim the laser (end of meter) 4-6 inches away (about the distance of a pencil) from the barcode you want to read. Then press and release the “Scan” button on the upper right of the touchscreen to turn it on (it will stay on for about 8 seconds). Move the meter up to LOOK FOR THE RED LASER LIGHT (usually appears a couple of inches LOWER than where you are aiming). MAKE SURE THE LASER BEAM COVERS THE WHOLE BARCODE. Hold the bar-coded object still while you are positioning the laser beam to read it. MAKE SURE THE LASER BEAM COVERS THE WHOLE BARCODE, THE BARCODE IS AS FLAT AS POSSIBLE AND THE BEAM IS NOT CURVED: Not Acceptable Acceptable

10. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/20049 The Tour of the ACCU-CHEK® Inform Backlight Button (backlights the screen in a dark room condition) Menu Button (always gets you back to the main menu) Purple Power Button (make sure you turn off the meter after use) Forward Arrow Button (acts like an “enter” key or allows you to go forward) Bar Code Scanner (for scanning strips, control bottles and IDs) Test Strip Port (insert strip electrode end first) Touchscreen Display (showing the “Main Menu” screen) Code Key (automatically calibrates the strip lot number)

11. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200410 Power Up Screen How many hours until quality control is due Battery gauge (shown as FULL) To turn the meter on, press and release the Purple Power Button. The meter will perform self-checks after power-up for 7 seconds (will beep when done). Press the Forward Arrow Button to get to the“Operator ID” screen ICU 4 Location where the meter is assigned

12. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200411 Input Operator ID and Menu Screen Position the Inform 4 to 6 inches away from your bar-coded ID badge and scan it (scanner will stay on for 8 seconds), OR... Press and release the “Scan” button to turn on bar code reader Press the “Control Test” menu item Input your operator ID number manually, then press the Forward Arrow Button to enter it and continue to the “Menu Screen” to run a control: Your operator ID Number will be displayed here Back button (like a backspace) Your operator ID is usually your employee ID number on your bar-coded badge. Press the “ABC...” button to display the alpha keyboard. Press the “123…” button to return to the numbers keyboard. 1234567890 Operator name should be displayed here SMITH JOHN

13. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200412 Running Controls REQUIRED label showing that a Level is due now Press the “Scan” button to read the control bottle bar code level and lot number If you press one of the “Level” buttons (not recommended), you will be asked to “Scan” the Control Lot (see below left). You will“Scan” the control bottle and then the strip vial for each control test. The ACCU-CHEK® Inform meter will automatically run that level control in any order. It is a good practice to only remove the quality control bottle you are actually running. Use the“Scan” button to scan your “Control Lot” on each control bottle Use the “Scan” button to scan your “Strip Lot” on the strip vial REQUIRED label gone when a Level has been successfully run Enter “Control Lot” Screen Enter “Strip Lot” Screen

14. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200413 Screens While Running Controls Press the “Forward Arrow” button when done to continue to run the next control, run a patient test or if finished, TURN OFF THE METER Hold control bottle horizontally Squeeze small drop at the end of the control bottle Apply to curved BOTTOM edge of the yellow reaction area and fill window

15. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200414 To Run a Patient Input the 7 digit “Patient Admission Number” by scanning their bar-coded wristband, or... Press the “Patient Test” menu item Back button (like a backspace) you may also manually input the 7 digit “Patient Admission Number” in the “Patient ID” screen and when complete, press the Forward Arrow Button. The Patient Admission Number will be displayed here as you type Press the “ABC...” button to input patient’s last name if a “Patient Admission Number” has not been generated yet. 1234567 Press to “Scan” barcode

16. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200415 Screens While Running a Patient Test The result for this test is outside the hospital’s normal range. Comments are not required for within “Range” (normal) or “Out of Normal Range” results. The “Range” button below the result will remind you whether the result is within “Range” (normal), “Out of Normal Range” or “Out of Critical Range”. 1234567 Use the “Scan” button to scan your “Strip Lot” on the strip vial

17. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200416 Patient Test Results that are “Out of Critical Range” The “Comments” button will also be flashing to alert you a comment is required for this result. Press the “Comments” button to add a comment. The result for this test is outside the hospital’s “Critical Range” (greater than 400 mg/dl) The “Range” button will be flashing “Out of Critical Range” (to alert you) Press “OK” to continue. Customized “pop-up” message appears to remind you to run a STAT lab draw for this result. 1234567

18. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200417 Screens While Adding Comments use the down arrow button to scroll to the next 4 comments if needed to de-select a comment, just press it again you may add up to three (3) comments per test you may also add a custom comment by pressing the “Custom” button when you are complete, press the “Forward Arrow Button” to get to the summary screen (see right) press the “Forward Arrow Button” when done Press the comment(s) you want to add It will turn dark to let you know the comment is selected Your comment or comments Summary Screen 1234567 Down button for the next 4 comments Custom button to add a “custom” comment

19. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200418 Miscellaneous Information The Accu-Chek INFORM® has been programmed by SMH to warn you (and eventually lock you out) if the meter has not been downloaded after a certain time period (you may use any download station within the hospital). Only valid (certified) operators will be allowed to use the meter (all others will be locked out). You must be certified annually. If cleaning is required, you may either use alcohol, a damp cloth with a soapy solution or a 10% bleach wipe (to disinfect). Dry off the meter with a soft towel after cleaning. Do not saturate the meter or place a damp meter into a docking station. If a replacement meter is needed, a replacement meter should be available in the laboratory. Keep the lid tightly on the strip vial (strips expire the date on the vial). Do not use strips that have been left out of the strip vial. Write the date on each new bottle of glucose controls (the discard date on control bottles is 3 months after opened).

20. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200419 Troubleshooting Tips Tips regarding docking and un-docking the meter:  Always wait 3-5 seconds after taking meter off base unit before pressing the Purple Power Button to turn the meter on.  NEVER place a wet meter (from cleaning or a spill) into the electric docking station.  Make sure the ACCU-CHEK® Inform meter is OFF before docking in base unit.  Whenever you dock the meter, you should see a box around “Transmitting” for 15 to 45 seconds (after that you will see a box around either “Connecting” or “Idle”). Recessed Reset Button  Insert a large paperclip or the blue pin from a Roche Safe-T-Pro™ lancet and push the “recessed reset button” for about 1 second.  The “Palm Computing Platform” will appear on the screen and the meter will restart. Re-dock the meter and allow it to “Transmit”. You will not lose any patient data by resetting the meter. If you have any issues with the meter not responding, you may reset the meter. TO RESET THE ACCU-CHEK® INFORM METER:  Turn the meter over. Locate small hole on the bottom right side of the ACCU-CHEK® Inform meter (on battery cover).

21. ACCU-CHEK® Inform Full Training Copyright © 2004 Roche DiagnosticsV2.1 12/200420 Fingerstick Glucose versus a Venous Puncture Glucose Performed in the Laboratory In situations of decreased peripheral blood flow, fingerstick blood testing may not be appropriate (i.e. severe dehydration - increased plasma sodium in the critical range, hypotension, shock or peripheral vascular disease). Underdosing the Accu-Chek® Comfort Curve™ strip can lead to erroneous readings. All users should be aware that the yellow window of the strip must be completely filled during the entire process. ² Tietz Textbook of Clinical Chemistry, 2 nd Edition; Carl A. Burtis and Edward R. Ashwood, Editors; 1994; Page 959 and 1975. ¹ Tietz Textbook of Clinical Chemistry, 2 nd Edition; Carl A. Burtis and Edward R. Ashwood, Editors; 1994; Page 959. In the non-fasting state, capillary (finger stick) blood glucose levels can be up to 70 mg/dL higher than venous (lab draw) blood glucose levels¹. Glycolysis (the breakdown of glucose) can be another cause for a higher meter-to-lab analyzer comparison². One of the main benefits of using a bedside meter is the elimination of the issue of glycolysis, especially in neonate samples². Be sure to send the blood sample immediately to the lab for processing within 30 minutes.