1. A Quality Improvement and Patient Safety project for Kaleida Health April 2010

2. Kaleida Health’s commitment to patient safety is: That all diagnostic testing and procedures are performed as ordered by accreditation agency mandates To have, and follow, a consistent, concise and accurate means of identification confirmation when performing blood glucose (BGT) point of care testing (POCT).

3. How Kaleida will reach this National Patient Safety Goal (NPSG) Double identify all patients prior to any treatment-

4. Why is this so important? Patient ID errors have the potential to occur during all phases of treatment and diagnosis. Our mandate by accreditation agencies is to reliably : identify the individual as the person for whom the service or treatment is intended, and to match the service or treatment to that individual. After much consideration, BGT was chosen as the stepping off point.

5. Why the emphasis on double identifiers for Blood Glucose Testing? Test is performed frequently Number of tests performed make it high volume BGTs are done in all patient care areas Moving forward all POCT will have similar requisitions for use in double-identifying patients

6. What is the new process? 1. Obtain a written order from an LIP (MD, NP, PA) for BGT testing. 2. Make sure order specifies: Patient name Frequency of testing Date and Time. 3. Enter this as a new order in PowerChart

7. How do I enter the order in PowerChart? 1. Click on Nursing Orderable>Request for POCT>Glucose Finger stick, then enter requested information: — Routine/Priority — Requested date and time of start — Frequency — Duration 2. Place the requisition that prints from your unit printer in the designated time slot of the BGT binder or folder.

8. Duplicate orders Duplicate warning alert Check for duplicate orders

9. If you find a duplicate requisition cancel it! To cancel or d/c 1. Enter PowerChart 2. Go to Nursing Orderable 3. Highlight the desired occurrence- make sure you have the correct occurrence 4. RIGHT click 5.Chose the occurrence to cancel or d/c  To d/c all occurrences – d/c the parent order and all child orders associated will also be cancel  To d/c the individual occurrence just cancel that single occurrence.

10. Be careful!  Perform the right test  on the right patient  at the right time.

11. Procedure for drawing a blood glucose test: 1. Wash hands- 2. Double identify patient using the POCT BGT requisition and patient ID band. 3. Perform the BGT per protocol- Scan the patients ID band (do not scan the requisition - the requisition barcode is invalid) 4. Document results of BGT on requisition 5. Communicate the result of the BGT to the nurse caring for the patient 6. Return requisition to the designated folder or binder on your unit

12. Results are not normal? Draw a Confirm Glucose Test Remember : you must draw a glucose in an SST tube and send it to the lab if blood glucose results are: less than 50 in an adult or less than 45 in a neonate. greater than 400 in any patient Be sure to: Notify the nurse caring for the patient immediately so that a STAT blood glucose level bar code label can be generated.

13. Procedure for Confirming a Glucose 1. Double identify the patient using the patient ID band and Bar code label 2. Obtain blood sample 3. Label blood sample at the patient bedside, also indicating the “actual result” on the label 4. Deliver STAT sample to the lab 5. Document and follow process used for reporting critical values in the Critical Values Communication Book

14. Sometimes a confirmation is not required: If the LIP (MD, NP, PA) determines that a confirm glucose is not required: check the appropriate box on BGT requisition return the requisition to the BGT book in appropriate time slot as directed

15. Note: Order requisition is not a permanent part of the medical record.

16. What happens if I need a reprinted requisition? For a reprint 1. Enter PowerChart 2. Go to Nursing Orderable 3. Highlight the desired reprint- make sure you have the correct occurrence 4. RIGHT click 5. Drop down to Print> Reprint Requisition

17. Down time procedure Downtime procedures for both PowerChart and the Glucometers remain unchanged.

18. Thank you! Thank you for what you do every day to keep our patients safe. If you have any questions: Call Clinical education, the Laboratory, Quality Director, Or call 859-8740