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Tulare Local HealthCare District

dba TulareRegionalMedicalCenter

Clinical Staff utilizing the

NOVA glucometer

Nova Glucometer Module

Nova Glucometer Module

Introduction:

Welcome to the learning module on the Nova glucometer. This module is the cognitive portion of the initial and annual review for bedside blood glucose monitoring. This module will review key information on the Nova meter and prepare the learner for successful completion of glucometer competency at Centralized Annual Update and/or during the new hire process.

Description:

This moduleis designed to refresh the glucometer user’s knowledge of the Nova meter, the possible trouble shooting issues with the meter, and best cleaning recommendations. The module includes procedure review, and a post-test.The user will perform a QC in the presence of a super user during CAU and/or orientation.

Objectives:

By completion of this module, the employee will:

  1. Recognizethe purpose and function of the Nova meter.
  2. Identify the recommended cleaning product and cleaning frequency for the meter.
  3. Differentiate between proper and improper application of blood to the test strip.

Target Group:

RNs, LVNs, MAs, certified ED Techs performing bedside blood glucose monitoring.

Continuing Education Credit/In-service Credit: In-service only

Prepared by: Carol Bradford, RN, BSN, PHN Staff Educator

with input from Lab Scientists

Course Sequence:

  1. Read the Procedure
  2. Take the Post-test. Must pass with at least 85% or better.
  3. Submit the completed test via the computer Learning Management System.
  4. Perform a high and low QC and at least one patient testannually

TULARE REGIONAL MEDICAL CENTER

DIVISION OF CLINICAL SERVICES

STANDARDS OF CARE

GUIDELINES

BLOOD GLUCOSE MONITORING

Qualified to Perform:

RN, LVN, MA, PA, SI, ED Tech II

STANDARD OF CARE:

All patients at TulareRegionalMedicalCenter requiring bedside blood glucose analysis can expect adequately trained staff to perform the testing procedure. All appropriate staff will be competent to operate monitors. Employee identification numbers will be used when performing quality control [Q.C.] Tests and Patient Tests. No employee will be allowed to use the monitor until they have completed training.

STANDARD OF PRACTICE:

Appropriate staff will demonstrate and maintain competency necessary to promote a safe outcome for the patient requiring bedside blood glucose analysis. Competency must be renewed yearly to continue using the monitor. Evidence of competency must be accomplished during the employee’s first 6 months of employment, then yearly through Centralized Annual Update by the Education Department. If competency is not proven, the employee will be locked out of the monitor. As reference, all staff may refer to the “StatStrip Glucose Hospital Meter Instructions for Use Manual”. Other references for staff are laminated “Quick Guides” and designated Laboratory personnel or designated Education Department staff and department super users.

POLICY:

  1. Use

The Blood Glucose Monitor should be used for screening and treatment purposes only to measure a patient’s blood glucose level from a whole blood sample. The device is not to be used for the diagnosis of Diabetes Mellitus.

  1. Principle

Glucose is measured by enzyme, amperometric.

  1. Specimen

Type:

Use fresh Whole Blood: Capillary, Arterial, Venous and Neonate.

Blood samples in Sodium, Lithium, and Ammonium heparin may be used.

EDTA, citrate, oxalate, and sodium fluoride are not recommended for use.

  1. Equipment and Materials

Equipment:

Nova StatStrip Glucose Meter (Temperature range 15 to 40°C (59 to 104°F)

Materials:

StatStrip Glucose Test Strips (180 day use once opened, label bottle with end expiration date)

StatStrip Glucose Control Solution, level 1 (low) (90 day use once opened, label bottle)

StatStrip Glucose Control Solution, level 3 (high) (90 day use once opened, label bottle)

Safety Lancets

Alcohol Swabs (for patient use only)

Cotton Balls

Preparation:

Leave meter in the Docking/Charging Station until needed for use.

When the “Battery Low” symbol displays on the meter screen place the meter on the charging station or change to a fully charged battery.

Storage Requirements:

Store StatStrip Glucose Test Strips at 15 to 30°C (59 to 86°F).

Store StatStrip Glucose Control Solution at 15 to 30°C (59 to 86°F).

NO MONITOR SHOULD BE BORROWED FROM ANOTHER NURSING DEPARTMENT.

  1. Quality Control

The Nova StatStrip Glucose Control Solutions:

Level 1- Glucose (low) (90 day use once opened, label bottle with end expiration date)

Level 3- Glucose (high) (90 day use once opened, label bottle with end expiration date)

Do not use any reagent or test strip after their expiration date.

Gently roll control solution prior to application.

During each 24 hours of testing, analyze a StatStrip Glucose Control Level 1 and 3. In the event a meter is not functioning properly, obtain a loaner meter from Central Processing. Meters must be logged in and out, with explanation of mechanical problem.

  1. MonitorRange:

The monitor will give analytical results from 10-600mg/dL. It is suggested but not mandatory that if the blood glucose is lower or higher than expected or less than 50mg/dL or greater than 400 mg/dL, to repeat the test with a new test strip. It is suggested but not mandatory that all patients with glucoses greater than 400mg/dL be confirmed by clinical laboratory methods. Neonatal glucoses less than 40mg/dL should also be confirmed. Results >600 will be displayed as HI. Results < 10 displayed as CRITICAL LOW.

  1. Message/Comment Codes:

If there is a failed quality control test, enter a comment. Select the appropriate comment from the options available. If action is required for a patient test, enter comment.

  1. Reporting Results

Laboratory staff will be responsible for reviewing QC data and collaborating with nursing in the event problems arise. All staff using the Blood Glucose Monitor are responsible for knowing how to perform QC tests with 90% accuracy. Periodic random observation of staff performing blind samples will be observed by Laboratory Department personnel.

  1. Disposal of materials:

Test strips and lancets after use are considered to be medical waste and therefore are to be

disposed of in the sharps container. Test Strips could also be contained in a glove after use and disposed in regular trash, (but must be contained).

  1. Monitor Cleaning:

The meters should never be immersed in any cleaning agent. Always apply the cleaning agent to a soft cloth to wipe the meter surface, allow recommended contact time, dry thoroughly. Clean meter after each use, when visibly soiled and/or after use in isolation with the following guidelines:

  • Dilute Bleach (Gluco-Chlor 10% solution)
  • 70% Isopropyl (rubbing) Alcohol may be used.
  • Commercial surface decontamination preparations that are approved for use by facility can be used (PDI Sani-wipes, “purple top”).
  • Avoid harsh solvents such as benzene and strong acids.

Wipe all surfaces (avoid electrical areas at top and bottom)

CAUTION: DO NOT immerse the meter or hold under running water.

DO NOT spray the meter with a disinfectant solution.

PRESCRIBED ACTION:

A. PROCEDURE  PATIENT TEST:

Nova StatStrip Glucose Hospital Meter

1.From home screen press Login.

2.From the Patient Test screen, press the Accept soft key.

3.Enter (scan) Patient ID.

NOTE: to scan the patient ID Number, press the Scan soft key on the screen. Then scan the patient’s barcode with the bottom of the meter.

4.Once the Patient’s ID number has been entered, confirm # and press the Accept soft key.

5.The Enter Strip Lot screen displays. Enter or scan the strip lot number, press the Accept soft key.

6.The Insert Strip screen displays. Insert a test strip as shown on the meter screen.

7.Wash patient’s hand with soap and water then dry thoroughly. Alternatively, use alcohol pad to clean area, dry thoroughly after cleaning.

8.Holding hand downward, massage finger with thumb toward tip to stimulate blood flow.

9.Use a safety lancet to puncture finger, squeeze the finger to form a drop of blood.

10.The Apply Sample screen should be displaying. When the blood drop appears, touch the end of the test strip to the blood drop (angle meter downward to touch strip to blood) until the well of the test strip is full and the countdown appears on the screen (meter beeps when sample accepted).

11. The test results will appear in 6 seconds.

WARNING: The test strip must fill completely upon touching the blood drop. If the test strip does not fill completely, do not touch the test strip to the blood drop a second time. Discard the test strip and repeat the test with a new strip. Do not remove the test strip while the countdown is in progress.

NOTE: Strips are front fill strips (not top fill). Best results occur with angling meter downward to the drop of blood and placing the meter flat on a table until results appear).

12. Remove strip and dispose according to your institution’s policies and procedures.

WARNING: Do not allow blood or control solution to travel down strip and enter meter. If this does occur do not attempt to clean, remove battery, invert meter and contact lab ASAP.

13. To accept the result, press the Accept soft key.

To reject the result, press the Reject soft key. (If rejecting a result it will not post to the patient medical record but will post to lab for troubleshooting.)

To add a comment, press the Comment soft key, and then Accept.

All data is stored into memory.

NOTE: A single up arrow displays for abnormal high result and 2 up arrows for critical high value.

NOTE:Remember to accept data before docking the meter to prevent loss of comment.

14. Log out of meter when testing complete.

B. PROCEDURE - QUALITY CONTROL TESTS:

StatStrip 1 (low) and StatStrip 3 (high) Glucose Control Solutions shall be used to check QC

Performance:

  • Every 24 hours.
  • If a patient test has been repeated and the blood glucose results are still lower or higher than expected.
  • When troubleshooting the system.
  • If the meter is dropped.

Control solution test results should fall within the ranges printed on the test strip bottle if the system is working properly and the correct test procedure is followed. If control solution test results fall outside the expected range, the system is not functioning properly. Repeat the test and mark the result with a note. DO NOT use the system to test patient blood glucose levels until the control solution results fall within the expected range.

Results that fall outside the expected range may indicate:

  • Procedural error (under-dose strip).
  • Old or contaminated glucose control solution.
  • Incorrect lot number or code number entered in the meter.
  • Test strip deterioration.
  • Meter malfunction.
  • Control solution outside the functional temperature range.

Nova StatStrip Meter QC Test

1.From Home screen, press Login.

2.Enter or scan your operator ID.

3.From Patient Test screen, Select QC.Select the control level you wish to run.

4.Scan the test strip lot number and press Accept.

5.Scan the control lot number and press Accept.

6.Insert the test strip into the meter.

7. Gently roll the control solution vial (do not shake). Waste first drop of QC. Touch drop of control solution to the end of the test strip until the well of the test strip is full and countdown appears on screen (the meter beeps when sample is accepted).

WARNING: The test strip must fill completely upon touching the QC droplet. Do not add a second QC drop to the test strip. If error occurs, discard the test strip and repeat the test with a new test strip.

8.The result appears in approximately 6 seconds.

9.Remove the test strip and dispose of it according to your institution’s policies and procedures.

10.To accept result, press Accept or enter Comment, then Accept.

NOTE:If control solution test results fall outside the expected control range, repeat the QC test and mark the result with a note.

WARNING: Do not allow blood or control solution to travel down strip and enter meter. If this does occur do not attempt to clean, remove battery, invert meter and contact lab ASAP.

11. Log out of meter when testing complete. (May also dock meter to logout)

C. GENERAL LIMITATIONS:

1.Use only fresh whole blood. Do not use serum or plasma.

2.Sodium, lithium, and ammonium heparin are the recommended anticoagulants for use with the Stat Strip Glucose Meter.

a. Depending on the amount of heparin used in the collection syringe and whether it is filled to capacity with blood, the concentrations of heparin may be 20 I.U. per mL to over 100 I.U. per mL. When liquid heparin is present in excess, it may cause dilution errors.

b. A lyophilized lithium heparin giving a final concentration in blood of not more than

20 I.U. per mL is acceptable.

3.EDTA, citrate, oxalate, and sodium fluoride are not recommended for use.

4.Glucose Interferences:

The Stat Strip Glucose Meter exhibits minimal interference from substances. For a complete list refer to the “StatStrip Glucose Hospital Meter Instructions for Use Manual”.

D. PROCEDURE FOR ABNORMAL RESULTS:

Obtain a laboratory draw for critical high and critical low results, mark actions with a note.

It is suggested but not mandatory that all patients with glucoses greater than 400mg/dL be confirmed by clinical laboratory methods.

Neonatal glucoses less than 40mg/dL should also be confirmed.

Results > 600 will be displayed as HI. Results < 10 displayed as CRITICAL LOW.

  1. TROULBESHOOTING:

A system error message may indicate improper application of blood to the test strip or other detected error in the testing procedure. In some situations, improper use may cause an inaccurate result without producing an error message. Simply remove the test strip and repeat the test with a new test strip. While resolving an error message, if at any time the patient’s symptoms indicate the need for treatment, provide appropriate medical care before you continue troubleshooting. For additional troubleshooting information see the StatStrip Quick Operating Guide.

If the scanner is not functioning well, clean the scanning area with a damp clean cloth (do not allow moisture to enter electrical area below scanner).

If the meter is dropped or if a patient test has been repeated and the results are outside the expect range, perform a QC. If it fails, get a loaner meter and report the failure to the lab.

For best results, always dock meter when not in use. (By docking the meter the battery will charge, patient information will be uploaded to the medical record and the meter will download admits and discharges of patients.)

F. DOCUMENTATION:

1.Document all teaching in the patient’s medical record.

2.Document blood glucose values obtained on patients:

*Medication record (eMAR)

G. ASSOCIATED NURSING DIAGNOSES:

1.Impaired Blood Glucose Level

2.Alterations in Nutrition Level

3.Alterations in Urinary Elimination

H. PATIENT/FAMILY EDUCATION TOPICS:

Educate patient and family on:

1.Diabetes Process

2.Purchasing and cost of monitor and all supplies

3.Use and care of monitor

4.Safe disposal of supplies

5.Advantages of blood glucose testing

REFERENCES:

Nova Biomedical StatStrip Glucose Hospital Meter Instructions for Use Manual

Revised: 6/12/12, 10/21/13, 11/8/13, 09/23/15

Reviewed and Approved Standard of Practice Committee: 03/05/18 CB

Reviewed and Approved Chief Nursing Officer: 03/05/18 AG

Reviewed and Approved Laboratory Director Gary A Walter, MD: