"Critically Ill patient deifinition or parameters

I am opening up this question again for everyone's definition of critically ill for glucose meter usage if you care to share.

Thanks,

JoAnn

I am currently working with our head of ICU and trying to get the head of the ER to approve a working definition that was created by the head of our ICU.

It did not go over well with the Critical Care Committee at the last meeting I went to.

Here is what we are looking at:

Point of Care glucose measurements in the critically ill can be erroneous and therefore can lead to errors in insulin administration.  The following defines a subgroup of patients in whom the accuracy of POC glucose measurements is questioned.

• 1. During CPR and within 1-hour post resuscitation.


• 2. Severe hypoxemia - O2 saturations < than 75% and or PaO2 < than 27mmHg.


• 3. Extremes of Hematocrit -- < 15% or > 55%.


• 4. Vasopressor use.


• 5. Significant peripheral tissue oedema.


• 6. Impaired capillary refill > 5 sec.


• 7. Raynaud's disease with peripheral vasospasm.


• 8. Significant hypothermia - < 32 degrees C core.

Which meter are you using? If you have Nova, then you don't need a definition. If you have Abbott or Roche, then I would think about your ability to audit what you define. If I was inspecting you and you had a very narrow definition that included very specific patient conditions, I would ask to see how you are verifying that all patients that fit that definition are not getting capillary glucose. Or you will at least want to be somewhat vague with your recommendation using terms such as "use caution when..." and "up to provider discretion...".  We used Abbott meters at my previous organization, and chose to do our own high complexity study on our meters with samples from all of our ICU's across our system. The meter still performs just as good as Nova, but Abbott has still not submitted their critically ill designation data, which is disappointing. We chose to consider all patients in the ICU for ANY reason, to be critically ill, because that was much easier to control. We could lock out users that did not have a BSN or the minumum college credits. For the most part, since most of our sites were Magnet, almost all of the ICU and NICU nurses had a BSN and were fine.  

Thanks Silka for your advice on critically ill.

I have the  Roche meter and I want to keep the definition in alignment with the package insert and be also have the ability to audit it and for compliance.

Keeping fingers crossed that Roche will have their study approved by FDA , sooner than later!

:)

JoAnn