POC Glucose questions regarding PCTs/CNAs

1. Most of our glucose  meter testers are CNAs, ER techs,  except in ICU, Nursery and Surgery  where we do not have CNAs. We only have RNs in ICU, Nursery,  Surgery and  Cath Lab. 
2. All units except ICU, Nursery,  Surgery,  and Cath Lab . . 
3. CLIA only require high school graduate for moderate complexity,  and glucose meter is waived test.  I think, you just make sure they are monitored well  in their techniques. They have to be  taught and observed well ( and corrected)  especially when they are new. Most are better than nurses especially the seasoned CNAs who takes the  glucose samples.  
4. We have a separate CLIA certificate for hospital  waived tests. 
           High  and moderate complexity tests are under the LAB CLIA certificate 
5. I am under the  medical director  of the laboratory. 

What glucometer do you use?
By safeguards, I mean do you have a policy in place such as an escalation range specific for PCTs/CNAs such as if the glucose result is less than 70 or greater than 250 enter a specific comment code to let POC know that the primary nurse was notified.

1. Do you let PCTs/CNAs perform POC glucoses?  Yes
2. If you do let PCTs/CNAs perform, what areas can they perform glucoses? i.e. acute care, step down units, critical care areas  all but ER and NICU
3. Any safeguards or qualifications for PCTs/CNAs put in place? Training, Yearly competency Meter lockout if not met
4. Is POC split off from lab with a separate CLIA? yes
5. What is your administrative structure? Who oversees the POC program from medical director, technical director, administrative director? Hospital MD as Medical Director, POC specialist as
techinical . POC specialist reports to Quality , patient safety for administrative functions.

We use the Abbott Precision Freestyle.  We have one training and competency for all operators.  All operators have the same requirements for notification of Action or Critical values.  We do have a stop placed in the BGM for those values so that any operator has to enter a Comment Code.

We have NOVA StatStrip Glucose Meters.  These are FDA  approved for critical care areas but we still teach  nurses that venipunture is a better specimen collection method  than capillary, if results are in question and patients have decrease peripheral flow, etc limitations specified in the product insert.  
All employees have to view BrainShark ( NOVA video) for training and recertification plus our own Healthstream module and exams. We have them do this so everyone has the same information. On the Healthstream, we add some items  that the staff have to know  specific to our facility.  

PCTs work in all areas. Our critical care is 14 beds (small hospital), so the majority of staff are RNs. Freestyle is used in all areas of the hospital.  Our hospital is part of a large system and they have defined the conditions system wide defining what is not appropirate for use in Policy/Procedure and it states under what conditions to use alternative methods.

1. Do you let PCTs/CNAs perform POC glucoses? Yes
2. If you do let PCTs/CNAs perform, what areas can they perform glucoses? If a PCT/medical assistant works an area, they are allowed to perform glucoses
3. Any safeguards or qualifications for PCTs/CNAs put in place? No difference for PCTs than for RNs or LVNs
4. Is POC split off from lab with a separate CLIA? The are CLIA#s for the hospital POCT, and there are clinic CLIA#s - none of those are 'the lab's CLIA#.
5. What is your administrative structure? Who oversees the POC program from medical director, technical director, administrative director? Sorry I can't respond to this; it's not for me to share since it appears I'm not in that current structure. 

1. Do you let PCTs/CNAs perform POC glucoses?  No, we don't have CSAs in all departments. Some depts used to like to train them to only do QC as a daily duty but then we had the situation where CSAs only knew QC and RNs only knew how to run patients and no QC. Not ok with me - if you use it you need to know both and running patient test is not in the scope of practice for our CSAs. Nor do they have access to Cerner to document critical values. Because of these items, we removed CSAs as users about 4 years ago.
2. If you do let PCTs/CNAs perform, what areas can they perform glucoses? i.e. acute care, step down units, critical care areas
3. Any safeguards or qualifications for PCTs/CNAs put in place?
4. Is POC split off from lab with a separate CLIA? No, hospital based POC falls under lab CLIA.
5. What is your administrative structure? Who oversees the POC program from medical director, technical director, administrative director? Lab Medical 
director is over POC, then POCC and I report to our administrative director. 

1. Do you let PCTs/CNAs perform POC glucoses?  Yes
2. If you do let PCTs/CNAs perform, what areas can they perform glucoses? i.e. acute care, step down units, critical care areas All areas of hospital.
3. Any safeguards or qualifications for PCTs/CNAs put in place? Training yearly, lock out if not renewed
4. Is POC split off from lab with a separate CLIA? No same CLIA # as our main lab
5. What is your administrative structure? Who oversees the POC program from medical director, technical director, administrative director? POC Coordinator, technical director then medical director.

1. Do you let PCTs/CNAs perform POC glucoses?  yes  on the glucometer, not on the Istats though
2. If you do let PCTs/CNAs perform, what areas can they perform glucoses? i.e. acute care, step down units, critical care areas  All areas including critical care and ED
3. Any safeguards or qualifications for PCTs/CNAs put in place? Because they are not considered 'care givers' they have to report critical values (<50 >400) to either a nurse or physician and document in EPIC
4. Is POC split off from lab with a separate CLIA? No same CLIA for in house POCT
5. What is your administrative structure? Who oversees the POC program from medical director, technical director, administrative director? Medical Director, admin director, POCC

We use the Nova statstrip, Telcor, SQ and EPIC