Repeat Critical BGM policies
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We are re-examining our 'repeat critical BGM policy'.
Specifically, repeat testing on patients in the ICU or the CTICU who are on an insulin drip and/or steroids.
We use the Accuchek Inform II.
Our current policy calls for a repeat BGM within 5 minutes before taking any other action. (Every single time a critical result is obtained.)
If the repeat is critical, for the FIRST time, there should be a lab confirmation for BGMs >400.
Subsequent critical high results are to be repeated but no lab draw is necessary.
Critical low results are also repeated within 5 minutes, but no lab draw is required. A follow up, done 15 minutes post treatment, is the policy.
So-- with a patient on an insulin drip, they are not doing repeats. However, they are getting more lab draws. On the one hand, these people very well may fall into the category of 'critically ill', and should not be tested on the Inform II, anyway. Often, these are our 'frequent fliers' who periodically show up in the ED with glucose levels >1000. I am working with the Critical Care supervisor to try to come up with some 'happy medium' where they aren't doing a bazillion fingersticks when they know the results are going to be high (Also, I learned that they often draw from a line to do the BGM, becasue they can't access the fingers). They DO want to follow policy, but it doesn't really fit in their area.
I am thinking of adding a comment just to *their* meter configuration, which acknowledges that this is an insulin drip patient and the results are expected.
And then, to go along with that, put a 'carve out' into the policy that explains the exception for this area.
I have also suggested that perhaps testing the glucose on the EPOC would be better in this case rather than the Inform II because of the 'critically ill' factor, and there is no expectation of repeating the EPOC. Furthermore, once they know the Inform is only going to read "HI" (>600), they should discontinue glucometer testing and send to the lab until they are within measuring range.
I would like to know how other institutions handle these types of situations.
Thanks in advance!
Specifically, repeat testing on patients in the ICU or the CTICU who are on an insulin drip and/or steroids.
We use the Accuchek Inform II.
Our current policy calls for a repeat BGM within 5 minutes before taking any other action. (Every single time a critical result is obtained.)
If the repeat is critical, for the FIRST time, there should be a lab confirmation for BGMs >400.
Subsequent critical high results are to be repeated but no lab draw is necessary.
Critical low results are also repeated within 5 minutes, but no lab draw is required. A follow up, done 15 minutes post treatment, is the policy.
So-- with a patient on an insulin drip, they are not doing repeats. However, they are getting more lab draws. On the one hand, these people very well may fall into the category of 'critically ill', and should not be tested on the Inform II, anyway. Often, these are our 'frequent fliers' who periodically show up in the ED with glucose levels >1000. I am working with the Critical Care supervisor to try to come up with some 'happy medium' where they aren't doing a bazillion fingersticks when they know the results are going to be high (Also, I learned that they often draw from a line to do the BGM, becasue they can't access the fingers). They DO want to follow policy, but it doesn't really fit in their area.
I am thinking of adding a comment just to *their* meter configuration, which acknowledges that this is an insulin drip patient and the results are expected.
And then, to go along with that, put a 'carve out' into the policy that explains the exception for this area.
I have also suggested that perhaps testing the glucose on the EPOC would be better in this case rather than the Inform II because of the 'critically ill' factor, and there is no expectation of repeating the EPOC. Furthermore, once they know the Inform is only going to read "HI" (>600), they should discontinue glucometer testing and send to the lab until they are within measuring range.
I would like to know how other institutions handle these types of situations.
Thanks in advance!
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