Rapid Response/Visitor Testing

I'm currently fighting through this exact situation. We have always allowed use of fake medical record number entry in the glucose meters and iSTATs for certain situations. Our policy reads "Hospital meters are for patient use only. The ONLY exception to this is if testing is requested on a non-patient (employee, family, visitor) by a provider during a provider overseen incident (Dr. Blue or Rapid Response). Meter users may not use the hospital meters to test themselves or other non-patients at any other time. 

This has always been our policy and we rarely ever had a situation outside of this. However, in the past 9 months, it's happening all the time! Ex.
User feels sick and checks their own glucose, diabetic parent forgot their glucose meter and RN used the hospital meter to check them, etc. This is currently in the hands of our Clinical Practice council as we cannot allow this to happen. This is outside of the scope of MN nurses - they are not allowed to assess and treat patients.  But, it turns out that the hospital has no guidance for staff to follow in these situations so we are working on what that should look like. I've also discovered that no one really knows how the Dr. Blue or Rapid Response situations are documented, on the hospital side. So 
all I can do right now is educate and document all details I can get in my middleware. Hoping to improve the process soon!

Hi,
Small Community Hospital - 100 bed - CAP/TJC accredited.
We have a generic barcode on all of the crashcarts - "Crashcart911" - operator must submit specifics to Nursing Supervisor, Clnical Lead or myself.  I reconcile these results. All Rapid Response or Code Blue events on nonpatients are documented via an incident reporting system with all the pertinent information.  So, if the person refuses to go to ED at least the incident report has the person's information listed and the glucose result.
We also use this barcode for patients in the Emergency Department and Express Care if they need glucoses before being registered.

There have been times when it's impossible to reconcile results but at least there is documentation!

I also keep a record of the glucometer results in my QA file using the attached form.

Patient ID Correction Form.docx

Speaking to Danyel's issue of staff use... this has become less of an issue at our organization since Risk weighed in on the matter and this is discussed during orientation with clinical staff.  I know there are staff scanning the QC barcodes performing the test on themselves then adding the comment - "Operator Erro"
Born............but not yesterday...............I send them a message through the meter to please mix the QC before and between tests....it lets them know I see you.

Amanda - you just blew my mind with the running themselves as QC! I never even thought of that! I'm going to pretend I don't know about that. 

Yes, we are getting to the point of having Risk and Compliance lay down the law. It shouldn't have to be me. 

We had to change our meters to Pass or Fail displayed to the operator (rather than a number) for QC to avoid those same issues. 

I also had to change QC to Pass/Fails years ago for this reason.  Here's another one - was reviewing Proficiency Testing results (prior to CAP going to WBGQ) and noticed strange results on days that PT was not being performed. Turns out an enterprising staff nurse knew about the PT option and was running herself as PT. Since then, I have to remember to enable/disable PT testing after the WBGQ is completed.

We have our glucometer just show Pass/Fail for QC as well, instead of displaying the actual result. We had an uptick in these occurrences last year and created a WINK (What I Need to Know) and sent it out to all nursing managers and staff. The WINK is in the format of an SBAR. We often find it difficult to file an incident report when these events occur b/c of how our online report system works, so instead we have our Hospital Quality dept. keep track of these occurrences for us (we loop them in when we catch it happening). They usually are the ones that follow up with the staff member and manager. Usually making them sign a form stating they understand why it cannot occur and they won't do it again in the future. We also have a statement in our glucometer policy stating our glucometers are for patient use only.