Glucometer Criticals

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We're having a tough time getting our glucometer criticals documented/charted as being called critical. Any suggestions?

11 Replies

Roseline Hernandez

Tue Mar 18, 2025 at 3:37PM

In our institution (900 bed hospital), we use the Nova Stat Strip glucometer. We have the glucometer setup to automatically document the results as critical when they are within the critical range. We also have a screen on our glucometer (the next screen after the critical result) where the end user can select a comment such as Provider Notified or Repeat Test. During the glucometer training, we stress the importance of documenting the critical on the glucometer because, not only does the critical comment come across the POC middleware, but it also appears on the LIS and the EMR. I also have "documentation of critical comments" as a quality monitor and frequently meet with Nursing Education to help us keep in compliance.

Liz Reed

Tue Mar 18, 2025 at 3:39PM

Thanks Roseline... we also have the "Provider notified" statement but the date & time, exactly who was notified and credentials (MD, RN) and performed the test was also required. Do you just have the generic "Provider Notified" on the meter or do your operators also key that specific information in?

Dan Bailla

Tue Mar 18, 2025 at 3:44PM

Provider Notified in the Glucometer device is not sufficient to meet CAP's critical call documentation requirements.
We have a provider notification documentation application in the patient chart where all critical calls need to be
documented that satisfies CAP's requirements. 1. Name of person who called, 2. Notified provider Name 3. Date and time

Michelle Cheslock

Tue Mar 18, 2025 at 3:48PM

This is another of those times where POC lives in a bit of a gray area. If you're following CAP standards, they state (COM.30000):

In the point-of-care setting, the identity of the testing individual and person notified need not be
recorded when the individual performing the test is the same person who treats the patient. In
this circumstance, however, there must be a record of the critical result, date, and time in the test
report or elsewhere in the medical record.

So the argument could be made (at least the way our sites do POC testing) that the person running a POC test is a member of the patient's care team, and is one of the people that the critical could be called to anyway. The result, along with all the above required information, will be recorded in the patient's EMR, and so meets the CAP requirements.

Liz Reed

Tue Mar 18, 2025 at 3:49PM

Dan... what program do you use? We have EPIC.

Alma Knudson

Tue Mar 18, 2025 at 4:14PM

You’re your middleware to create a rule that if the threshold is breach, it will flag in your LIS and so it create documentation and action.

Sincerely,
Alma
“Far and away the best prize that life offers is the CHANCE to work hard at work worth doing” – Theodore Roosevelt

Alma Calzado-Knudson, MBA, CLS, MT (ASCPi & AMT)
Manager, Lab Quality and Point of Care Testing
Student Education Coordinator
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Brandy Kenny

Tue Mar 18, 2025 at 4:36PM

Since we allow our PCTs to perform bedside glucose testing, and they are not considered a "a person who treats the patient" we require our RNs to acknowledge all critical values in the Critical Value Flowsheet in Epic. This meets the CAP requirement and we have never had an issue with meeting the standard. I review a report of all critical BGLU each morning and notify the nurse managers if there are any missing acknowledgments.

Dan Bailla

Tue Mar 18, 2025 at 4:37PM

Liz,
We use Orchid. We request our LIS workgroup to create this function in power chart.

Sonia Guzman

Wed Mar 19, 2025 at 7:59AM

CAP wrote an article that was helpful Critical result notifications at the point of care - CAP TODAY

Hope it helps.

Liz Reed

Wed Mar 19, 2025 at 8:32AM

Thanks Sonia!

Kriston Williams, DCLS

Mon Mar 24, 2025 at 11:29AM

Here's how I've dealt with the issue. In our middleware (UniPOC) every user is built with their credentials attached, ex Jane Doe, RN (PCA, Tech, MD, etc). I rely on the note from CAP in COM.30000, “In the POC setting, the identify of the testing individual and the person notified need not be recorded when the individual performing the test is the same person who treats the patient.” In UniPOC I’ve built a custom view, where I exclude anything that was performed by an RN/MD. From the list, I then review each critical in EPIC for documentation. To accomplish this, I review nursing Flowsheets, where they record the information under “Provider Notification” using the reason Critical Glucose POCT Value. Here they can comment the value and who they spoke to. When there is not record of documentation, I email that user and their manager, with instructions and how to properly document. It’s a time-consuming process, but it’s been working at my facility.

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Glucometer Criticals