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Discussion

Glucometer Quality documentation

My company recently drafted a glucometer quality control log for in-home checks. It requires the nurse to run a control solution before doing a finger stick when new lots of test strips or a new glucometer is used. The log sheet requires that the VNA nurse enter strip lot numbers, glucometer serial number, range, expiration dates...etc. Everything EXCEPT the results of the control solution check ??!! I was always under the impression that if results from a test are not documented, then the test, for all intents and purposes, never happened. To make a long story short, the nurse exec who drafted the form says it's not necessary to document control test values because it's home use and the regulatory bodies here in Massachusetts don't require it. Now as a former analytical chemist for 20 years..... this makes absolutely no sense. Results from control testing is ALWAYS documented...no matter what the setting, otherwise what's the point of the log?

Can anyone provide me with sources that I can cite to prove my case. Their position is so counterintuitive that it's literally keeping me up at night. It has implications on pt. safety along with nurse and company liability.

Thanks,

Ken:no:

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While I can not provide you with sources to cite, I agree with you that this makes no sense. Why bother at all if the control test is not documented? Either put down all relevant info or don't bother with the form at all. I could see some astute attorney going to town with this foolish form in a courtroom, if there was an issue about the control test being performed. Perhaps you could contact one of the manufacturers for info on this. Even so, I think you are dealing with somebody who is stubborn and most likely won't listen to reason or "evidence based" info. I wonder why they are going through with this at all.

If the glucometer is the patient's own, follow the manufacturer's instructions for testing with a control test, and I would document the results because if it wasn't written, it wasn't done.

I never see this done anymore, so I think it is not something they usually do with home models anymore. If it belongs to the agency, make sure you are CLIA approved to be using the glucometers this way (professional diagnositic). Home BS checks are normally done with the patient's own glucometer, and you are teaching them how to do it. If it is your agecy's glucometer then you have to log the results as though you were in the hospital doing these checks.

No place that I have worked since 1997 does their own glucometer checks anymore. Are you JCAHO or CHAPS accredited? If so, you might look to them for guidelines. If you are associated with a hospital I would call their QI dept. for guidelines. If you are checking the patient's glucometer for accuracy with your own test, you are taking a big risk. The manufacturer is responsible for testing for accuracy and for supplying testing solution if it is required.

We issue our clinicians glucometers with which to perform glucose checks on our patients. The information that you mentioned is recorded--in addition, they are required to perform the calibration checks every day that the glucometer is in use, and once weekly if not in use. They are required to document both the high and low values of these checks and if the result is within the acceptable range for that machine. Anytime that a medical decision may be based on a result (the blood glucose, in this case) you must be able to verify that the result is accurate. This verification is done by proving that the machine is calibrated correctly, thereby giving an accurate result. If these calibration checks are not documented, how would (for example) you prove to a court of law that an abnormal glucose --which resulted in a change in insulin (for example) which led (again for example) to a detrimental result to the patient was accurate?? I cannot think of any argument for NOT recording the result--what harm would it cause to record this info--my mantra has always been better to document too much than too little!!:)

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