Working in Partnership

Cascade Training for Blood

Glucose Meter
Working in Partnership

Cascade Training Introduction

This resource folder has been provided for your information when
carrying out training with your counterparts.

Please feel free to add any other relevant diabetes information.

If you have any questions or concerns, please do not hesitate to

contact:

HOSPITAL CONTACTS:
Working in Partnership

Hazard Warning Notice

The need for Quality Assurance and Training in the use of Blood
Glucose Meters was identified in the hazard warning notice
(HN(hazard)(87)13).

The notice states that:

“Use of Blood Glucose Meters by untrained staff, without

adequate management supervision of the equipment and without
the use of Quality Control Procedures, can lead to misleading
results, adversely affecting the treatment of patients.”

The Hospital Procedure for following the guidelines set by

D.O.H is as follows:

! Quality Control must be carried out every 24hrs

! All staff must be trained prior to using the PCx meter for
the first time
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Health and Safety

Health and Safety is very important when using the Glucose

Meter in your clinical environment. To ensure standards are met,
please adhere to the following guidelines:

• Always clean patients’ hands/fingers prior to doing a test.

(Especially if the patient has been reading a newspaper, eating
fruit etc.)

• Take the workstation with you to the patient’s bedside.

• Take small sharps bin with you to patient’s bedside.

• Wash your own hands and put on gloves prior to testing

patient.

• Dispose of all used SHARPS AND STRIPS in sharps bin.

DO NOT PUT USED SHARPS BACK IN WORKSTATION!

Always ensure meter is clean after use and workstation left tidy
and safe.
Optium Xceed™
First User Training
Optium Xceed™ Meter
Oversized Backlit Display

Battery Cover (at rear) :

1 x CR2032 Lithium Battery

Backlight Button :
On / Off
Back Scroll Button* :
* For HOME PATIENTS ONLY
Scrolls back through memory & Forward Scroll Button* :
averages
* For HOME PATIENTS ONLY
Changes settings i.e. date, time, etc.
Scrolls forward through memory &
averages
Changes settings i.e. date, time, etc.
Access LOT Memory & Error Codes
Mode Button :
On / Off
Assigns Control Icon to QC Tests
* For HOME PATIENTS ONLY Strip Port :
Switch from Memory ~ Averages Highlighted yellow for easy identification
Access Change Settings Mode Strip & Precision Link Port
Access LOT Memory & Error
Codes
Optium H™ Test Strips

9 20 Second Test Time

9 Individual Foil Wrapped Strips

9 Tip/Top Fill

9 Fill Trigger electrode designed to prevent short sampling

9 Free From Many Common Interferents

9 Apply a second blood drop within 30 seconds

The MHRA say training should include

• Basic principles of testing

• Demonstration of proper use of system
• Consequences of improper use
• Instruction in sample collection
• Instruction in the importance of complete documentation of all results
• Appropriate calibration and QC testing
• Practical experience to satisfy instructor that trainee is competent
Calibration

• To obtain an accurate blood glucose

reading, the meter must be calibrated once
for each new box of electrodes
• Retain the calibration bar for the duration of
that box
• The meter will beep once the LOT number
is displayed (if beep function activated)
Blood glucose testing

• Open the test strip using the

triangular notch in the foil
• Fresh test strip for every test
Blood glucose testing

• Insert test strip and check display,

•(a)

• Check lot number

• Wait for flashing symbol

•(b)
Blood glucose testing

Prepare the sample site then:

• Collect a drop of blood

• Touch and hold the drop of blood to either
tip or top of strip
• Strip sample chamber provides a visual
confirmation of sufficient sample
• Move finger away from the electrode
when ascending bars appear at the top of
the display (beep sounds if activated)
Blood glucose testing

• The meter will count down from 20

seconds
• If the test fails to start, a second drop can
be applied within 30 seconds of applying
the first drop of blood
Result & Memory

• The result will be displayed (beep will sound if

activated) and the meter will automatically turn
itself off after 60 seconds
• To access the last results only press the centre
on/off button once. The last result will appear,
immediately followed by the test result
recorded with the date and time

(Please note: The Optium Xceed™ can display

the last 450 blood glucose readings with date
and time, this feature is only for patients testing
at home)
Display messages

Message Explanation
• LO Result less than I.I mmol/L
• HI Result above 27.8 mmol/L
• KETONES? Result higher than 16.7 mmol/L

Battery Icon;
• Displayed with results Batteries becoming low
• Displayed alone Batteries exhausted
Display messages

Message Explanation
• Test Error 1 Temperature
• Test Error 2 Meter Error
• Test Error 3 Test Strip Error
• Test Error 4 i) Extremely high result
or
ii) Problem with test strip
• Test Error 5 Blood applied too soon
• Test Error 6 Calibration error
• Test Error 7 Damaged strip
• Test Error 8/9 Meter Error – contact CCL
Limitations of use

• All meters have limitations and these are detailed in every box of test
strips in the insert
• The system should always be used within these limitations to ensure
accurate results and prevent inappropriate treatment
• For the majority of tests the limitations will not be an issue
Limitations of use

• Care should be taken with those patients who are extremely unwell
particularly if they are:

- Severely dehydrated
- Severely hypotensive or in shock
- In a hyperglycaemic-hyperosmolar state e.g. DKA

• In these cases test results may be erroneously low

• If in doubt, send a venous sample to the lab
How to ensure the meter is performing correctly

• By running Quality Control tests on a

regular basis, as per your hospital
protocol
• Use MediSense Control Solutions
• To adhere to shelf-life, date bottles once
opened and use within 90 days
• Check results against inserts
Demonstration

• Take a meter and perform a test using a capillary sample or the

control solutions
• For the quality control tests find the record book and document
your result
The importance of performing QC Tests

• If QC is not performed, misleading results may lead to inappropriate

treatment
• Always record the results
• Follow your hospital protocol to avoid putting your patients at risk
• Under MHRA (Medicines and Healthcare products Regulatory Agency)
guidelines it is your responsibility to perform/document QC results
• This should be in accordance with the manufacturers instructions,
detailed in a Standard Operating Procedures (SOP)
Standard operating procedure

• According to MHRA guidelines on near patient testing there must

be an SOP in place wherever POCT is performed

• Abbott supply the department with instruction manuals and

procedures for the use of all Abbott blood glucose testing
equipment
Standard operating procedure

• It is essential that any SOP’s written by the hospital reproduce the

instruction manual guidelines exactly

• SOP’s must be regularly reviewed by a nominated person to ensure they

follow the CURRENT VERSION of the manufacturers instructions

• Failure to adhere to the most current instructions could result in you as

an individual being liable for any error in testing

Source: Management and use of IVD point of care devices – MDA bulletin
External Quality Assurance (EQA)

• Whereas QC is a means of checking the patient results are reliable,

EQA involves the analysis of samples with unknown values from an
external source
• These may be sent out on a regular basis from the laboratory
• Results are then subject to analysis to compare results across different
sites
MHRA say training should include;

• Basic principles of testing

• Demonstration of proper use of system
• Consequences of improper use
• Instruction in sample collection
• Instruction in the importance of complete documentation
of all results
• Appropriate calibration and QC testing
• Practical experience to satisfy instructor that trainee is
competent
Any Questions?
Post Training Quiz
1. What type of glucose meter do you have in the ward/department?
2. What are the strips called which you use in this meter & where can you get them from?
3. What is calibration and when should you carry it out?
4. Which way do the strips go in the meter?
5. Can you apply a second drop of blood to the same strip?
6. Do you clean hands before you do a test?
7. How often should Quality Control Tests be carried out?
8. What does "Ketones?” mean?
9. What does “LO” mean?
10. What does “HI” mean?
11. How long do the Q.C solutions last for?
12. Can the batteries be replaced?
13. What types of batteries are required?
14. Where do you get replacement meters?
Post Training Quiz Answers
1. The Optium Xceed™ meter is used in this department
2. Optium H strips are used with the meter & are available from pharmacy
3. Calibration sets the meter up to use a particular box of strips & should be carried out whenever a
new box of strips is opened
4. The test strip should be inserted with the contact bars facing up
5. You can apply a second drop of blood within 30 seconds
6. You should always clean your hands before performing a test
7. QC tests should be performed within the guidelines stated on page 2
8. KETONES? = Blood glucose is above 16.7 mmol/l
9. LO = Blood glucose is below 1.1mmol/l
10. HI = Blood glucose is above 27.8 mmol/l
11. QC solutions last 90 days from opening
12. Yes, the batteries can be replaced by the user
13. The Optium Xceed™ uses 1 coin cell battery (CR2032)
14. To obtain replacement meters please refer to the details on page 2
 Congratulations !

You have completed the training session

Thank you
Working in Partnership

Cascade Training Checklist

Please make sure you go through the following tasks with your
trainee and tick off once completed.

• Hazard Warning Notice

• Optium Xceed Workstation

• Calibration Procedure

• Blood Glucose testing procedure

• Display messages

• Health and Safety

• Quality Control Procedure

• Post assessment Quiz

Date training carried out:

Print Name Trainer………………………………………………
Signature Trainer………………………………………………
Print Name Trainee……………………………………………..
Signature Trainer………………………………………………

To be retained by trainee
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Name of Hospital………………………………………………
Name of Ward or Department ………………………………………………

Date Trainer Trainer Trainee Trainee

Print Name Signature Print Name Signature