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MEMS GLUCOMETER TRAINING. MEMS Education Committee 2008. NOTE. Information within this presentation should be tailored to the Blood Glucose Measuring Device used by the service and should include a review of the manufacturer’s instructions. Purpose.
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MEMS GLUCOMETER TRAINING MEMS Education Committee 2008
NOTE Information within this presentation should be tailored to the Blood Glucose Measuring Device used by the service and should include a review of the manufacturer’s instructions.
Purpose ~To prepare currently certified and future EMT-Basics to utilize a Blood Glucose Measuring Device under current MEMS Protocol Standards.
Objectives At the conclusion of this program participants will be able to: State when blood glucose measuring is indicated Describe the importance of a full patient assessment in conjunction with test results Demonstrate accurate calibration Demonstrate appropriate procedures for measuring blood glucose Explain proper maintenance, care & storage Understand the need for a CLIA Waiver
Indications for BG Measuring Signs and Symptoms consistent with • Acute Stroke • Altered Mental Status • Known Diabetic Patient • Trauma with potential for Head/Spinal Injury • Combative Patient • Seizures • Overdose • ETC…
Altered Mental Status(Common Causes)AEIOU-TIPS Alcoholism Trauma Epilepsy Infection Insulin Psychiatric Overdose Stroke Underdose
Pre-Hospital Care (FOLLOW THE PROTOCOLS) 1. Scene Safety/Survey 2. Perform initial assessment Considering/Treating ABC’s 3. Ensure cervical spine immobilization as indicated 4. Activate ALS-ALS must be activated when using the glucometer.
Pre-Hospital Care 5. Perform focused history and physical exam (a). SAMPLE history • Signs/Symptoms (when did they start?; how long did they last?) • Allergies • Medications (When last taken?) • Prior Medical History (diabetes?, seizure disorder?) • Last oral intake (When did patient last eat)? • Events leading to illness/injury
Pre-Hospital Care • Focused history & physical exam, cont. (b). Take base line vital signs (c). Determine blood glucose level (d). Evidence of hypothermia/hyperthermia? (e). Can the patient swallow normally?
Pre-Hospital Care • Do not administer anything orally if the patient does not have a reasonable level of consciousness and normal gag reflex. • Contact medical control prior to administering glucose to patients suspected of Acute Stroke/Head/Spinal Injury.
Pre-Hospital Care • If patient is unconscious or seizing, transport on left side. • If patient’s BP drops below 100 systolic; treat for shock • Monitor VS every 5 minutes if unstable; every 15 minutes if stable. • Notify intercepting ALS service/provider
Glucose Measuring Devices • Used to Check Blood Sugar Levels • Many different types and models
Procedures • Careful attention to BSI & safety • Select Finger • Massage blood into distal end • Clean finger with appropriate aseptic technique (if using alcohol, let dry or wipe dry with sterile gauze) • Use lancet or Auto-lancet device • Apply drop of blood onto test strip and follow individual glucometer instructions • Dispose of sharps and soiled supplies in appropriate container
Device & Accessories Test Strips Glucometer Lancet
Glucose Measuring Steps Step #1 Step #2 Step #3 Locate Glucometer Open Up Case Turn Power On
Device Variations Some glucometers turn on automatically. Know the features of the glucometer your service uses.
Glucose Measuring Steps, cont. Step #4 Confirm Codes
Glucose Measuring Steps, cont. Step #5 Insert Test Strip
Glucose Measuring Steps, cont. Step #6 Obtain Blood Sample
Glucose Measuring Steps, cont. Step #7 Apply Drop of Blood If inadequate up to 15 secs., add additional blood
Glucose Measuring Steps, cont. Step #8 Document Results
Results Measured in milligrams per deciliter Normal blood glucose range is typically 80-120 mg/dl (fasting) Treat the patient, not the numbers
Maintenance & Calibration • FOLLOW MANUFACTURER’S RECOMMENDATIONS: • Techniques • Frequency • Batteries • Care & Storage • Device • test strips • Temperature Can Affect Machine Accuracy!!!!
Documentation • Reasons for procedure • Time of procedure • Results of procedure • Response to treatments • Changes in signs/symptoms
BSI & Cleansing Issues • Dispose of all sharps and blood contaminated materials properly • Cleanse only outside of monitor with general disinfectant (manufacturer approved) • Do not immerse/ inject/spray any liquid into device
CLIA WAIVERS • Required for all services using a glucometer • The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). • The objective of the CLIA program is to ensure quality laboratory testing.
CLIA WAIVERS • There is a Biennial Fee of $150.00 for this waiver • An application for a CLIA Waiver can be obtained by going to: • http://www.cms.hhs.gov/clia/ • This must be filled out by all services intending to use glucometers, whether they are volunteer or paid. • Or call Margaret Naas, Bureau of Health, and request application, 287-9339
Summary • Indications for blood glucose measuring • Importance of a full patient assessment in conjunction with test results • Accurate calibration procedures • Appropriate blood glucose measuring procedures • Proper maintenance, care & storage procedures • CLIA Waiver Compliance
Practice Session • Students should complete a calibration procedure and test sequence under the direct supervision of an instructor • Demonstrate proper technique for obtaining a Blood Sugar correctly. • Showing proper aseptic technique • Sharps disposal