EMT-Basics Glucometer Training Program 2008

1. MEMS GLUCOMETER TRAINING MEMS Education Committee 2008

2. 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.

3. Purpose ~To prepare currently certified and future EMT-Basics to utilize a Blood Glucose Measuring Device under current MEMS Protocol Standards.

4. 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

5. 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…

6. Altered Mental Status(Common Causes)AEIOU-TIPS Alcoholism Trauma Epilepsy Infection Insulin Psychiatric Overdose Stroke Underdose

7. 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.

8. 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

9. 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?

10. 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.

11. 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

12. Glucose Measuring Devices • Used to Check Blood Sugar Levels • Many different types and models

13. 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

14. Device & Accessories Test Strips Glucometer Lancet

15. Glucose Measuring Steps Step #1 Step #2 Step #3 Locate Glucometer Open Up Case Turn Power On

16. Device Variations Some glucometers turn on automatically. Know the features of the glucometer your service uses.

17. Glucose Measuring Steps, cont. Step #4 Confirm Codes

18. Glucose Measuring Steps, cont. Step #5 Insert Test Strip

19. Glucose Measuring Steps, cont. Step #6 Obtain Blood Sample

20. Glucose Measuring Steps, cont. Step #7 Apply Drop of Blood If inadequate up to 15 secs., add additional blood

21. Glucose Measuring Steps, cont. Step #8 Document Results

22. Results Measured in milligrams per deciliter Normal blood glucose range is typically 80-120 mg/dl (fasting) Treat the patient, not the numbers

23. Maintenance & Calibration • FOLLOW MANUFACTURER’S RECOMMENDATIONS: • Techniques • Frequency • Batteries • Care & Storage • Device • test strips • Temperature Can Affect Machine Accuracy!!!!

24. Documentation • Reasons for procedure • Time of procedure • Results of procedure • Response to treatments • Changes in signs/symptoms

25. 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

26. 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.

27. 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

28. 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

29. 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

30. Questions?