MEMS GLUCOMETER TRAINING

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MEMS GLUCOMETER TRAINING

• MEMS Education Committee
• 2008

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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 manufacturers instructions.

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Purpose

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

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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

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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

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Altered Mental Status(Common Causes)AEIOU-TIPS

• Alcoholism Trauma
• Epilepsy Infection
• Insulin Psychiatric
• Overdose Stroke
• Underdose

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Pre-Hospital Care

• (FOLLOW THE PROTOCOLS)
• 1. Scene Safety/Survey
• 2. Perform initial assessment
• Considering/Treating ABCs
• 3. Ensure cervical spine immobilization as
  indicated
• 4. Activate ALS-ALS must be activated when using
  the glucometer.

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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

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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?

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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.

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Pre-Hospital Care

• If patient is unconscious or seizing, transport
  on left side.
• If patients 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

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Glucose Measuring Devices

• Used to Check Blood Sugar Levels
• Many different types and models

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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

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Device Accessories
Test Strips
Glucometer
Lancet
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Glucose Measuring Steps
Step 1
Step 2
Step 3
Locate Glucometer
Open Up Case
Turn Power On
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Device Variations
Some glucometers turn on automatically. Know the
features of the glucometer your service uses.
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Glucose Measuring Steps, cont.
Step 4
Confirm Codes
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Glucose Measuring Steps, cont.
Step 5
Insert Test Strip
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Glucose Measuring Steps, cont.
Step 6
Obtain Blood Sample
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Glucose Measuring Steps, cont.
Step 7
Apply Drop of Blood
If inadequate up to 15 secs., add additional blood
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Glucose Measuring Steps, cont.
Step 8
Document Results
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Results

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

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Maintenance Calibration

• FOLLOW MANUFACTURERS RECOMMENDATIONS
• Techniques
• Frequency
• Batteries
• Care Storage
• Device
• test strips
• Temperature Can Affect Machine Accuracy!!!!

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Documentation

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

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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

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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.

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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

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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

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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

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Questions?