Anne,

 

I am not totally involved in this at present, however when I drew up out Trust POCT policy a few years ago this was a point our senior nurses strongly thought should be covered and following discussion the following paragraph was included:

 

'The (ward) responsible officer should obtain adequate evidence that patients are trained and competent, and that any devices they use comply with acceptable quality and safety standards, before they be allowed to perform their own testing (e.g. blood glucose testing). The terms of the Trust Self-Administration of Medicines Policy must be adhered to. Reference to the appropriate pathology department is required to ensure results obtained by devices not previously authorised for use within the trust are reliable. If in doubt the POCT committee should be consulted.'

 

I hope that helps, though clearly your local policy will depend on local attitudes and approaches. Our senior nurses saw this as an opportunity to check self-monitoring was being done properly, and to avoid any hidden biases in results in chopping from meter to meter. I appreciate there are counter-arguments.

 

I glossed over this important point in my enquiry about glucose meter usage last week in a failed attempt of conciseness. I have had about six replies so far, so not enough for statistics yet but not bad. Many thanks. I reproduce my question at the end and the replies so far which I have tried to make anonymous. Sorry that will make this message quite long, but the replies are interesting and your point is relevant.

 

On your specific point, I suppose if you think any diabetic who normally self-monitors should not use their own meter in hospital, but needs a properly maintained hospital meter at their immediate disposal, with measurements made by a trained staff member, then clearly since there are a lot of diabetics we probably do need lots of meters all over our hospitals.

 

If you feel that most patients who need self monitoring have their own meters and would prefer to self test, and hospital meters should be reserved mainly for acute diabetic management, e.g. new diabetics, changes in treatment, patients who have problems with their own meter, uncontrolled acute illness (though lab results may be better), diabetic episodes, etc. (and not necessarily for Mr Bloggs who is in to have his nose fixed) you could concentrate valuable hospital resources on fewer 'key' acute wards.

 

 Before dismissing patient self-monitoring, can I mention I once wrote up as a poster a small local comparison of QA results between hospital staff measurements and participating patients who self-monitored at home. The patients at home performed statistically slightly better. I guess they might be more motivated to get the right result!

 

Best wishes

Steve

_________________________________________________________________________________________________

Last weeks question

 

Several reports over the years suggest that where POCT glucose meters are used, it should only be used to monitor known diabetics and not for diagnosis. On that basis and as a devil's advocate I was wondering whether most hospital wards/departments actually need their own glucose meter?

 

Have any of your Trusts (or equivalent organisations outside the UK) considered reducing the total number of glucose meters (and by implication strips) in use on their wards, on clinical or cost grounds. If so have you succeeded and have you saved any cash? (and to whose budget?)

 

On the other hand you may think there should be still more glucose meters!

 

I think it might be interesting to compare how many meters are in use per hospital. Has anyone looked at that on a regional/national scale? (Have I forgotten some enormous audit?) I suppose it would need relating in some way to hospital size, e.g. number of wards, beds or patients. I would produce a histogram if enough people care to reply to me or the mailbase to generate any sensible information.

 

 

Responses to date:

For University Hospital of xxx (approx 1300 beds);

1. 175 MediSense Optium hand-held meters
2. 8 Medisense PCx data compatible meters
3. The above placed on 102 wards
4. 3 HemoCue glucose meters on 2 wards
5. Approx 450 000 test strips p.a. (including QC/EQA samples)

 

Please could you share any info that may be forthcoming?

Cheers

­­­­­­­­­­­­­­­­­Here at xxx we have a glucometer (or more) on most wards and one on each crash trolley. There were not the best records over who has one/how many etc though this is improving with the introduction of link nurses, tightening of training and documentation, and the running of an EQA scheme for the glucometers. There are about 40 wards with between 1 (most wards) and 15 (ICU etc) glucometers on each ward.

­­­­­­­­­­­­­­­­­­

Hi Stephen, interesting thoughts since we were discussing here just yesterday how we might determine how many meters the wards actually need since we are drawing up a spec for a new glucose monitoring system so I'd be interested in any replies that you get and hope you'll share with the list. Since patients with diabetes are admitted to all types of hospital ward then I think in general that most locations will need one for general monitoring as well as to identify possible reasons for unexplained acute collapse. ITU here operate tight glycaemic control on all patients so are high intensity use.

K has conducted a recent audit of our meters so should be able to give you a break down of numbers by wards, ITU, A&E etc. without too much difficulty (!).

If anything, the number of glucometers is increasing. But we have a lot of HI patients and complicated endocrine patients etc. so maybe this is a special case as so often in paediatrics.

Hi Stephen,

 

At XX General (600 beds) we have 104 glucose

meters on wards/departments.Also 9 blood gas analysers providing glucose and lactate. At YY Hospital (350 beds) we have 56 meters and 3 blood gas ditto. At ZZ Hospital (100 beds, mainly out-

patients) 34 meters

At AA Hospital (135 beds, mainly

psychiatric, day surgery and rehab) 26 meters

 

My thinking on the subject is that in a main DGH where

you have on-site lab facilities, there is logically

less call for meters to be on wards, but the wards do

not seem to see it this way. Requests for meters on

wards have risen (despite a lot of screaming when I

brought in cross-charging for my services and the EQA

at £15 per meter per year!) But with all those meters

I cannot understand why we still get so many blood

glucoses in the lab from wards. See box, tick it? The

wards will argue that for sliding scales the lab

results are too slow and I can agree with that. The

majority of glucoses done one the ward are routine,

and they should only be sending lab confirmation of

unexpected or out of range results.

 

A/E and ITU use the blood glucose on the gas analysers

for tight glycaemic control, management of sepsis, and trauma/resus situations.

 

I had considered moving to one of the connectivity

glucose meters such as the Medisense QI, with

automatic QC lock-out and downloading of patient

information to the HIS, but these cost £300 each and

there isn't the funding. We would need fewer meters

but ITU insisted that they would need a meter at every

bed for infection control.

 

I have saved money by moving our Bayer blood glucose

strips, urinalysis strips and Bayer hCG pregnancy

tests all onto a TOMS contract rolled up with our

laboratory reagents. This gets us the VAT back and has

enabled me to purchase 17 Clinitek status urine

readers with the savings and reimburse £9000 per year

into the Trust's funds.

 

Interestingly, since changing over to the Bayer hCG

preg tests that can only be read on the Status

instrument, Pharmacy tell me that usage has gone down

by a third. Couldn't possibly be that a lot of them

were going home with the nurses????

 

The manufacturers make their money on the strips. I

recently heard that a glucose strip actually costs

0.1p to make and costs the NHS 31p so some profit

margin!

 

­­­­­­­­­­­­­­­­­­­­­­­­I think that's all but apologies for any I have missed.

Regards

Steve