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					                   Capillary Blood Glucose Monitoring
                                 Policy



Document Version number: 1.0
Date Written: March 2007
Reviewed : July 2008

Author: Jo Butler

Job Title: Diabetes Consultant Nurse, Beta cell, Queen Mary Hospital ,Roehampton

Email Address: jo.butler@wpct.nhs.uk

Contact Number: 020 8487 6447

Date Approved by Trust Board: N/A

Date Approved by PEC: N/A

Date Approved by Clinical Policy Group May 2007

Date Equality Impact Assessed: May 2007



Next Review Date: October 2009




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                               Policy Reference Information


Policy Reference Number
                                                                  1.0
Version Number
                                                                  Agreed
Status
Author/Lead                                                       Jo Butler

Passed to Communication Team and SSP
                                                                  July 2008
Date of Last Review Date
                                                                  Oct 2009
Date of Next Formal Review
-
Date of Approval by Trust Board
                                                                  May 2007
Date of Approval by Clinical Policy Group

Website Address of Policy

                                Document Revision Record

  Version         Description         Section/page       Reason for     Author   Date
                 of Change(s)            where            Change
                                       change has
                                      taken place




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                     Capillary Blood Glucose Monitoring Policy
                                  Wandsworth tPCT



Introduction
Capillary blood glucose monitoring is a vital part of care and management of
people with diabetes if utilised appropriately (1,2,7,10,11 ,12)
Treatment is often initiated or changed on the basis of blood glucose
measurements; therefore accuracy is vital (1,2,10,11,12).
Incorrect technique, faulty or incorrect use of meters can lead to misleading
results that may compromise the health and safety of the patient
(1,2,4,6,7,8,9).
All those involved in capillary blood glucose monitoring should have a clear
understanding of this vital clinical task and should adhere to the common
policy (1,2,10,9,10).

Terms of Reference- The policy applies to the following staff groups.
Health care professionals (HCP) who are permanently employed by
Wandsworth tPCT (i.e. not agency staff) and have attended the blood glucose
monitoring training sessions organised by the Organisational Development
Department and have the support of their manager where appropriate. In the
majority of cases the relevant staff group are nurses, but other health care
professional groups including healthcare support workers may attend the
training sessions.

Aims
The purpose of this policy is to describe the framework within which staff are
enabled to perform capillary blood glucose monitoring accurately, safely and
appropriately with minimal discomfort to patients.
Staff will use the WtPCT preferred meter, following completion of training.
Staff will also use a single disposable lancing device.
To understand the rationale and mechanism for internal quality control and
external quality assurance.


Objectives: Methods to Achieve Objectives: In order to achieve the
objectives of this policy staff will attend a 2 hour study seminar, delivered by
the diabetes clinical nurse specialists and the meter manufacturers. The
following learning outcomes will result :

        Basic principles of measurement
        Expected results in the normal state
        Recognition of abnormal results and how to manage these
        Correct use of the equipment
        Knowledge of operator dependent steps
        Correct technique for the collection of appropriate blood samples
        Relevant aspects of health and safety
        Accurately maintaining documentation of the data produced
        Mechanism for calibration, quality control and quality assurance


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        Knowledge of contra indications.
        Practical experience of the equipment including steps to satisfy the
         instructor that training has been understood
        Knowledge of and access to information on trouble shooting, potential
         source of errors and error messages
        Understanding of Internal Quality Control (IQC)
        Understanding of External Quality Control (EQC)
        Accurate record keeping

Management Responsibility
Only staff who have been trained and whose training and attendance has
been recorded maybe permitted to carry out the procedure. Managers have a
responsibility to ensure their staff are appropriately trained.

Implementation
Managers will be responsible for ensuring that any staff member who
performs capillary glucose monitoring is familiar with this policy. Health Care
Professionals are accountable for their own clinical actions in accordance with
their professional code of conduct (example – Registered Nurses the NMC
Code 2004). Health care assistants will have their competency assessed by
their clinical supervisor against the learning outcomes/ competency
framework. Monitors with registered serial numbers will only be supplied to
community staff and clinical areas where staff have attended training.


Training Requirements
Staff will attend a 2 hour study seminar prior to using the WtPCT preferred
meter, and thereafter the recommended annual update.. They will be made
aware of their accountability (3) and learn how to identify the need for capillary
blood glucose monitoring. Training will follow the Department of Health (DoH)
and MHRA guidelines (14)

Knowledge base.
Staff who are involved in training, conducting blood glucose monitoring
and/or advising people with diabetes should be aware of potential sources of
error and the contraindications of using the blood glucose meter. Staff should
be able to interpret the results, instigate appropriate action and/or be able to
give the correct advice.

Review, audit and monitoring
Compliance will be monitored by maintaining records of attendance at study
sessions and through the medical devices team tool.

Disclaimer: Failure to adhere to this policy constitutes a clinical risk and may
lead to action being taken under the disciplinary procedure. As the equipment
used varies from that used in other healthcare settings, staff must use the
procedure shown on the WPCT training session.


The Capillary Blood Glucose Monitoring Policy will be reviewed annually


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References and Further Reading

1. Department of Health and Social Security (1987)
Hazard warning Blood Glucose Measurements: reliability of results produced
in extra-laboratory areas

2 Royal College of Nursing, Diabetes Nurses Forum publication. (1987)
Guidelines on the use of blood glucose monitoring equipment by nurses in
clinical areas

3. NMC London (2004).
The NMC Code of Professional Conduct: standards for conduct, performance
and ethics

4. Medical devices Agency Adverse Incident Centre Safety Notice MDA SN
9616 (1996).
Safety Notice, Extra-Laboratory use of Blood Glucose Meters and
Contraindications, Training and Advice to the User

5. DoH Medical Directorate Safety Action Bulletin No.65 November. (1990)
Lancing Devices for Multi-patient capillary Sampling: avoidance of cross
infection by correct selection and use

6. British Medical Journal (1990).
A code of practice for the safe use and disposal of sharps

7. Aldridge V, Journal of Diabetes Nursing Vol. 9 No10 (2005)
Self-monitoring of blood glucose: Invaluable in managing diabetes.

8. Gallichan M, BMJ Vol.314 March 29 (1997).
 Self-monitoring of glucose by people with diabetes: evidence based practice

9. Guilding L British Journal of Nursing Vol.1No9. (1992)
Capillary blood glucose monitoring.

10.Owens D, Barnett A.H. Pickup J. et al, Diabetes and Primary Care Vol.6
No1 2004 8-16 (2004).
Blood Glucose self-monitoring in type 1 and type 2 diabetes: reaching a
multidisciplinary consensus.

11. International Diabetes federation (IDF) Brussels (2005).
Clinical guidelines Task force, Global Guideline for Type 2 Diabetes

12. New England Journal of Medicine 329, 977-86 (1993)
Diabetes Control and Complications Research group. The effect of intensive
treatment on the development and progression of long-term complications in
insulin dependent diabetes mellitus (




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13. Turner et al, BMJ 317, 703-720 (1998)
The United Kingdom prospective Diabetes Study, 14. MHRA & DoH,
London. (2005)
Point of Care Testing – Blood Glucose Meters. Advice for health care
professionals




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