Protocol for Initiating Insulin Therapy at Home

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					             POWYS LOCAL HEALTH BOARD
                                                 Cover sheet

                     Policy for Blood Glucose Monitoring by a Designated Person

 Rev         Date                                                                              Planned Review Date
                                    Purpose of
                                    Issue/Description of
                                    Change

 LDSAG       March       Initial Issue                                                         March 2006
 003         2004




 Responsible Officer                Approved by                                                Date

 Diabetes Specialist Nurse          Local Diabetes Advisory Group                              March 2004
                                    Clinical Governance Audit and Medical                      September 2004
                                    Group
                                    Clinical Governance and Risk                               October 2004
                                    Management Committee

                                         PROPRIETARY INFORMATION-

This document contains proprietary information belonging to the Powys Local Health
Board. Please do not produce all or any part of this document without written permission
from the Board.




    Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
    Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 1 of 6
       Policy for Blood Glucose Monitoring by a designated Person


Introduction and Purpose

The Diabetes Nurse Specialists for Powys have produced this policy in
consultation with the Consultant Diabetologists, Consultant Physician and
Endocrinologists, General Practitioners, Diabetes Nurse Specialists,
Pharmacy, Infection Control, Practice Nurses, Ward Managers, District
Nurses and all members of the LDSAG (Local Diabetes Services Advisory
Group). It is based on current evidence and national recommendations.

Patient monitoring of blood glucose can be used as part of an integrated care
plan in combination with appropriate therapy. The purpose of this policy is to
ensure efficient and effective blood glucose monitoring.

Blood glucose monitoring may be undertaken by a designated person who
has completed updating with Powys Local Health Board Training and
Education Department and agrees to undertake the role in accordance with
their Code for Professional Conduct.



Monitoring and Review:

This policy is to be used until such time as the Diabetes Guidelines are
replaced by the Diabetes Toolkit (under development)

This policy will be monitored and reviewed 2 yearly or before that time, if
circumstances alter sufficiently to require review. The manufacturer’s
guidelines for the meter being used within the hospital/primary care should be
followed carefully.



Quality Control

    All meters should be quality controlled using solution / test strips obtained
     from pharmacy and compatible with the meter in use and performed as per
     manufacturer’s guidelines for meter.
    Quality control should be performed daily on meters in use and weekly if
     not used frequently enough to require daily.
    It is the responsibility of the individual practitioner to ensure the meter has
     been quality controlled.
    All results from quality controlling of meters should be documented in a
     record book for each individual device and signed for audit and legal
     reasons. The Ward Manager or designated person should audit quality
     control documentation annually.


Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 2 of 6
Devices

The Following devices should be used at present:

In Welshpool, Newtown, Llanidloes and surrounding district nursing teams –
Medisense

In all other areas Bayer – Elite

In the Medical practices – one make and model should be used within each
Practice

No new system should be used unless approved by the Local Diabetes
Advisory Group and the Drug and Therapeutics Committee for the Local
Health Board

Responsibilities:


Individual staff will be responsible for ensuring that:

    The policy is read and complied with, in conjunction with the infection
     control manual and consent to treatment policy

    Training in use of appropriate devices updating of current best practice
     (refer to Diabetes Guidelines ) is attended to maintain competencies.

    This policy is read in conjunction with the Powys Local Health Board
     Consent to Treatment Policy.

    Guidelines are read in conjunction with Powys Local Health Board
     Infection control and sharps policy.

    Meter is quality controlled prior to its use for patient monitoring.

Aim

    To provide guidance for designated persons to perform blood glucose
     monitoring (B.G.M.) to provide an efficient and effective service to patients.

The individual is professionally accountable for their own actions or omissions.


Objectives


1. To ensure continuity of care.



Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 3 of 6
2. To provide education and support for each individual.

3. To maintain patient and staff safety during an invasive procedure.

4. To provide training and assessment for designated persons wishing to
   perform B.G.M.


Selection of Patients

1. Refer to Diabetes Guidelines for screening for diabetes.

2. Adults and children with Diabetes Mellitus identified by the Medical
   Practitioner or the Registered Nurse/Midwife and documented in the
   multidisciplinary notes.

Education and Training Requirements
1. Education in theory and practice of blood glucose monitoring.

2. Reasons for blood glucose monitoring (and interpretation of the results for
   Qualified Health Professionals – see Diabetes Guidelines)

3. Education in the use of the equipment used in the procedure and its safe
   disposal (please refer to infection control manual).

4. Observation of the procedure.

5. Supervision by a competent practitioner until competence is achieved .


Equipment Required:
        Blood glucose monitor with strips
        Multi-person finger pricker with lancets - clarify whether single use or
single patient use and/or decontamination requirements for multi-person use
(refer to Infection Control Manual or Infection Control Team)
        Appropriate control solution
        Tissues
        Washing facilities
        Sharps Container
        Access to waste bin
        Disposable gloves
        Chart for recording blood glucose reading




Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 4 of 6
          Procedure:


Action                                                        Outcome

1. Approach the patient in a confident                            To ensure the patient
   manner and explain the procedure,                               understands the procedure and
   allow time for the patient to ask                               gives informed consent.
   questions and discuss problems.
   Explain each step of the procedure.                            To ensure patient is relaxed

2. Practitioner to wash his/her hands                             To reduce the risk of
   and put on gloves. Ensure site for                              contamination. To promote blood
   finger pricking is clean (do not use                            flow to the fingertips
   alcohol swabs, use damp cloth or                               Alcohol hardens the skin
   ask patient to wash hands with
   soap and water).

3. Select a digit and using a multi-                              To obtain blood sample.
   person finger pricker positioned on                            To prevent patient to patient
   the side of the digit, operate as                               contamination.
   manufacturers instructions. Attempt
   to rotate sites.                                               To reduce patient discomfort

4. Follow manufacturer’s guidelines                               To reduce the risk of inaccurate
   for use of meter                                                results.

5. Discard the lancet from the finger                             To reduce the risk of accidental
   pricker into a sharps box, dispose                              needle stick injury and patient to
   of used strip in apporpriate bin.(As                            patient contamination.
   per Infection Control Manual and
   Sharps Policy)

6. Record the result from the blood                               For legal reasons
   glucose meter as appropriate for
   area of work

7. Qualified Health Professionals to                              To ensure patient understands
   explain results to the patient and                              the procedure.
   health care assistants to report
   result to appropriate member of
   staff.




Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 5 of 6
References and Bibliography


ACB News May 1999 Point of care Testing Guidelines, Quality Matters. Issue
433 p 16 – 23

Association of Clinical Biochemists, Sept 1993, Guidelines for the
Implementation of Near Patient Testing ACB Administration Office:London

Audit Commission in Wales 2004 Baseline Review of Diabetes Services in
Wales Powys Local Health Board, Audit Commission:Cardiff

Department of Health 1997 A Review of Near Patient Testing in Primary Care
Health Technology Assessment Programme 1997 Department of Health
Publication

Gallichan M 1997 Self monitoring of glucose by people with diabetes;
evidence based practice. British Medical Journal 314: 964.

Near Testing Welsh Scientific Advisory Committee 1995, Welsh Office;Cardiff

NICE 2002 Management of Type 2 Diabetes and Management of Blood
Glucose Sept 2002 NICE;UK

UK Prospective Diabetes Study Group UKPDS 34, 1998 Effect of intensive
blood glucose control with metformin on complications in overweight patients
with type 2 diabetes, Lancet 352: 854-65.

Welsh Assembly Government (2002) National Service Framework for
Diabetes (Wales): Standards. Cardiff: Welsh Assembly Government.

Welsh Assembly Government (2003) National Service Framework for
Diabetes in Wales Delivery Strategy. Cardiff: Welsh Assembly Government.




Powys Local Health Board. REF: LDSAG 003/PLHB GNP 0003 Blood Glucose Monitoring Policy. Author: Diabetes Nurse
Specialist. Approved: Clinical Governance and Risk Management Committee, October 2004. Review: March 2006. Page 6 of 6

				
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Description: Protocol for Initiating Insulin Therapy at Home