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Anticipated patient outcomes

There have been several trials investigating the benefits of tight glycaemic control to near normal levels. D’Hondt (2008) refers to three randomized controlled trials in which intensive insulin treatment was used in hospitalized patients. The trials showed that intensive insulin treatment to achieve tight glycaemic control did result in reductions in length of stay, sepsis, dialysis and hospital mortality and morbidity (Furnary et al. 2000, Krinsley 2004, van den Berghe et al. 2001). Blood glucose testing is integral to achieving this tight control but there is currently no absolute conclusion for the standardization of this treatment (D’Hondt 2008). It does, however, indicate that keeping blood sugar levels as near normal as possible should be the ultimate aim of blood glucose testing.

Legal and professional issues

The DH report (1996) highlights that there must be standardization in training, reliability and quality control for blood glucose testing. In order to achieve this, the following aspects must be considered when selecting monitoring devices.

1. Equipment is designed for use by nonlaboratory staff and is suitable for use in the clinical environment.

2. All equipment is compatible and will give reliable results.

3. The biochemistry laboratory is involved in the purchase and maintenance of the equipment. This may involve the purchase of one type of device from one company for the whole hospital, to reduce costs and provide standardization (Lowe 1995).

4. The equipment should be easy to use and the staff should be involved in the choice of device (Hall 2005).

5. The ongoing cost and maintenance of the device need to be considered, including buying strips, control solutions and replacement devices (Hall 2005).

6. Written standard operating procedures should be available and kept with the device.

7. Training is given to the operators of the equipment and records are kept of this. After training, the following learning outcomes should be demonstrated by the operator (MDA 2002):

– knowledge of the basic principles of measurement and normal ranges

– the proper use of equipment as stated by the operating instructions

– the consequences of incorrect use

– health and safety procedures for the collection of blood samples, that is, to prevent spillage and needlestick injuries

– the importance of complete documentation

– use of appropriate calibration and quality control techniques

– an understanding that blood sugar analysis should only be used as a guide to diagnosis and treatment and decisions should be made formally with laboratory results (DH 1996).

It is a hospital and government directive to keep records of training and quality testing results and the frequency of these quality control tests may vary according to manufacturer or hospital policy (Walker 2004). Independent quality control should be carried out with the collaboration of the biochemistry laboratory and external auditing of quality control should be undertaken, which may be provided by the company providing the equipment.

Preprocedural considerations

Equipment

All equipment should be checked for expiry dates (according to individual hospital trust policy) and successful calibration, and stored according to manufacturer’s guidelines.

Blood glucose monitor: a medical device which measures the concentration of glucose in a human blood sample using a blood glucose test strip (Roche Diagnostics 2004).

Testing strip: strip with a small window used to collect a sample of the patient’s blood to be inserted into the blood glucose monitor. The strips must be calibrated with the monitor prior to use (Roche Diagnostics 2004)

Lancet: a device used to draw out a small amount of blood from the patient for testing of glucose level. Singleuse lancets are used to minimize the risk of crossinfection and accidental needlestick injury and set to the correct depth according to the skin turgor (Roche Diagnostics 2004). Disposable