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Driving quality in diabetes care

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A new generation of Point of Care blood glucose testing meters with wireless connectivity to the hospital’s IT systems is raising the quality of data collected andspeeding up nurse’s access to blood glucose results therefore improving patient safety and care.

In January 2009 Stepping Hill hospital in Stockport became the first to adopt Accu-Chek Inform II glucose monitoring with full wireless connectivity to cobas IT 1000. Glucose results generated by nurses and healthcare assistants, using Accu-Chek Inform II meters, are uploaded to the electronic patient record immediately and wirelessly.

“It’s been brilliant,” Samantha Ekin, Point of Care coordinator at Stepping Hill, says. “It gives you real time information. With a fixed system they would then have to dock that meter before the information is sent across, whereas with wireless, as soon as that result is acknowledged on the meter it is sent straightaway into the patient files.”

This has enabled diabetes nurse specialists to review patients immediately and decide who needs to be seen as a priority, change their treatment regime and monitor the impact of those changes. It helps them pick up trends and intervene earlier to improve the patient experience and outcomes.


There was some staff resistance initially, Sam Ekin says, because staff felt that they were being checked up on. Also using the Accu-Chek Inform meters takes a few seconds longer, staff need to log in, input patient details and scan the reagents before taking a reading, and the meter will not work unless it has been quality checked.  “It makes them do every step, whereas before they could just bypass several,” Sam Ekin says. “Two or three years into it, nurses recognise that it’s worth the extra few seconds. They know that if the meter is allowing them to do a patient test that they’re qualified to do it, also that the meter is always ready to use. Ultimately, that everything is okay, and they will get a fast accurate reliable result, before they didn’t have this assurance.”

The functionality of cobas IT is highly user definable, Sam Ekin says, “you can adapt it to your environment. Overall the service we’ve had from Roche has been fantastic - the training they gave and the training products.”

As well as glucose testing, the cobas IT 1000 system can include blood gas, urinalysis, coagulation and cardiac readings. Stepping Hill has extended Point of Care testing to INR and Hb testing, and plans to add blood gases, HbA1c, D dimer and urine, then integrate the system within the community.

Plymouth Hospitals NHS Trust has had Point of Care testing for over a decade. Tony Cambridge, chief biomedical scientist at the Trust, says “using Accu-Chek Inform II meters is enabling diabetes nurse specialists to evaluate patients more quickly and try to get them out of the hospital and back home. If they pick up on a trend, they can act on that trend before it becomes acute.”

Point of Care testing already extends into the community, including a primary care hospital and some GP surgeries.  Both Plymouth and Stockport Hospitals NHS Trust are amongst the first organisations to apply for clinical pathology accreditation (CPA) for Point of Care testing.

Tony Cambridge says while glucose tests take an extra few seconds, “that’s the sort of delay we want to put into the system so that people are 100 per cent confident that they have the right patient, that they are generating the right result and that they’re taking the appropriate action to treat them”.

“It stops results getting confused with the wrong patient,” he says, which sometimes happened previously if the reading was not written down immediately. “In some instances some results never made it to the clinical staff at all.”

How the system works and its advantages

Each operator is given their own ID and log in once they have been trained. Only trained operators can access the system.

The cobas IT 1000 software collects patient IDs, records the reagent batch, test result, and the operator’s details at the exact time the test was performed so there is an audit trail which drives quality.

The manufacturer Roche has developed adaptable e-learning and re-certification, cobas academy, allowing nurses and other operators to undertake convenient training at their own pace. Operators can then be observed performing a quality control and patient test using either real blood or a simulant to assure competence.

The meters cannot be used unless they have been quality checked with two different samples within the last 24 hours, which helps ensure consistent, accurate and quality readings.

Use of the system has eliminated transcription errors, where an operator misreads the result - a particular risk at night when the lights are down. 

When a result is abnormal there are prompts on what actions could be taken.   Operators are able to add comments on the action they take, such as deciding to repeat a reading or refer to a clinician.

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