Prevention
Best Practices for
Blood Glucose Monitoring
Glucose testing plays an important role in treating diabetes.
Your residents, whether they have Type 1 or Type 2 diabetes,
should be tested routinely, per physician’s orders, and care
should be provided based on the results obtained.
Testing blood glucose in a long-term care facility follows
Occupational Safety and Healthy Administration (OSHA),
Joint Commission and Centers for Disease Control (CDC)
guidelines to promote safety and best standards of care. The
glucose monitor, proper finger stick site location and type
of lancets used play an important role in obtaining accurate results.
Resident Blood Glucose Testing Procedure
• Explain the procedure to the resident.
• Check the expiration date on the test strips.
• Calibrate the monitor (if necessary) according to the
manufacturer’s instructions.
• Ensure the displayed calibration code matches
the code on the calibration bar and the code
on the test strip package insert.
• The calibration bar is stored in the carrying case until
all of the test strips in that box have been used.
Improving Quality of Care Based on CMS Guidelines 29
KEEP IN MIND
that one lancet type may not serve the needs
of all of your residents.
• Ensure that the monitor and test strips are at room
temperature. If there is a temperature change,
the monitor and test strips should sit at room temperature
for 10 to 12 minutes.
• Insert a test strip in the monitor according to the
manufacturer’s instructions.
• Lance the resident’s finger, obtain a sample of blood.
• Apply the blood sample to the test strip when prompted
by the monitor.
• If your monitor allows for the addition of a second drop
of blood, please refer to the user’s manual for
detailed instructions.
• Dispose of the used lancets and test strips
immediately according to the facility’s policies or the
state mandates.
• Record the result in the resident’s record
and follow physician orders for notification and
providing care.
• Document all interventions in the resident’s
medical record.
Fingerstick Testing Using a Safety Lancet
This section addresses best practices regarding how to
prepare for and perform a fingerstick test while protecting
the nursing staff from infectious cross-contamination.
When to conduct a fingerstick test
Always follow physician orders. Some recommendations for
scheduled fingerstick tests are:
• Before a meal
• 1 to 2 hours after a meal
• Before bed
30 Healthy Skin
Choosing the correct lancet
Using the correct lancet is as important as using proper
technique. Blood sample size varies depending on the
glucose monitoring system you choose. A higher gauge
(thinner) lancet can be used for smaller sample sizes and
may result in less discomfort for the resident. However, keep
in mind that one lancet type may not serve the needs of all
of your residents.
Although there are a variety of safety lancet brands on the
market, there are only two lancet designs:
Pressure Activated – the lancet is activated by applying
pressure to a person’s fingertip.
Non-Pressure Activated – the lancet is activated by pressing a button, or a firing pad, on the device.
Test site recommendations
Here are some guidelines regarding preferred test site
locations:
• The puncture should occur on the side or the top
of the finger.
• It is better to test either the side or tip (not the center)
of the finger because tissue is about half as thick
there and a finer gauge (thinner needle) can be used.
• Never lance directly on a resident’s fingerprint, as
the nerve endings there could cause a great deal
of discomfort.
• Preferred puncture sites are the middle and ring fingers.
C O M PA S S
Fit Right Program
Survey Readiness
Ta g F 3 1 5 & Q I S
Preparing the finger
1. For optimal blood flow, it is recommended that you
warm the test site prior to lancing. Place a warm,
moist towel on the area for three to five minutes; at
a temperature no higher than 107 degrees F, or 41.7
degrees Celsius (this increases arterial blood flow and
will not burn the skin). Alternately, you can warm the
skin by massaging the hand, beginning from the palm
and slowly working toward the fingertips.
2. Next, cleanse the site using a 70 percent isopropyl
alcohol solution.
3. Allow the area to air-dry so that the alcohol’s antiseptic
action can take effect (if skin isn’t dry, test results can
be inaccurate).
Be survey ready at all times with Medline’s
Compass Fit Right Program— an incontinence reference for front-line caregivers.
Performing the test
After you have prepped and cleaned the finger, it is time to
perform the test. Puncture the site, and then use a gauze
pad to wipe away the first drop of blood. Apply the blood to
the testing strip, being sure to follow the manufacturer’s
instructions. Once the test is over, use a 2'' x 2'' gauze pad
to wipe away any excess blood, and then apply slight pressure (or follow your facility’s policy and procedure).
• CNA & RN Workbooks
Compass Fit Right Program – Survey
Readiness Tag F315 & QIS includes
quality improvement forms and tools,
plus the following:
• Program Manual Binder provides an
overview to implementing a thorough
incontinence program and compiles
program manager guidance on how
to use the various components of
the program.
• Practical Guide to Understanding
F315 & QIS
• DVD Education (with CE hours)
• Continuous Pressure Ulcer
Prevention Tablets
• Measuring Tapes
Test site rotation
Some residents have their blood sugar tested daily, while
others might be tested as often as four to six times a day.
The more frequent the testing, the greater the chance of
fingertip soreness. That is why it is important to rotate the
puncture site with each fingerstick. Additionally, site rotation
helps to minimize callous formation. Avoid “milking” a finger,
since it can cause tissue fluid contamination of a specimen
and result in a false low reading.
Source
D.O.N. Instruction Manual. A Diabetes Resource for Long-Term Care.
Medline Industries, Inc., Mundelein, IL. 2009.
Improving Quality of Care Based on CMS Guidelines 31
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References
1. http://cdc.gov/ncidod/dhqp_uti.html
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©2008 Medline Industries, Inc. Medline and Silvertouch are registered trademarks of Medline Industries, Inc.
www.medline.com