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Pre‐procedural considerations

Equipment

Errors can occur during any phase of the testing process. Common sources of error include patient or operator method, environmental exposure and device malfunction (Sudhakaran and Surani [190]). All equipment should be checked for expiry dates (according to individual hospital trust policy), and it should be calibrated and stored according to the manufacturer's guidelines (MHRA [117]).
Equipment selection should include:
  • Blood glucose monitor: a medical device that measures the concentration of glucose in a human blood sample using a blood glucose test strip.
  • Testing strip: a 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.
  • Disposable 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 needle stick injury; they must be set to the correct depth according to the skin's turgor (Roche Diagnostics [180]).
The accuracy of glucose meters is a factor for consideration when purchasing or renting glucose meters (MHRA [117]). Home glucose meters, which have been adopted for use in some hospitals without additional testing, may not give the high level of accuracy required (Karon et al. [90]).

Specific patient preparation

Patients should be advised to wash their hands prior to testing. Alternatively, the test area should be cleaned with soap and water and then dried, and the use of alcohol‐based handrub should be avoided to ensure non‐contamination of the result (Adam et al. [2]). The patient should be encouraged to warm their hands before sampling to promote blood flow and increase the chance of obtaining an adequate sample of blood to cover the test strip (Wallymahmed [206]).
Procedure guideline 14.8

Blood glucose monitoring

Table 14.17  Prevention and resolution (Procedure guideline 14.8)
ProblemCausePreventionAction
Inaccurate resultsDevice maintenance issues:
  • inadequate meter calibration
  • failure to code correctly
  • poor meter maintenance
  • out‐of‐date test strips
Ensure staff receive adequate training and clear instructions on how to calibrate the device ( MHRA [117], Walden et al. [205]).
Repeat steps 1, 2 and 3 of Procedure guideline 14.8: Blood glucose monitoring appropriately and according to the manufacturer's instructions and/or local guidelines.
Inadequate amount of blood on the test strip
Ensure staff receive adequate training.
Ensure there is an adequate amount of blood available to apply to the testing strip.
Repeat the blood sugar measurement, ensuring that the window on the test strip is entirely covered with blood.
If the error persists, ask a colleague to repeat the test. If the error still persists, report glucose meter to a technician and use another machine.
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