Stepping Hill Hospital, Stockport, Lancashire, UK
The task of keeping control of patients’ blood glucose level becomes more challenging due to the increasing number of glucose tests performed in hospitals. One reason is due to the growing epidemic of diabetes.
The World Health Organization (WHO) expects an increase of the global prevalence of diabetes by 110% over the next decades, which means that 366m people will suffer from diabetes in 2030. Secondly, the implementation of tight glycemic control (TGC) protocols raises the number of measurements and complexity of data processing.
Stockport NHS Foundation Trust’s main hospital is Stepping Hill looks after a population of approximately 350,000 people from Stockport and the High Peak area of Derbyshire to the east. In 2008, the trust implemented a completely interconnected point-of-care testing (POCT) system for their diabetes monitoring equipment which includes eight blood gas analysers, six Hemocue (total haemoglobin), three Coagucheck meters for INR monitoring and 90 glucose meters.
Reasons for purchase
Prior to implementation, the hospital had been using manual handheld glucose meters on the wards for blood glucose testing, but concern about quality control and quality assurance caused the Point-of-Care Committee at the 850-bed general hospital to look for a new system.
A risk assessment was performed on how the trust performed blood glucose measurements and the risk was considered to be too high. Patients were being put at risk because it could not be guaranteed that a meter had been checked for quality control.
The trust decided to look for a point-of-care wireless connectivity system that would allow full data capture of patient and quality control information as well as operator identification to enable only certified staff to use the equipment. Following a tender process, the trust implemented the Roche Diagnostic Inform II glucose meter with Cobas® IT 1000 data management system.
The Accu-Chek® Inform II wireless blood glucose monitoring system is a connected hospital blood glucose meter with wireless capability. Based on proven and reliable diagnostic technology, the Accu-Chek Inform II system has several connectivity options to ensure rapid transmission of patient results and quality control data, via cobas IT1000 data management software, onto the hospital information system (HIS) via the laboratory information system (LIS).
Stepping Hill Hospital was the first site to adopt the Accu-Chek Inform II blood glucose monitoring system with full wireless connectivity. With Accu-Chek meters located in every ward and department within the hospital, the wireless connectivity of the blood glucose meters has enabled monitoring in real time on a daily basis.
This allows the performance of all 90 meters within the hospital to be easily viewed and monitored via a single screen in the laboratory, whenever it is required.
Before the system’s installation, the performance of an individual meter could only be monitored by direct ward audit or via the bi-monthly external quality assurance, which was extremely time consuming and only accurate at the time of the audit or testing.
With results captured and transmitted immediately to the HIS via the Cobas IT1000 POC data management software and the LIS, the system eliminates the possibility of transcription errors and allows authorised medical staff to have instant access to a complete patient record.
Wherever the patient has been tested within the hospital, their blood glucose results are now available to authorised members of the medical/nursing team, without having to refer to hand-written notes. This new streamlined approach has improved workflow and ensures that medical teams are fully informed. This, in turn, ensures that patients receive the most appropriate care at the right time.
The wireless capability of the Accu-Chek system, combined with the data management functionality of the cobas software, also ensures real-time verification of patient and operator identity at the bedside, which further improves patient care and safety.
With the Accu-Chek system, users must regularly perform quality control tests or the instrument will not allow a measurement to be performed. The frequency of the quality control tests and the number of levels can be determined via the data management system. This is then sent out to each meter and this ensures that no glucose meter is used to perform a patient test without the correct quality control checks performed.
The data, together with information identifying who conducted the test, is recorded and transmitted over the wireless network to Roche’s Cobas IT 1000 Point-of-Care testing data management software, where it is stored for quality control purposes.
The hospital was the first site to install the Accu-Chek Inform II system and some staff questioned the security and reliability of using the wireless network for transmitting results. The ability to transmit results from the docking station via the Ethernet network was a reassuring safety factor. The system is also hard-wired, which gives a back-up should the wireless network fail. This ensures continuity of the flow of data.
Although it was not originally part of the hospital’s specification, wireless connectivity has helped save time and improves efficiency. Wireless connectivity means greater efficiency with less effort.
One of the major advantages of the systems is the manner in which problems or issues are dealt with. The POCT co-ordinator is responsible for all aspects of point-of-care testing, from instruments themselves to staff training and support. POCT connectivity means that problems can be resolved quicker with more information available. Ninety per cent of issues are user errors, but the system picks up and records these problems, such as when an operator has not applied enough blood to the strip.
Because the information is instantly available on the system, this can usually sort out problems quickly without the need for the instrument to be located and investigated. Compared with the old system, it means that issues can be resolved from a desk rather than walking to a ward. With the time saved, additional support can be provided for the medical staff and patients, such as developing a new website with information and guidelines on measuring blood glucose levels.
Staff efficiency and training
Connectivity is also helping staff to work more efficiently when changes in procedures are made or updates to the instruments are needed. For instance, when moving over to a new maltose interference-free strips, the meter configuration was changed on the data management software, which took off the maltose warning seen on the glucose meters. This information then goes out to all meters instantly. Without connectivity and the wireless meters, this information would have to be advertised across the hospital.
The connectivity system also provides a complete operator database, including information on when each operator was trained and on what equipment they were trained. The system also then captures the number of tests – both quality control and on patient – each operator performs. This allows for automatic competency testing and to streamline training for those who require it, if they are not performing enough tests to ensure competency.
Helping to focus on patient care
It is not just the POCT co-ordinator that is seeing the benefits of wireless connectivity; it is helping inpatient the diabetes specialist nurse, Fraser Burton, work more efficiently, too. Part of the diabetes team of doctors and dieticians, Fraser takes the blood glucose results and interprets them, making clinical decisions on the results. This involves visiting patients with diabetes around the hospital and ensuring their diabetes control is adequate.
Knowing that the wireless network is providing up-to-date patient information, he can see what is happening with the patient’s blood glucose levels before he goes to see them. As he explains: “Having a connectivity system in place allows patient blood glucose results to be seen on the computer screen instantly, which was an unexpected benefit. It means that the workload for the day can be prioritised according to the needs of the patients.”
Furthermore, once he is on his rounds, he can check to see whether a patient’s condition is deteriorating via any ward computer terminal. In acute cases with poor diabetic control, such as diabetic ketoacidosis where clinical changes need to be made quickly every half an hour, having the results available immediately via the connectivity system is a significant advantage, helping him and other medical staff administer optimum care at all times.
The connectivity system now drives the point-of-care testing offered at Stepping Hill Hospital. The information on operators, quality controls and patients’ results enables a quality-assured point-of-care testing system. A lot more time can be focused on demand management and ensuring the appropriateness of POCT testing and the effectiveness of it on patient care.
Stepping Hill Hospital, through the point of care committee, is dedicated to ensuring that, where possible, if a connected piece of equipment is available this is equipment of choice.
Having a connectivity system has enabled projects in the community to be linked into the hospital systems.
This ensures the results are held on one central record for all patients, wherever they are having the testing performed.