Process improvement for bedside capillary glucose testing in a large academic medical center: the impact of new technology on point-of-care testing

Point-of-care testing (POCT) for the management of patients with diabetes h as become a standard of care. Originally, diabetic monitoring was accomplis hed by manual urine dipsticks. The development of hand-held, battery-operat ed capillary glucose monitors radically improved the ability of physicians and nurses to monitor diabetic patients during their hospital stay. Capilla ry glucose meters have been shown to provide accurate results under control led conditions, but a number of early meters had issues with the quality of testing when used by non-laboratory personnel. Bedside capillary glucose t esting was first initiated in our hospital in 1990, using a first-generatio n glucose meter that could measure a glucose value within 2 min. Operator e rrors were common because the glucose strips required wiping and the testin g required timing. Furthermore, these early meters had no data storage or d ata management capabilities. In 1995, we transitioned to a second-generatio n meter with a rudimentary data management and storage capability that coul d be downloaded to a portable laptop. A log of quality control (QC) data co uld be derived from the download. A major problem with this device was the need to bring the instruments and laptop together, which was labor intensiv e and difficult to sustain over long periods of time in a large institution . We recently implemented a third-generation instrument (the Abbott Precisi on PCx) with a data management system (Precision NET). This device signific antly expands the data management and networking capabilities of the bedsid e glucose meter, as shown in Table 5. Glucose Values can now be performed i n a fraction of the time of the first-generation meters, the need to wipe t he glucose strips has been eliminated, and only certified operators can use the instrument. Networking technology allows for centralized quality contr ol management, and the ability to network with other point-of-care technolo gies using intranet and in the near future internet applications. Collectiv ely, these developments have radically improved the efficiency and quality of bedside capillary glucose testing, and have significantly enhanced the a bility to manage this important technology. (C) 2001 Published by Elsevier Science B.V.