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In this forum we explain and discuss various clinical pharmacy services and its practical approaches. Eg: Anticoagulant Management Therapy, Medical Reconciliation Service, Treatment Chart Review, Therapeutic Drug Monitoring, Patient Education and etc. NOTE: To read/reply any topics under this section members must spend 20 BB Points to get the access.
Forum rules: To read/reply any topics under this section members must spend min 20 BB Points. Members can take part in developing clinical pharmacy services related conents and they earn 50 BB Points/Topic. Moreover all your posts will be reviewed and valideted by the moderators of this forum.
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#2423
Introduction

Its a disease screening service provided by pharmacists.

Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia). Particularly important in diabetes management, a blood glucose test is typically performed by piercing the skin (typically, on the finger) to draw blood, then applying the blood to a chemically active disposable 'test-strip'. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood. The test is usually referred to as capillary blood glucose.

Conditions where a patient's blood glucose may need careful monitoring are:

a) In order to make a diagnosis of diabetes mellitus.
b) In the acute management of unstable diabetic states, diabetic ketoacidosis, hyperosmolar non-ketotic coma, and hypoglycemia.
c) In order to make a diagnosis of hypoglycemia,
d) Where blood glucose levels are not in keeping with the patients clinical status.

Objectives

This activity helps to train clinical pharmacists in the following areas:

+ Monitoring of blood glucose using Glucometer.
+ To understand the role of Pharmacist in Diabetic Disease Management.
+ The need for an interdisciplinary, shared responsibility between pharmacists and physicians to improve patient treatment outcomes.

Procedure

• Any blood glucose monitor used must have undergone the calibration prior to use.
• Verbally confirm the identity of the patient by asking for their full name and date of birth. If client unable to confirm, check identity with family/caregiver (To avoid mistaken identity)
• Introduce yourself. (To promote mutual respect and put client at their ease)
• Wear identity badge which includes name status and designation (For patients to know who they are seeing and to promote mutual respect)
• Ensure verbal consent for the presence of any other third party is obtained (Students for example, as the client has the choice to refuse)
• Explain procedure to patient including risks and benefits and gain valid consent. (To ensure client understands procedure and relevant risks and to allay fears or anxieties)
• Check that quality control test has been carried out that day – test machine if necessary (To ensure machine is functioning correctly)
• Advise patient to wash and dry their hands using soap and water, prior to procedure – assist if necessary. Do not use alcohol gel. (To prevent sample contamination)
• Decontaminate hands prior to the procedure (To reduce the risk of transfer of transient micro-organisms on the healthcare workers hands)
• If indicated, apply single use disposable apron (To protect clothing or uniform from contamination and potential transfer of micro-organisms)
• Apply single use disposable non sterile gloves (To protect hands from contamination with organic matter and transfer of microorganisms)
• Prepare single-use disposable lancet device as per manufacturer’s instructions (To ensure correct use of equipment)
• Remove new test strip from vial, replace lid tightly (To prevent deterioration of remaining strips)
• Within 30 seconds, insert test strip (yellow window facing up) into test strip slot The meter should turn on automatically (To initiate process of analysis)
• Check that current meter code and test strip code match. If a new pack of strips is required, the meter should be recalibrated. (To ensure machine is calibrated to test strip)
• Ask patient to sit or lie down (To ensure the patient’s safety and minimize the risks if they feel faint when blood is taken)
• Using the single use lancet, obtain a blood sample from the side of the finger (Side of finger is a less painful site to use)
• Sites should be rotated if testing is frequent (Reduce the risk of infection from multiple puncturing and prevents areas from toughening)
• Avoid using thumb or index finger Less painful (most frequently used digits have a more sensitive nerve supply)
• The finger may bleed without assistance, but may need ‘milking’ gently (Droplet needs to be of sufficient size to cover test pad)
• Apply a drop of blood to the strip by holding the patient’s finger to the edge of the strip until the yellow window is completely filled with blood. (The blood will be drawn into the strip automatically )
• Do not place blood on top of the strip (A bleep should be heard which indicates that the test is beginning)
• If any part of the yellow window remains yellow after the initial drop of blood has been applied, a second drop of blood may be applied to the edge of the test strip within 15 seconds of the first drop. If more than 15 seconds have passed, the test result may be erroneous and you should discard the test strip and repeat the test
• Dispose of used lancet into a sharps container (To reduce the risk of inoculation injury)
• Remove test strip from meter and switch meter off
• On completion of procedure remove and dispose of PPE to comply with waste management policy. (To prevent cross infection and environmental contamination)
• Decontaminate hands following removal of PPE (To remove any accumulated transient and resident skin flora that may have built up under the gloves and possible contamination following removal of PPE.)
• Decontaminate reusable equipment using a Trust approved cleaning wipe. Decontamination of medical equipment is essential to the effective delivery of patient care
• Document all actions, observations and results (including consent and patient perceptions) in patient records.
• The Blood Glucose Tracker – Documentation Form is enclosed for your reference :
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