An On-line Quality Control System Achieves Analytical Goals for the Portable Glucose Meters From the Critical and Emergency Care Services in a University Hospital

摘要

Portable meters for blood glucose concentrations are used at the patient's bedside in Emergency and Critical Care services. Even though most devices have important technological advances that decreases operator error, the analytical goals proposed for the performance of glucose meters have been recently revised to reach <5% analytical error and <7.9 total error. We studied the old meters, and we found most devices with performance error higher than 10%. Besides, Emergency services have higher probabilities of manipulation errors due to higher number of patients, frequent changes in nurse personnel, and 24 h service. The aim of the present study was to establish a new on-line system to control portable glucose meters from the laboratory, together with an educational program for nurses working in Emergency room, Intensive care, Coronary Care, or Postsurgery Care services from a 1200-bed University Hospital, in order to achieve recommended analytical goals, so that we could improve the quality of diabetescare. We have evaluated the system by assessing total error of the glucometers using high and low glucose control solutions. The Hospital attends a population of 550,000 people and the Emergency Room attend more than 300 people every day. After three months, we have collected data from 40533 patient samples and 5642 control samples, obtained by 14 devices (PCx), directly from the control program (QC manager). The average of total error for low glucose level control (2.77 mmol/L) was 6.3% (range 5.5-7.6), and total error was even lower for high glucose level control (16.66 mmol/L): 4.8% (range 4.1-6.5). In conclusion, the performance of glucose meters used from Emergency Services in our University Hospital not only improved after the intervention but the meters achieved the analytical goals (total error <7.9% for low glucose concentration, and total error <5% for high glucose concentration), which will improve the quality of care of our patients.