Point‐of‐care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients

Abstract

Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.

What Can We Learn From Point-of-Care Blood Glucose Values Deleted and Repeated by Nurses?

“…Our initial work in this area identified likely POC BG measurement/operator errors that followed a consistent pattern, an extreme (high or low) POC BG value that was followed within 5 minutes by a POC BG that was normal or continued the previous POC BG trend for that patient without any documentation of intervention. 6 This project confirms the frequency of these POC BG measurement/operator errors. Initial POC BG values <40 mg/dL, 40-69 mg/dL, or >400 mg/dL were commonly deleted and repeated ( Table 2).…”

“…While our previously published QI project provided evidence for the hypothesis that erroneous POC BG values are frequently included in the EHR for ICU patients at one institution, 6 this project proves this hypothesis conclusively for all hospitalized patients at two large tertiary care hospitals. While untested, it is likely that our findings are applicable beyond our own institutions and that other hospitals may want to explore the option to give RNs and AP the opportunity to delete and repeat POC BG values that they believe are erroneous to prevent these values from being uploaded permanently into the EHR.…”

“…3-5 Recent work from our large regional academic medical center demonstrated that POC BG measurement errors cause an overestimation of hypoglycemic events in critically ill patients. 6 This work resulted in an ongoing quality improvement (QI) project at two regional academic medical hospitals to allow nurses (RNs) and assistive personnel (AP) trained to perform POC BG on patients to delete and repeat POC BG values that they believe may be measurement errors. The current work describes our findings from a 2-year evaluation of this QI project.…”

Validity of bedside blood glucose measurement in critically ill patients with intensive insulin therapy

“…Factors that physicians should consider for an appropriate and excellent glucose measurement and reporting system should include cost, accuracy, and time to result. [10] Several studies showed that POC blood glucose measurement with fingerstick capillary glucose measurement has high inaccuracy rate and seems to overestimate blood glucose levels[111213141516] in critically ill patients, especially those who are hypotensive, anemic, hypoxemic, have erythrocytosis, or receive vasopressors. [171819] This study compares the results of bedside blood glucose measurement versus laboratory blood glucose measurement in critically ill patients with intensive insulin therapy.…”