September 3, 1999

Measuring a patient's blood sugar is much easier than it used to be for Gino Chisari, RN, clinical nurse specialist on Bigelow 11. Not only is the actual test easier, but the time-consuming manual documentation that goes with the test is now automated. Thanks to a new device called a glucometer, Chisari and other nurses throughout the hospital have an easier time completing this frequently-used test.

According to Maryann Walsh, RN, of MGH Patient Care Services, the new device is part of a performance improvement effort to make tests simpler, more efficient and more effective for patients, and to improve the overall quality of the testing.

"Implementing the use of this device was a major collaborative effort among the Laboratory Medicine division in the Pathology Department, Patient Care Services, Information Services, Materials Management and many others at the MGH, as well as departments at BWH and Partners," says Walsh, who works closely with the Laboratory Medicine staff.

Chisari's unit was a pilot site for the new glucometers. "Our staff overwhelmingly have endorsed this technology," he says. "It is simple to use, convenient and much faster than the hand-held meters we used before."

Nurses and other clinicians access the device by scanning their ID badge into its data bank, which ensures they are authorized to perform the test. The patient's blood sample then is placed onto a paper strip and inserted into the device. The results of the test are available within 45 seconds, and at the end of the day, all test results from each patient care unit are downloaded to a central location in the Laboratory Medicine division. Reports then are processed electronically and sent back to the unit.

"Our previous process required reams of paper to produce the reports once a month," says Domenic Misiano, an administrator for the Laboratory Medicine division. "Now with this technology, reports are produced electronically in 24 hours, which streamlines the documentation process. It also saves valuable staff time in producing the reports and allows them to be read in a more timely fashion."

The new blood sugar testing is one of several performance improvement efforts being made to enhance lab testing throughout the hospital.

The Point of Care Testing (POCT) program was developed to help lab-testing sites throughout the MGH provide more effective and efficient testing for patients, as well as help sites comply with state and federal regulations. Many departments on the main campus have lab-testing sites, as do all of the MGH health centers.

The POCT program helps sites with reviewing test procedures, evaluating and choosing the most efficient testing kits on the market, consolidating the purchase of testing lots to reduce prices, pre-evaluating test kits once purchased and preparing user manuals.

The program also is particularly effective in preparing sites for inspection by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). "JCAHO now views laboratory inspection as an institutionwide inspection, so the survey is more complicated than it use to be," says Misiano, who also is program manager for the POCT program. "With the POCT program, we can help educate all sites about necessary regulations before inspection, and more importantly, we can set a single standard of quality for lab testing regardless of where tests are performed or who is performing them."

As a result of this effort, the labs received a high rating of 96 during the last JCAHO lab inspection in 1997. A POCT oversight advisory committee also has been established to help review compliance and help sites address any problems.

All clinical lab-testing sites now are preparing for the next JCAHO lab inspection, which has been scheduled for Sept. 7 to 10. For more information about this survey or the POCT program, call Misiano at 6-3858, Walsh at 4-8763 or Leonard Tochka at 6-1462.