Reducing Treatment Errors Through Point-of-Care Glucometer Configuration.

BACKGROUND: Blood glucose (BG) testing is the most widely performed point-of-care (POC) test in a hospital setting. Multiple adverse events reported to the Food and Drug Administration (FDA) revealed that treatment decisions may be affected by information displayed on the POC glucometer's results screen. A randomized, crossover simulation study was conducted to compare two results screen configurations for ACCU-CHEK Inform II, a POC glucometer. METHODS: Prior to the study, a heuristic evaluation of the results screen configurations and a pilot study were conducted to select the two results screen configurations for comparison. At two multicampus medical centers, 66 nurse participants experienced two computer-based simulation scenarios that asked them to interpret glucometer readings and make treatment decisions for simulated patients with 32 mg/dL BG levels and subtle symptoms of hypoglycemia. One scenario displayed a numeric value ("32 mg/dL"), and the other displayed a range abbreviation, such as "RR LO" (out of reportable range; low). Treatment errors were recorded when the participant did not treat the hypoglycemic patient with glucose or when they administered insulin. RESULTS: When ACCU-CHEK Inform II displayed an "RR LO" reading, 10.6% of participants made a treatment error, including 6.7% of participants with prior training on the meaning of an "RR LO" reading. None of the participants made a treatment error when ACCU-CHEK Inform II displayed a "32 mg/dL" reading. CONCLUSION: Displaying a numeric BG reading eliminated potentially life-threating treatment errors caused by confusing range abbreviations. Manufacturers should consider these findings during future research and development of POC glucometers.

Comparison of chest compression interruption times across 2 automated devices: a randomized, crossover simulation study.

OBJECTIVE: The goal of this study was to compare chest compression interruption times required to apply, adjust, and remove 2 different automated chest compression (ACC) devices using the same evaluation protocol. METHODS: Twenty-nine registered nurses and respiratory therapists used 2 ACC devices in separate resuscitation scenarios involving a patient manikin simulating a 45-year-old man in cardiac arrest in his intensive care unit room. Device presentation was randomized, with half of the participants using LUCAS 2 in the first scenario and the other half using AutoPulse in the first scenario. RESULTS: The mean chest compression interruption time to apply the ACC device to the patient was significantly shorter for AutoPulse (mean [M] = 31.6 ± 8.44) than for LUCAS 2 (M = 39.1 ± 11.20; t(28) = 3.65, P = .001). The mean chest compression interruption time to remove the ACC device from the patient and resume manual compressions was also significantly shorter for AutoPulse (M = 6.5 ± 3.65) than for LUCAS 2 (M = 10.1 ± 3.97; t(26) = 3.36, P = .002). There was no difference in the mean chest compression interruption time to adjust the position of the ACC device on the patient between AutoPulse (M = 14.3 ± 5.24) and LUCAS 2 (M = 12.5 ± 3.89; t(23) = -1.45, P = .162). CONCLUSIONS: The results of this study trended in favor of AutoPulse. However, the interruption in chest compression to apply either device to the patient was notably longer than the maximum interruption time recommended by the American Heart Association.