In-hospital bedside blood glucose monitoring: the importance of a quality control program

This study examined the adequacy of a quality control program to assure accuracy of blood glucose monitoring performed at the bedside by nurses in a general pediatric hospital. A standard quality control program during which all nurses received inservice training and demonstrated proficiency resulted in accuracies (percentage of values within 15% of the laboratory) of only 68.6% and 69.2% over two successive 3-month periods. A standardized refresher course did not improve accuracy. Expansion of the program to include identification and reinstruction of individual nurses who had more than 20% of their blood glucose measurements more than 10% off the laboratory value or any one value more than 40% off the laboratory during the previous quarter resulted in improved accuracies (83%, 78%, and 91%) over three successive 3-month periods. These findings indicate that a systemic quality control program including individual monitoring and remedial retraining is required to improve the long-term accuracy of bedside blood glucose monitoring by nurses in a general pediatric hospital.