A quality assessment scheme for blood glucose monitoring: competition improves performance

Quality assurance procedures are often ignored or forgotten about by wards involved in the blood glucose monitoring of patients. We have devised a complete quality assurance scheme for checking the ward performance of 38 B-M Reflolux meters and two B-M Accutrend meters. Quality control (QC) material, supplied commercially and distributed by the laboratory, is analysed and recorded daily by the wards (internal QC). In addition, a 'spiked', whole blood sample is prepared by the laboratory and distributed for analysis to all wards at six-monthly intervals (external QC). The laboratory also conducts a monthly survey of meter operation (quality assessment) based on a 'scoring system' that allows easy identification of poor performers. Poor performers are counselled accordingly and, if poor performance is persistent, their meter is removed. In our experience, the publication and distribution of ward quality assessment scores has increased competition between wards in terms of avoiding low scores, dramatically improved performance, and ultimately led to improved patient care.