This is to record any compliance issues:  

• DATIX 

• Password Sharing 

• Infection Prevention and Control 

• Incorrect Patient ID 

• Blood Gas Discrepant Results 

• Glucose Discrepant Results 

• Information Governance Requests (requests for patient records) 

There are also email templates in the spreadsheet to send to ward staff when we have seen badge sharing and IPC issues.  

We should also submit a Datix to report the incident.  

If a machine is left in a poor state when you arrive to do changes (covered in blood, syringe left in the machine, etc.), you can speak to a Nurse in Charge and point out that the machine isn’t safe to use when left like that. If you don’t feel comfortable doing so - let Band 4/6/7 know so we can raise it with their ward managers. It may be useful to take a photograph of the state the machine is left in. 

• Open the Compliance Log spreadsheet  and go through this with the caller – fill in as many details as you can.  

• Send the User the 'Incorrect patient ID' form 

• Once this has been returned to POCT - we can change the patient ID to one they have provided on the form. You can pass this to Band 4/6/7. 

• Find the patient result in question via Rapidcomm / BioConnect 'Patient history' search (make sure the time / date matches on the form provided as on Rapidcomm too) 

• For BioConnect - use the edit function, change the patient data and click save 

• For Rapidcomm - Double click the result - scroll down to patient ID, change the data, and click save 

• Email the user to let them know it has been actioned 

• They need to complete the Discrepant Results Form ASAP (we need to email this to them) - Q-Pulse: POCT-FOR-19 (Blood Gas), POCT-FOR-22 (Glucose)  

• Ask the caller if they have sent a comparison to the lab – if not, advise them to do this. They should run a comparison on another analyser as well, however on the lab results can be considered the most accurate/correct. 

• ALWAYS advice users in situations where they believe there are discrepant results - If possible, to run the exact same sample using the same patient ID through another close by BGA analyser so we have some comparison data. This is something you should advise to be done on all future patient samples involving that machine for POCT data comparisons. Advise caution to only use the results from the comparison machine. 

• Always inform Band 4/6/7 of any discrepancy issues. If none of them are in - The Duty biochemist (found in the blue room) is also available for advice 

• For BGA machines - Run a full calibration and 3 x levels of each QC. Any issues found during these checks or on the advice of clinical leads / review of QC chart data - Replace the full measurement and wash waste. 

• For Glucose machines - ALWAYS replace the meter. Bring the meter in question back to the office - and run 5 x days’ worth of consecutive patient data (Using QC as patient tests). Any issues found - Return the meter to Nova as faulty. If no issues are found - return the meter to the V&V'd spare Pool. 

• Exact location 

• Analyser details – either serial no., asset, name – so we can identify the correct machine if they have more than one 

• Description of the issue 

• If it’s an issue with staff access – take names of staff so we can check if they are in date or if there might be an issue with their cards rather than the meter 

If it shows dashes with a question mark, this is usually a problem with the sample (e.g., a micro clot or air bubbles), but they can try running the sample again as long as its within 10 minutes of taking the sample.  

If it shows dashes and up/down arrows, this means the sample is above or below the analyser’s ranges, so they may need to send a sample to the lab for a result. 

If it is blank, check Rapidcomm – A failed QC and calibration will display on the screen so staff should check this prior to running the sample. We can monitor this from the office and change cartridges if needed, but ward staff will need to go to a nearby analyser for these results until the QC/Cal passes. 

Glucose meters that are reported faulty can be swapped out with a spare, and the faulty one returned to Nova for replacement. 

Other meters – we should have a spare available in the office that we can give to the ward while we remove their analyser to send for repairs. Most, especially Siemens, just need reporting via email with the collection address. They will then send a decontamination certificate for us to print and complete and sent back with the analyser, and book the collection (Siemens is usually TNT) – they will send a shipping label to print.  

If the PAS number is used, the meters should be able to remember the patient and not display the override message – as long as the patient was on PAS prior to being scanned, and also that the meter is docking and transferring data correctly. NHS and A&E are still correct to use, but patients won’t be recognised using these.  

If they have just dropped the meter in a sharps bin and are asking to be able to retrieve it, pass on contact details for Infection Prevention & Control Advice – Monday to Friday 8.30am – 5pm: 

• Email: leedsth-tr.Infection-Prevention@nhs.net 

• Telephone: 0113 20 66339 

 
In the past, Sharpsmart (the company who provide the sharps bins) have been able to get meters out of the bin for wards, however I think they were contacted via IPC. There are Sharpsmart porters at the hospitals, but they may only be able to remove and replace the bins and not go inside them to get anything out. They might be able to provide more information.  

• SJUH: 07708478218 

• LGI: 07708478219 

If the meter is recovered from the bin, we can replace as if it is broken (the ward probably shouldn’t try to continue using the meter in case of infection). Make sure to carefully remove and package. Check with Nova if this can be returned to them.  

• That they are using this month’s QC and that they are running the correct level 

• We can look for this on Rapidcomm if their meter is connected 

• Make sure they are storing the QC in the fridge and letting it warm up for a few minutes before analysing, and that the strips are stored at room temp with the lid on 

• They can only be dipped into so many times (20?) before the sample is contaminated, so if a ward is using QC a lot for training or if their analyser is having issues and asking for QC often, this will mean they are using it quicker 

We can give them another set of QC if they are having issues, or theirs have been thrown away accidentally - but try and troubleshoot just in case it is user error! 

Wards will often call when they notice the date on the blue sticker is due/overdue – advise them:  

• If it is on the meter itself it can be ignored and we will remove it (if they ask why – explain it’s because the meters don’t plug in directly) 

• If it’s on a dock/base (or a machine that plugs directly into the wall), they will need to contact Medical Physics to perform the Electrical Safety Test 

• Unfortunately, the blue stickers aren’t anything to do with Point of Care and we can’t come out and perform the required tests.  

• If the ward has called Medical Physics and have been told they don’t have anything to do with POCT equipment – let the ward know that this is incorrect, and they will have to make it really clear that it’s a blue Medical Physics sticker, for the Electrical Safety Test on the base/docking station.  

If a ward wants their QC Day changing, we have to go to the ward at the day and time they prefer, switch QC off, then switch it back on and run a QC.  

It may be useful from now on, if we are made aware of a QC Day, to make a note of it in the Urinalysis Inventory, for when wards call with QC issues. It would be helpful if we know when their QC Day is set to, as they may not realise. 

If the test table is stuck inside the analyser, we can remove the bottom to get it back out. There are instructions here.  

Base disconnected - We will go to the ward and switch off the analyser and remove all of the wires. Give the analyser a wipe as this often occurs when its dusty. Then plug all of the wires in, ensuring they are tightened/in fully 

Staff have been trained and can’t access the meter/Not connecting to RAPIDComm – we are currently working on replacing the TP Links with Dongles. In the meantime, we can try to reset the TP Link, or we can bring the analyser back to the office, connect using an ethernet cable and after it has downloaded, return it to the ward.  

When you return a Clinitek Status+ for repair, please do not send in the Connect Platform, unless you are specifically asked to do so by our POC Support/Helpdesk Teams. The easiest way to diagnose whether a fault exists with the Status+ or the Connect Platform, is to remove all of the cables from the Connect Platform, and plug the power supply directly into the analyser. If the fault remains, the cause will be the Status+, rather than the Connect Platform. 

When returning a Status+, please make sure all the cables are unplugged (including the power supply). Failing to unplug the power supply can cause the analyser to be damaged in transit. Please do provide the unplugged power supply when returning an analyser. 

If the Connect Platform is required to be returned with the analyser, please liaise with our POC Support/Helpdesk Teams, and let them know that there will be two boxes to be transported. Sending the Connect Platform in a separate box, which is labelled, prevents it becoming lost in transit. Please do not tape two boxes together (with a single address label). 

Take as many details as you can when booking a session – their name, ward and phone/emails so we can contact them if we need to. It can also be useful to agree on a location where we will meet them e.g., by reception or by the analyser.  

We can train a couple of people at a time depending on what the training is and what room it will be (e.g., for blood gas training, the amount of people will depend on which ward, as some locations only have enough room for one-to-one training). 

Staff that are based on a ward and don't want to be Key Trainers can attend training with us, but try and encourage them to go to a Key Trainer! We can provide them a list of trainers nearby; these can be found in the analyser inventories. This just takes some pressure off of us and means we have more time available for Key Trainers who can’t be trained by anyone else.  

For glucose/ketone, we also provide monthly Nova sessions.  

• Email them with the Key Trainer email and link to POCT Devices and Supporting Documentation 

• Update Melvis – when we provide training, select ‘Trust Specialist’ instead of Key Trainer. For Nova/Siemens training, I think the option is ‘Company Specialist’. 

• If they are a new trainer – add them to the email list (we use the email lists to inform large groups of staff about EQA, upcoming Nova training, etc) 

• You can add ‘KT’ into the location on BioConnect or at the start of their Operator name on Rapidcomm, so we can identify Key Trainers that are being updated incorrectly 

Key Trainers can't train themselves or other Key Trainers - if they need updating, they need to book a session with POCT. However - check whether it’s an update they want or if they are just informing us of a new ID card number 

LGI Ext: ?23398

LGI Transfusion Team Ext: 23984

A couple of weeks before the session, the Band 4s will send an email out to the Key Trainer email lists to let them know the dates, times and locations of Nova training – this is so that they can book on if they need an update, but they can also pass this on to their wards. Both Key Trainers and Non-Key Trainers can attend the training. Nova will only go through the meter and how to use it, the additional Key Trainer training needs to be done by POCT.  

Ideally, we will go in at the end of the session and talk through KT information for the Key Trainers. If we can’t do it in the session, we can arrange to go to their ward another time (it takes 5-10 minutes).  

The Key Trainers should write on the register whether or not they are Key Trainers so that we are aware. 

Nova will give us the training registers – they will usually hand both to LGI. We then need to update access, Melvis etc as we would for a normal training register. The register should also be scanned and filed away in G Drive in case we need it again (very common for Key Trainers to say they have received training at a Nova session but we haven’t updated their KT status – ideally, we need to see if they wrote on the register that they were a Key Trainer. If they didn’t, it’s likely that we didn’t realise so didn’t provide the additional training).  

• They can contact us or their nearby key trainers (there should be at least 1 on each ward, and also nearby wards and clinical educators) 

• If they contact us – we can offer alternative solutions if it is urgent. For example – we can extend their access for a month to give them more time to attend training. This will only work for staff that have been trained previously.  

• Also, if they contact us, we can look into other possible issues – for example if they think they have been trained and lost access suddenly, could it be a new card? Is the barcode faded, and we can print a new one?  

• Ideally, new staff should approach someone for training when they first start, and not wait until they are working a shift alone/outside of POCT hours, when we aren’t able to provide help.  

• If they have a shift coming up where there won’t be anyone to run samples for them (for example a night shift), they should contact us prior to this so that we can find a solution – hopefully we can either give them training, or give them a list of all the nearby trainers so they can arrange training that day. In extreme circumstances, we could potentially offer phone training and give them temporary access.  

We have been asked if they can have an emergency OOH password for running samples – the short answer is no. But also, they shouldn’t need it due to the above.  

This will then be discussed in POCT committee and then FOPS. They will consider how many samples they will run, if there’s any similar tests available nearby, etc. 

If it’s a completely new machine that we don't already have in the trust, they can submit an 'expression of interest' form.  

For more details about the Approval Process, there is a flow chart on Q-Pulse (POCT-BEN-23) 

Q-Pulse:  

• Blood Gas - Application for New POCT Equipment: POCT-FOR-34 

• CoaguChek - Application for New POCT Equipment: POCT-FOR-38 

• DCA Vantage - Application for New POCT Equipment: POCT-FOR-36 

• Glucose/Ketone - Application for New POCT Equipment: POCT-FOR-37 

• HemoCue - Application for New POCT Equipment: POCT-FOR-39 

• Urinalysis - Application for New POCT Equipment: POCT-FOR-35 

• Expression of Interest Form (for a new service): POCT-FOR-41 

On wards that run both RSV and Covid, they should have 2 separate fridges to keep this stock separated.  

Glucose/Ketone - Strips and QC fluid are ordered from the pharmacy 

• Glucose L1 QC - 46947  

• Glucose L2 QC - 46949  

• Glucose Strips (Pack of 1800) - 42214  

• Ketone Strips (Pack of 50) - 46951 

Urinalysis – Strips and Cassettes are ordered through the pharmacy. Paper rolls are ordered from Siemens?  

• Urine strips - 4200746  

• Urine hCG Cassettes – 10310618 

• Urine Printer Rolls - 8727986 

We hand out Urinalysis QC monthly, but if they are having issues, we can check the problem and give them another set if necessary. 

Blood Gas - We hand out paper rolls and sample ports regularly. They may request some if they are running low so we need to go and hand these out. We get sample ports and paper rolls as part of the PolarSpeed deliveries, if you notice we are running low, make Band 4 aware so we can order more with the weekly PolarSpeed order.  

Biohazard Wipes – these are ordered through Supplies, the code is H9730.  

Blood Gas syringes – depending on the location, they will have a bi-weekly/monthly/quarterly standing order. Low usage areas are ad hoc – they will need to contact us. If we have syringes in stock, we can hand them out. If not, we can order them ad hoc. Make sure to ask if they need them with or without needles. 

• Capillary Tubes 500 x 175UL – 2043295 

• Capillary Tubes 50 x 175UL – 6440221 

• Non-Needle (Line) Syringes (box of 100) – 11561347 

• Needle Syringes (box of 100) - 11561349 

Capillary tubes are ordered ad hoc and are not part of the PolarSpeed orders.  

Wards may also want to order capillary tube caps:  

• Caps for Multicap-S Capillary Tubes 

• Pack size 100 – 10311054 

• Pack size 200 – 10328655 

We order BioHazard Wipes and Capillary Tubes for the lab – hopefully they will let us know when they are running out so that we can order them in time.  

DCA – Paper rolls and capillary holders – can be ordered from Siemens, the GP can order them directly? Spare Capillaries HBA1c 10 pack - Siemens code 0888741 £7.41 

DCA – Cartridges are ordered on the PolarSpeed for LGI (but eventually this will change to CfLM). IQC is ad hoc – we usually order around 90 which would last 3 – 6 months (this covers maintenance days and weekly DCA orders) 

There should be an entry for each error/cartridge. For example, if there is a D23 error that expires a Wash/Waste, and we replace this and then a D40 occurs, they would be listed as 2 errors.  

The Breakdown log is for our use. It is discussed at POCT Committee – we have a target of 98% uptime so anything below this is flagged.  

When you type ‘Non-Functional’, this is how it works out the down time of an analyser so the details must be correct – you will need the dates and the start time and finish time. Please check that these numbers are correct – it’s a common mistake to put the wrong date or times, or to leave them blank. When entries are completed incorrectly, it means the Band 4s must go through and correct them so we can put together the presentation for POCT Committee.  

Partially Down – e.g., D2/D3 errors and failed QC/cal that don’t affect the gases (the sample can still be run and a result for some of the parameters will be available) 

Non-Functional – A cartridge has expired, system errors, hard drive errors, there are failed QC/Cals/D errors that affect the blood gases (pH, pO2, pCO2). 

If multiple errors occur, these can be added to the same entry unlike the cartridge error log. But the start time would be the time of the first error, and the Finish time would be the time that all errors are resolved and the analyser is working correctly. We would write the first error that occurred, and any following errors in the ‘Follow Up Actions’ column. 

Blood Gas – Report by phone (0845 600 1955) or Teamplay Fleet. An engineer will come out to fix it.  

Other Siemens analysers (urinalysis, DCA) – Swap with a spare, try to fix in the office. If the issue can’t be fixed, email Siemens to report (you will need to give them the serial number, model and description of the problem. When arranging to send to them, they will need to know which address to collect from). They might give some instructions to try, but usually they will email back with a decontamination form we need to complete after cleaning the analyser (attach to the analyser or place in the box with the analyser), and they will book for TNT to collect (usually next day) – they will send the shipping label to attach. 

• Run QC replicates – usually 3 sets of QC over 3 days. There is a spreadsheet to record the results here, which Band 6/7 will need to review and sign off 

• For DCAs – as well as QC replicates, run a mini maintenance (optical test). 

• Glucose/Ketone – as Nova send out new replacements rather than repairing the meters, we would V&V these before putting them into circulation.  

Find out why they don't want it anymore - if it’s because no one knows how to use it, for example, we can arrange training sessions for them. 

PolarSpeed should unbox and put away their deliveries. They will also do a stock check and deliver ambient storage (paper rolls etc) to the office.  

When deliveries arrive ad hoc, we have to unbox them and put them away.  

The following are part of the PolarSpeed order:  

• DCA cartridges 

• Blood Gas measurement cartridges 

• Wash/Waste cartridges  

• AQC cartridges  

• 1200 Reagent and Wash 

• Paper rolls 

• Sample ports 

• EQA adapters (for blood gas EQA ampoules) 

• 1200 Waste Bottles 

• 1200 Deprot and Conditioner 

1200 Sensors and Sensor Fill Solution aren’t included on PolarSpeed – we order these ad hoc – however they are included in the Blood Gas stock log. When the PolarSpeed delivery arrives, all of the stock should be checked and added to the Stock Log. The best way to do this, is to go through each tab and make sure it matches what we have in stock.  

If previous stock is missing, highlight it red and write ‘Missing’ in the comments. If stock has passed the expiry date, write ‘Expired’ in the comments and throw it away.  

It’s important to do weekly stock checks as we rely on this to monitor what we have, upcoming expiry dates, and to make the weekly PolarSpeed orders. 

The stock logs for all analysers except blood gas will be in the analyser inventories. 

• CoaguChek strips and QC – we hand out stock to wards at least every 2 months  

• i-Stat and HemoCue – We don’t hand out stock to the wards, but we do need to make sure we have cassettes/cuvettes and QC in stock for EQA (Alinity and HemoCue every 2 months, i-Stat 1 monthly). When running the EQA, if you notice we won’t have enough stock for the following EQA, let a Band 4 know so that we can order more in plenty of time  

• Liat kits and QC – Keep an eye on how much we have and expiry dates and let someone know if you think we are going to run out soon so we have plenty of time to order more 

Q-Pulse 

• Replacing the Automatic QC Cartridge (AQC) Instruction Sheet: POCT-BEN-10 

• RL1200 Automatic QC cartridge Delivery Suite Only: POCT-BEN-14 

• RP500 Replacing the Measurement and Wash-Waste Cartridge: POCT-BEN-13 

• RP500 Replacing the Wash Waste Cartridge Instruction Sheet: POCT-BEN-11 

• RL1200 Replacing the Wash Cartridge Delivery Suite Only: POCT-BEN-16 

• RL1200 Replacing Reagent Cartridge: POCT-BEN-15

These vary depending on the meter, but generally we need the following information: 

• The faulty meter name, serial number and asset number 

• The replacement meter name, serial number and asset number 

• The reason for the swap 

• The date of the swap and your initials 

• If it has been reported to the manufacturer and if so, the date and the reference number. 

• For meters except glucose/ketone – the dates of when it has been sent for repair and returned from repair 

There is an Analyser Swap Out Form (Q-Pulse: POCT-FOR-10) which can be used to get signatures from ward staff involved – we have used these previously as there have been issues when wards have said we haven’t fixed/replaced their meter, or that they have a missing meter because we’ve taken it away and not returned it.  

This isn’t to be confused with the Removed Equipment Form, which is for when a ward/GP is returning their meter to us because they’ve decided they no longer need it.  

If we are sending a spare DCA, we either need them to send us a list of staff and their codes to add on, or we need to check that their Key Trainer knows how to add people on themselves.  

What do we check when scoping a location for a new meter install or move? 

• A sink nearby 

• Clinical waste and/or sharps bins 

• Plugs and network ports 

• That food isn’t stored nearby/general health and safety 

• For urine – it’s not in direct sunlight 

Alerts should be acknowledged within 1 hour of the alert being raised. Once actions have been taken and the alert has been acknowledged, we should monitor the sensor to see if the actions taken have resolved the cause of the alert. 

Never move a sensor from the location it is required to monitor unless specifically instructed by the Quality Team 

Things to watch out for:  

Urine EQA - Blood results should be negative. If they aren’t, this usually means the test table needs cleaning or the sample is contaminated. 

Bilirubin - Like Co-Ox EQA, we can usually run 3 machines per sample. This is light sensitive. Remember to switch display question result on/off. 

• We need to run the samples on i-Stat 1 Spares 1 and 2 in our office 

• We need to hand out a set of samples to LGI and SJUH labs for them to run Lactate – ask if the machine is working and they are ready for the sample beforehand, as we can give them the samples, we run on the lab BGAs. LGI will give the results to us to input for them.  

Double check the serial number on WEQAS against the serial number on the print out.  

Make sure the information that has been requested is completed – this is usually date received and date of running and storage conditions. For Liat, they will need the Lot number and expiry date of the cartridge used. 

Also, double check the Distribution (e.g., BG0824) is correct.   

Blood Gas:  

• Inputting Blood Gas - H+ should be left empty.  

• Watch out for the parameters as they are usually a slightly different order on WEQAS than the print out. 

When you send a new meter to a non-trust satellite, after it has been set up and docked, switch the connectivity off – this is because they have docks for charging, and it may confuse the meters if they are docked and can’t connect.  

Barcodes – as they aren’t connected, training isn’t updated like it is on wards at main sites/trust satellites. They are given sets of barcodes that we print. When the Key Trainers train their staff they give them one of these barcodes and send us a training register, so we can update this on the spreadsheet.  

The meters need updating regularly – dock them every couple of weeks to update. The connectivity of the training meters should always be off, so remember to switch it on to dock and then switch back off. They should also be deleted from BioConnect and NovaNet regularly.  

When handing out training meters – make sure there are enough batteries and that they have been charged. Make sure there are plenty of strips and QC fluid and that they are all in date.  

For example, SJUH Ward 81 are given a 4^th meter, this would be J-81 4A. If that breaks and they need a replacement, the next meter is J-81 4B.  

If the ward only has 1 meter, stick to letters rather than numbers – for example, if LGI Maternity Assessment have 1 meter, this would be L-MAC A, then L-MAC B and so on as they get replaced. This is to avoid any confusion in how many meters a ward should have – for example if it was named L-MAC 1 this might suggest they should have more than one. And if it’s replaced with L-MAC 2, someone might think they should have 2 meters.  

It’s also important as we use NovaNet to check connectivity, if the meters are all named in different formats, it will be harder to look for them, and unless we check for or notice that the naming format is different, it might be assumed that some meters don’t exist (as in, were never given to the ward or docked). 

Example: (4) J81 Glu/Ket KT Training 

Once you have done a training session, it can be useful to edit the entry on the calendar to say how many of those booked on attended, and make a note of who did and didn’t attend, and any other changes that may have happened while on the ward (e.g., if someone booked in for glucose training and then also asked for blood gas training, or they weren’t originally going to be a Key Trainer and then changed their mind. Or if you go to a ward to train 1 person, and when staff see you, they ask to join). 

Some low usage wards will expire on time, meaning the date on the cartridge is when the cartridge will expire, because they won’t use all of the samples. It’s useful to be aware of the high/low usage wards and how to check if a cartridge needs changing, as replacing them too early is wasteful and it also means we go through stock quicker. For example, when a measurement cartridge is on 20% - at a high usage area this could last another 1-2 days, on a low usage area this could last up to a week.  

Q-Pulse: Opportunity and Solution Form (CQI board) BSHC-FOR-6 

We strongly recommend first checking for an available free socket, even if this requires relocating the device. If no free socket is available and the device fails, the use of a splitter may be considered as an acceptable last resort.

Please be aware that in certain areas of the hospital, for example Jubilee (LGC02, 03, 04, 05 & 06 sockets) and certain areas of CAH, we are unable to use splitters, but we can confirm that when you raise a ticket.

Unfortunately, we do not stock splitters, we would therefore be grateful if you could arrange to purchase some using the link below, so that they can be kept in your storage for future use – we would just need to arrange to pick one up from you for the cab side when needed.

Please note that for each socket there is a requirement to use two splitters—one at the socket side and one at the cab side.

Buy CE RJ45 Ethernet Splitter/Economiser - Pair - Cable adaptor

Going forward, if any device fails and a splitter is required, please quote WO252658 as confirmation that this is approved.

Quality Benefits

• Printed results/connectivity = no transcription = reduces medication errors (e.g. starting/withholding antibiotics based on wrong UA values)

• Blocks results from compromised strips = avoids acting on invalid data

• Traceability for audits (UKAS/ISO)

• Identifies bad strips and common interferences = reduces false positives/negatives

Reduced risk of missed UTIs

How: UTI diagnosis often relies on nitrite and leukocyte esterase on dipsticks.

• Visual reads are vulnerable to timing errors (reading too early or late) and colour misinterpretation, especially under poor lighting (sluices).

• Clinitek provides precise timing and uses a colorimetric reader, eliminating human subjectivity.

Impact:

·        Fewer false negatives = timely antibiotic initiation, avoids sepsis progression in frail/catheterised patients.

·        Consistent interpretation across staff = less reliance on experience/shift variation.

AKI Screening 

How: Dipsticks detect protein and blood which can indicate renal injury.

• Autamated reading reduces under-reporting of trace or mild positives, (can be early markers of AKI or glomerular disease).

Impact:

·        Early recognition = faster escalation (bloods, fluids, medication)

·        Especially relevant for post-op, septic, elderly patients, where AKI risk is high.

Please test the enclosed sample as if it were a patient sample, using your usual method.

Please record your results, meter serial number and strip / cassette lot number on the results return sheet (input sheet) below, scan and send it to the following email address:

Leedsth-tr.pointofcare@nhs.net

All results must be returned by the return date stated above. Please keep a hard copy of the results for your records.

Please ensure that all operators take turns to participate in the EQA programme. This procedure should not be carried out by the same operator on each distribution.

Posters must pass quality checks e.g.:

Index code = document control code for qpulse (given by Emma)

Version number = So staff know which is the most up to date document

Page number = page 1 of 1 to make sure there is no further information/page missing

Things to keep in mind when designing posters:

1. Does it already exist? Search key words on qpulse/ask team

2. Quality Improvement = does it improve the service/is there a need for it

3. LTHT/professional branding

4. Accessible to those who's first language is not English

5. Accessible to those with visual impairment - see Trust guidance on this

6. Is it aesthetic - we want to make wards look interesting for staff, as well as driving engagement with the poster

Issue 1

For an operator download to be accepted by the instrument all the operator certification date fields must contain valid date information. RAPIDComm does not check that this field is filled during operator import or download, and this can lead to empty certification date fields being included in the operator download from RAPIDComm to the instruments.

Every time the instrument receives an operator record without a certification date it sends a 'REJECT' message to the data manager. RAPIDComm then restarts the communication link and the process will start again, leading to an endless loop where stable communication is never re-established until the operator download contains valid data.

A tool has been released that allows quicker diagnosis of the cause of these issues.

Interim Solution:

Siemens PC Informatics R&D have released a software tool that will identify and automatically correct RAPIDComm operator accounts that are missing a certification date. When the tool finds an operator with a missing certification date it will enter a certification date 7 days into the future by default, but this value is configurable and can be set to a value that suits the customer's needs.

Issue 2

When existing operators are edited, if the RAPIDComm system notices that a value entered into a unique field is non-unique (e.g. a duplication of an operator ID or similar), RAPIDComm provides a warning that this information cannot be saved and prompts the user to make another attempt. The user enters unique data, and the information is encrypted. There is an issue within RAPIDComm that retains the encryption from the first attempt, and the second attempt before sending it to the device. The device attempts to decrypt but can only do so with the second decryption. This causes the password of the operator to appear to the device as either falsely too long, or contain special characters.

Every time the instrument receives an operator record where the password is too long or contains unsupported characters, it sends a ‘REJECT’ message to the data manager. RAPIDComm will then restart the communication link and the process will start again, leading to an endless loop where stable communication is never re-established until the operator download contains valid data.

A complete solution is being considered for a future release of RAPIDComm software.

Mitigation

To mitigate these issues, firstly please speak with Tim Hodkinson and ask if the tool is installed upon your server to help diagnose issues quicker.

Secondly, please make sure that all operators have a valid certification date, to prevent blank information being sent to the devices (and therefore rejected).

Thirdly, please be careful when amending current operators, and be mindful of creating duplicate data within fields that should be unique. This prevents data being encrypted twice, and being rejected by the device.

Multistix 8SG - correct strips

Multistix GP - incorrect, EXACT same packaging apart from name.

See picture for difference, the analyser wont recognise the GP strips as they don't have the extra white pad with ID on.

Some buffer stock is stored within Pathology.

UTM = Universal Transport Media

VTM = Viral Transport Media

debora.hardy@nhs.net

julie.foster19@nhs.net

'There is a clinical need for the analyser, but it's use is infrequent so any training offered would be well received.

BW,

Julie.'

FilePath =  G:\Point of Care

1. could the gloves be near clinell wipes?

2. could the capillaries be stored near clinell wipes?

3. could the patients be cleaned with chlorhexidine prior to taking sample?

4. could they be drawing samples from lines cleaned with clinell without flushing them first, or discarding of first few drops of blood?

During EQA testing, barcode entry can only be used for Operator ID – Just something to also consider.

Basically - this function only exists on the RP500E analysers, and we currently have less of these than we do the older model

Samples must be hand delivered to CfLM within 30 minutes of collection (do not send via pneumatic tube, as it can interfere with the gas measurements and pH levels, which may compromise the accuracy of the results.)

Upon arrival at the lab, kindly inform reception that the sample is pleural fluid requiring immediate or time-sensitive blood gas analysis. The team will ensure it is prioritised accordingly. 

Do they need to send an ICE form?

It needs to be requested in the same way that they would request any other pathology investigation. They should be able to find it on ICE by searching for the term “fluid ph”.

We don’t have any plans to make pleural fluid testing available at ward level in the near future.

Add to invoice box

Send to supplies

The Trust doesn't pay until they have had invoices

The fan speed for the RapidPoint (500) is faster than the RapidLab (1200) and having a filter part number for each suggests that the filter material is different for this reason

If you are not seeing the green connected symbol, try logging in so the analyser has some info to send.

Use the search function at the top right to narrow down results.

LGI CT:x23617

Please call before iSTAT troubleshooting to ensure no clinics.

Martin Wing D Floor

Leeds General Infirmary

Great George Street, Leeds LS1 3EX

Acute Hospital Laboratory

Jubilee Wing A Floor

Leeds General Infirmary

Great George Street, Leeds LS1 3EX

Centre for Laboratory Medicine

St James Hospital

Beckett St

Harehills

Leeds LS8 5RA

W3W//listed.successes.lodge

Chapel Allerton Hospital

Chapeltown Rd

Leeds LS7 4SA

Seacroft Hospital

York Rd

Seacroft

Leeds LS14 6UH

Wharfedale Hospital

Newall Carr Road

Otley, LS21 2LY

Pathology Reception

Chancellor Wing

St James Hospital

Beckett Street

LS9 7TF

LGI Office: (0113 39) 22338

LGI POCT Only Ext: (0113 39) 23639

Mobile: 07775996028

SJUH POCT Only: (0113 20) 69410

The process below describes how to erase patient data from StatStrip Glucose/Ketone, StatStrip Lactate or StatSensor Creatinine meters. Patient data must be erased before the meter is returned to our offices, in order to comply with The Data Protection Act 1998.

1. Dock the meter and wait until communication is completed.

2. Undock the meter

3. Change the date e.g. one year in advance

a)     by logging in

b)      go to the ‘Menu’

c)     press ‘Admin’

d)     Time/Date to a year in advance

4. Dock the meter

There should no data on the review results screen and the review facility should disappear from the screen.

For any problems or queries, please email support@novabiomedical.co.uk

Even though the analyser was on DHCP mode, it doesn’t request DHCP address every time its moved around, or been off for a longer time. It holds the old IP given by DHCP, doesn’t release it when it goes off.

As DHCP addresses are dynamic, they will be reused if they aren’t live in the network.

Manually force the device to initiate a new DHCP request from the analyser by disabling and reenabling the connection to reset it.

Level 1 Mean: 371 umol/L

Level 1 Range: 301-442 umolL

Level 3 Mean: 44 umol/L

Level 3 Range: 9-80 umol/L

Although the ranges are from an old lot, we have found that similar ranges have been applied to subsequent lots. They are unfortunately excessively wide and could result in considerable deteriorations in renal function going undetected.

To give just one example, an elderly patient with low muscle mass, and therefore a low baseline creatinine, who has an increase in creatinine from 35 to 79 umol/L (consistent with acute kidney injury stage 2) could have their creatinine reported as 40 umol/L (or even 9 umol/L, if you want to take it to the extreme) rather than 79 umol/L due to an analytical problem. This analytical issue would not be detected using your QC ranges, as any result between 9 and 80 umol/L would be considered a pass, and the inaccurate patient result would therefore be issued. As acute kidney injury can lead to permanent irreversible kidney failure, administering contrast to this patient could have serious consequences. Use of such wide QC ranges on the iSTAT could lead to this very scenario. Use of tighter QC ranges (which we have shown in LTHT the device is capable of – see below) would detect poor performance much more readily, and significantly reduce the chance of this occurring.

Our own QC ranges for this specific QC lot were:

LTHT level 1 QC range: 368-396 umol/L

LTHT level 3 QC range: 35-45 umol/L

These were derived using a total of 60 data points collected from four machines over three different days (mean +/- 2SD). You can see that these are much tighter than the official ranges from Abbott, and show that the device is far more capable than your own QC ranges suggest.

Because of this issue, we have to determine our own ranges for every new lot of QC used. This causes a significant administrative burden, in addition to patient safety issues, and as I believe I mentioned when we met, would influence our decision to use the iSTAT if given the choice again.

SJUH + LGI Radiology/CT have the iSTAT Alinity - CT scans often involve injecting an iodine-based contrast dye to improve image clarity. Since healthy kidneys are necessary to safely excrete iodine, it’s important for the wards to know if their patients kidneys are compromised before administering the contrast.

To check kidney function, the ward monitors creatinine levels using the Alinity. Creatinine is a waste product from muscle metabolism, and elevated levels can indicate impaired kidney function.

Yes, theoretically the Coaguchek does have this capability. Sadly, it hasn't been set up for our Trust. I've attached the Ward Handbook mentioned in the business case so you can take a look at the system currently in place.

I have queried if we could make your idea the thing that pushes for connectivity work to begin, unfortunately the info I have gotten back from my coordinator is that the departments involved in implementing this, namely DIT does not currently have the capacity to take it on. They are currently working through their workload in order of highest risk, and for the work to proceed it needs to be ranked as one of the CSU's top priorities.

I am in a meeting tomorrow where I can ask for further clarification on how you could request this (how realistic is your implementation of using POC INR testing, if results needed to be transcribed over to PPM+?). But I think it's important to note it sounds like implementation of this would not be quick. In short, it involves an Expression of Interest (EOI) submission followed by some pretty in depth end-to-end testing involving POCT, DIT, and middleware/PPM+ reps.

Please let me know your thoughts on this, or if you need any more information.

Best,

• If a cartridge is installed on or before the install by date, it works at full capacity (100%).

• If it is installed after the date has passed, the analyser will still accept it, but the cartridge won’t perform at its full potential. Its usable capacity is reduced (for example, to around 80%), meaning it will need to be replaced sooner than usual.

• A cartridge should not be installed once it has passed the expiry date - it should be disposed of

• 
  

In simple terms: Think of the “install by” date like the freshness date on food. You can still use the cartridge after that date, but it won’t last as long or work as efficiently, so you’ll have to change it earlier.

If a ward reports suspected incorrect results from a blood gas analyser:

• Change the cartridge: As a precaution, replace the measurement cartridge.

• Check the environment during installation:

  • Ensure there are no Clinell wipes nearby.

  • Look for analyser messages such as “Excessive sodium interferent detected.”

  • Note the time cleaning staff were present. If cleaning coincides with the analyser issue, it may suggest Clinell wipes were used around or on the analyser.

• Report details: Share all observations with the Band 4/6/7 staff.

• Escalation if recurring: If they identify this as a regular occurrence, they can liaise with the relevant departments to ensure the issue is addressed promptly.

Ketone testing is not validated for arterial blood

If patients hands are overly cold before pricking, suggest the staff warm it up by filling a glove with warm water to stimulate the blood flow

Key reasons for this gel-like transformation include:

• Bacterial Contamination: The most common cause is the introduction of bacteria into the vial, which metabolizes the preservatives and causes the liquid matrix to turn into a jelly-like substance.

• Improper Storage/Temperature Excursion: If the control is left at room temperature for too long or exposed to heat, the stability of the solution is compromised, leading to polymerization.

• Expiration/Degradation: Over time, the chemical composition of the QC material degrades, which can cause it to become unstable and form a gel. 

  
  

Recommendation:
If the urine control has turned into jelly, it should be discarded immediately, as it is no longer suitable for accurate testing. Always ensure the bottle is capped tightly and stored at the recommended temperature (usually 2-8°C, or as specified on the package insert) to maintain stability. 

You can order these through Oracle.

Options:

Urinalysis labels:

Product details for HHH473 - NHS Supply Chain Online Catalogue

Urinalysis sticky labels:

Product details for HHD219 - NHS Supply Chain Online Catalogue

To do this we will require you to submit a Trace Log from the RP500e to the Siemens Healthineers POC Helpdesk. The submitting of the Trace Log is crucial as it not only allows us to investigate the root cause of the issue and seek to implement product improvements but also calculate the unused percentage of the affected cartridge that we need to replace and send to you.

Trace Logs can either be submitted automatically by the RP500e via email if given the necessary permissions by your local IT Network team or copied on to a USB stick inserted into the RP500e and then attached to an email which is then sent to the Siemens Healthineers POC Helpdesk team.

In the middle of each calendar month, we will collect up each of your submitted Trace Logs, calculate the percentage of the cartridge we need to replace and organise the delivery of every full cartridge (100% volume owed) to be sent to you, as well as provide you with a report stating the cause of the cartridge to be replaced, and the percentage of the cartridge each Trace Log instructed us to replace for complete transparency throughout the process.

Where an owed percentage is less than 100% of a cartridge this will not be replaced in the current calendar month but will be carried over to the following month before being replaced. (e.g. Should Siemens Healthineers owe you 425% of an MCart over a calendar month, we will issue 4 x MCart replacements and carry the remaining 25% over to the following month).

Chlorhexidine

Perhexiline Maleate

Atomoxetine Hydrochloride

Benzalkonium compounds

Source: Siemens engineers

Find a spare meter, dock, and ethernet cable. Make sure they are all working correctly before taking them onto the ward.

Use the spare, working equipment to troubleshoot. Try each item one at a time — do not replace all of the ward’s equipment at once, as this defeats the purpose of troubleshooting.

• Try the new meter in the ward’s dock.

  • If it works, this is a meter issue. Check the meter settings or swap the meter.

• Try the ward’s meter in the new dock.

  • If it works, this is a dock issue. Swap the dock.

• Try the ward’s meter and dock with a new ethernet cable.

  • If this works, the issue was a faulty cable. Leave the working cable on the ward and bring the faulty one back for disposal.

If none of the above works, the issue may be the network port. Contact IT to:

• Activate the port if required

• Confirm multiple MAC address access (especially for dual or quad docks)

This process should help identify which element is causing the problem.

More In-Depth Instructions: 

1. Dock & Power Checks

• Is the meter connecting in the dock?

• Is it connecting according to NovaNet? You could check BioConnect to see if we are receiving QC or patient results

• Are the dock lights working?

• Is there any physical damage?

  • Damaged cables

  • Damage where the meter connects

  • Damage to the network port socket

• Is the dock plugged into:

  • Power socket

  • Network port socket

• Has the ward:

  • Changed the dock location?

  • Used the network port for another device as well as the dock?

• What type of dock is it?

  • Dual/Quad docks may not be set up to allow multiple MAC addresses

Make a note of the network port details and the door number – contact IT to check if the port is active or not – and if it is active for multiple MAC address if a dual/quad dock.

This will help us determine if the network port is the issue, or something else.

2. Swap & Test Equipment

Take:

• A meter you know docks successfully

• A spare dock that you know works

• Spare ethernet cables that you know work

Make sure all the above are working before you take them out to the ward.

Test in this order:

1.      Dock the known working meter in the problem dock. If it docks the issue, is the original meter.

2.      Dock the problem meter in a new dock – if it docks, the issue is the original dock

3.      Try a different ethernet cable. If it docks, the issue was a damaged cable

Actions after testing:

• If cables work → leave them

• If new dock works → consider an exchange

• If meter is faulty → check settings or exchange meter

👉 Always update inventory and exchange log if an exchange is performed

3. If the issue is definitely the meter – Check Settings

• Check Srv Host:

  • Must be POCT-NOVANET or POCT-NOVANET2 (site dependent)

This is often left blank, as it won’t allow both Srv Host and IP to be input when setting up. After the first dock/update, you can usually enter the Srv Host manually. This has fixed connectivity issues for me before.

• Additionally – check the entire IP and Port numbers, there are sometimes typos.

• All meters should be set to DHCP

Meter settings should be:

LGI:

Srv Host: POCT-NOVANET

Srv IP: 163.160.231.49

Srv Port: 57386

SJUH:

Srv Host: POCT-NOVANET2

Srv IP: 163.160.231.45

Srv Port: 57386

You can try swapping the Srv Host and IP to the other site’s details, to see if that works.

• Standard format for PCs running Windows OS only

• Not ideal for cross-platform use or embedded/medical devices

FAT32 (File Allocation Table 32)

• Most versatile and widely compatible format

• Cannot store files larger than 4 GB

• Ideal for medical devices and embedded systems

exFAT (Extensible File Allocation Table)

• Newer version of FAT with support for very large files

• Good for modern USBs with large files, but not always compatible with older or embedded devices

UDF (Universal Disk Format)

• Designed mainly for optical media (DVDs, Blu-ray discs)

• Can handle large files and is cross-platform

• Not supported on medical devices; should not be used

  
  

✅ Simple Takeaway

• UDF → designed for discs, not typical USB use

• FAT32 → most compatible, especially for devices

• exFAT → best modern choice for large files

  
  

Most USBs we use are already formatted as FAT32. Some may have other formats, but FAT32 is the safe default.

i-Stat Alinity Software Updates, VAS/eVAS, etc:

• Must be FAT32 format

• Must be USB 2.0

• Allocation unit size can be the default but safest choice is: 4096 bytes (4 KB)

This is 5 boxes (20 white boxes) every month.

Siemens send out the order at the end of the month, so will arrive with the ward around the start of the month.

We should have some DCA Carts in our cold room in case they need some ad hoc between SO deliveries.

^{Purpose: Check for pseudohyponatraemia caused by lipaemia}

^{Requirements: Serum sample. Avoid EDTA samples (damages potassium sensor). Must be capped if not checking gases.}

^{Stability: No time limit if capped; if uncapped, sodium levels may change due to evaporation}

Pleural Fluid pH

^{Purpose: Determine if pleural effusion is Transudate or Exudate}

^{Requirements: Heparinised blood gas syringe. Hand deliver only. Hand delivery prevents gas displacement.}

^{Stability: Must be run within 30 mins of collection.}

Carboxyhaemoglobin

^{Purpose: Detect carbon monoxide poisoning}

^{Requirements: Non-gel heparin tube (green and black). Run as whole blood (plastic capillary tube or syringe)}

^{Stability: 28 days}

Methaemoglobin

^{Purpose: Check for methaemoglobinaemia, reduced oxygen carrying}

^{Requirements: Non-gel heparin tube (green and black). Run as whole blood (plastic capillary tube or syringe)}

^{Stability: 2 hours}

Patient ID and Record Keeping:

Use Winpath nomenclature. Lab numbers are 7 digits like PAS numbers, so using a lab number can mean that the result will assign to an incorrect patient on EPR.

Common Reasons:

• Missing or Outdated Certifications: The operator has not completed the required training or recertification required for the system

• Download Error: The instrument did not receive the updated user list from the RAPIDComm master database during the last synchronization.

• Operator Database Synchronization Issues: The operator was recently added or updated in the system, but the changes have not yet propagated to the specific device.
  

How to Resolve the Error

1. Re-synchronize the Device: Force a manual communication download between the device and the RAPIDComm system to ensure it has the latest operator list.

2. Verify Operator Status in RAPIDComm: Check the RAPIDComm Web Application to verify that the operators in question are marked as "Certified" and are assigned to the correct device group.

3. Check Training Completion: Ensure that all certification, training, and assessment documents are updated for the rejected operators.

4. Confirm Device Connectivity: Verify that the device is online and properly communicating with the server. 

If the issue persists, the operator may need to be removed and re-added to the operator management system, or the device may require a reboot to clear its operator database.

This means we have to be careful if meters are removed to investigate discrepant results or datix incidents - if these aren't acted on quickly, and the meter is just kept in the office waiting for investigation, the results may delete themselves if not docked and backed up to NovaNet and BioConnect

 Within NovaNet, there is a specific configuration under Data Archive > Discard Patient Results, which defines how long NovaNet retains results before they are archived. Once results have been sent from the meter to NovaNet and BioConnect, they can be retained and accessed in BioConnect indefinitely, as it has the capability to store this information long‑term.

Source: email from Nova, April 2026

Depending on the level of dust and lint in the air where the system is being used, the air filter may need checking and replacing more frequently.

Keeping the air filters free of lint and dust prevents the analysers from experiencing temperature errors.

500e - we can add ranges for all sample types; but currently we have only done this for arterial. This is potentially planned in to update along with the analyser refresh. Currently, they will print arterial ranges with results but they won't print ranges for the other sample types

Sodium, Potassium and Chloride measurements are used to aid in diagnosis and treatment of electrolyte imbalances.

Ionised calcium measurements are used to aid in the diagnosis and treatment of parathyroid disease, a variety of bone diseases, chronic renal disease, and tetany

Glucose measurements are used to aid in the diagnosis and treatment of diabetes mellitus, hypoglycemia and hyperglycemia.

Lactate test is intended to measure lactate in whole blood. Lactate measurements that evaluate the acid-base status are used to aid in the diagnosis and management of acidosis (anion gap), shock and sepsis.

Neonatal Bilirubin test is intended to measure the levels of bilirubin in the blood of newborn infants to identify hyperbilirubinemia that can lead to kernicterus.

Total hemoglobin measurements are used to aid in the diagnosis of anemia.

Oxyhemoglobin measurements are used to aid in the identification of impaired oxygen update leading to hypoxemia.

Carboxyhemoglobin measurements are used to aid in the diagnosis of carbon monoxide poisoning.

Methemoglobin measurements are used to aid in the diagnosis of methemoglobinemia.

Deoxyhemoglobin measurements are used to aid in the evaluation of hypoxemia.

Report:

22/05/2026, cart number: 1234567890, D code / error, - insert action taken e.g. expired WW twice, resolved after MM change

POCcelerator moves - 01/04/28

We do use a very thin layer of Vaseline (paraffin - can't remember the hospital brand) to help the blood pool also."