PERFORMANCE EVALUATION TOOL FOR BLOOD GLUCOSE MONITORING

Directions: Below is a list of criteria to evaluate the student's skill in Blood Glucose Monitoring.
Indicate your evaluation by writing the score using the following descriptive scale.
0 – no t done 1 - incorrectly done 2 - correctly done

Procedure No. of times done Remarks

1 2
1. Check the doctor’s orders for the
frequency and type of testing to be done
Verify the client’s identity
2. Explain the procedure and its purpose to
client and family
3. Review the institutions policy and
review the manufacturers’ manual for the
use of equipments
4. Prepare equipment [glucose meter,
reagent strip, antiseptic pad, clean gloves,
sterile lancet, lancet injector, cotton balls]
 Glucometer
- Insert a test strip, contact bars end
first and facing up, into the test port
- Push it until it will go no further
- Turn the meter on and wait for the
display check to appear
- Wait for the code number to appear,
followed by the blood drop symbol with the
unit of measure. Make sure the meter and
test strip codes match
 Lancet injector
- Turn the cap counterclockwise to
remove it
- Insert the lancet into the lancet
holder and push down firmly until it is fully
seated.
- Twist the protective disk until it
separates from the lancet
- Replace the cap by turning it
clockwise until it is snug
- Adjust the puncture depth setting if
necessary.
Cock the sampler
5. Do hand hygiene before the
procedure and instruct the patient to do the
same.
6. Wear gloves
 Procedure No. of times done Remarks
1 2
7. Massage the finger gently towards
the center
8. Cleanse the site with alcohol and
allow the area to dry
9. Hold the finger of the patient with
the non dominant hand
10. Puncture the site with a lancet
injector in a 9O degree angle using your
dominant hand
11. Apply the blood to the reagent strip [
touch and hold the drop to the narrow
channel in the top edge of the strip until the
confirmation window is full before the meter
begins to count]
12. Apply pressure on the puncture site
with the use of a sterile cotton ball until it
no longer bleeds
13. Obtain the reading [accurate results
will appear in 5 seconds]
14. Turn the meter off, then dispose used
test strip in a sealed container
15. Remove the gloves and dispose
them and other materials in the proper
receptacle
16. Disposal of used lancet
 Remove the sampler cap [twist
counterclockwise]
 Eject the lancet then replace the cap
17. Reassure the patient
18. Wash your hands
19. Document the procedure, and any
other concerns and observations
TOTAL
AVE

Comments:__________________________________________________________________________
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MAJ, R.N, M.S.N

DRCM, RN, MAN, MPA