Upsala J Med Sci 91: 219, 1986 

Education of Untrained Hospital Staff for Decentralizing of 
Reflectometric Blood Glucose Assay 

Marta-Lisa Malm and Henning von Schenck 
Department of Clinical Chemistry, Linkoping University, Linkoping, Sweden 

To increase efficiency in larger public hospitals reflectometry of blood glu- 
cose has been one of the objects for decentralizing because of fast bedside re 
sults. Here, we report our preliminary experience with teaching hospital staff 
previously untrained in laboratory procedures. 

Methods: Personnel (n=49) were gathered in groups and trained in a 2 hourspro- 
gram. Glucmter (Ames/Bayer, A/B, Elkhart Ind.) and Dextrostix (a wash-out 
strip, A/B) instructions were given orally and as handouts. The importance of 
the size of the blccddrop, reaction time and terminating the reaction was em- 
phasized. First, glucose control solutions were used to determine the numberof 
outliers off the assigned values. Precision of replicates (n=5) was assessed 
by assaying a pool of MTA blood with a known glucose content. Then, the 
trainees obtained capillary blood from each other and determined the accuracy 
of the mean of their duplicates against a split capillary sample measured in 
an automated hexokinase method. 

Results: The control solution assay showed that the glucose concentration was 
overestimated by about 10%. The number of outliers was 9/49. The precision of 
replicates was plotted against relative frequency. This plot demonstrated (less 
3 outliers with C.V.% > 2 0 % )  two groups. One with a mean C.V. of 5+2% (n=29)and 
another with a mean C.V. of 1023% (n=lO). Accuracy shmed a regressionequation 
Y (teststrip) = 0.75X (hexokinase method) + 0.5X (n=49, r=0.79,range 4-8ml/L). 

Discussion: Training lowered the apparent number of outliers during theongoing 
program. Precision testing spotted analysts with problems. The largest group 
of analysts had good precision while a smaller group was identified for re- 
training. Accuracy data point at difficulties with the wash-out procedure. 

Conclusion: Extensive training is necessary for acceptable handling of wash- 
out strips. External control remains imperative for meaningful decentralizing 
of blood glucose. 

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