Is there a Joint Commission/CMS/CAP standard that says you must repeat any result outside the reference/normal range?
We are looking for a standard that says
1. the abnormal or critical results must be repeated either on the same device or laboratory confirmation
and 2. POCC must review critical <glucose> results (waived) to confirm that a follow-up was performed.
The hospital neonate hypoglycemia policy has changed to where if the glucose is 26-39 the administer glucose gel, feed them and recheck heel stick glucose in 1 hour. Does POC need to confirm these checks are done based on a standard?
I know it has been in our policy to always get a recheck of a critical POC glucose via the laboratory but I can't find why it is this way. Some nurses question why we would get a confirmation on a critical low because by the time phlebotomy shows up the treatment has been given and we are really just checking that treatment worked.
Is this strictly related to how you write your policy or are there JC/CMS/CAP standards I can reference.
Thank you,
| Topic | Replies | Likes | Views | Participants | Last Reply |
|---|---|---|---|---|---|
| Hemochron Sig Elite use outside of manufacturer temperature range | 0 | 0 | 42 | ||
| EPOC scanner issue post software update | 6 | 0 | 293 | ||
| PFA-100 | 0 | 0 | 121 |
No - it is up to the lab director to decide when or if tests should be repeated. It is also up to the lab director to decide what the definition of "critical" results are.
We do not require a lab glucose when a critical POC glucose is obtained, however we encourage them to repeat it on the meter first then send to the lab if the results do not fit the clinical picture of the patient. Meaning, it is up to them to decide if they want to repeat the test or not.
Secondly, we define two types of alert values, those that are critical require a call to the physician and documentation in Epic that the physician was called. Those that are urgent can be called to the nurse, and in the case of POC the nurse or physician is not required to document that they notified themselves - therefore most do not have documentation because they are not required to. We define most POC tests in the urgent category.
Critical call documentation is required, that is the only follow up the POC department should be auditing - that those tests your MD has defined as "critical" were followed up on according to policy. Your MD defines both critical and policy in that case.
We only require a lab test when the result is outside the linearity of the analyzer. As Silka said, if the results do not match with the clinical picture of the patient, the test should be repeated (but that is true even if the result is not critical).
Perhaps you could suggest a policy revision since there are no standards requiring a repeat of a critical result. It does make sense, though, that the babies' glucoses would need to be rechecked after glucose administration/feeding. Don't the nurses want to ensure they have an increased glucose post treatment?
Our NICU nurses are not required to notify on critical lows (as they would be notifying themselves). We audit for documentation of critical highs and lows on other patients, though.
Jessica R. - They do want to confirm which is why they are doing a heel stick 1 hour after. My question for this was does POCC take responsibility of the review to make sure that they were in fact repeating in one hour.
Oh, okay. I wondered because you had said, "Some nurses question why we would get a confirmation..."
It is up to your MD whether he/she wants you to confirm the repeat.
Nursing and Laboratory policies should flow together.
Usually a physicians executive committee decide on hospital critical values.(Pathologists, ER MD, Hospitalists, Neonatal MDs, etc.) CAP/TJC/CLIA decide what documentation is required when reporting a critical POC result.
<40 mg/dL - Neonates to Adults do not require a lab draw unless MD requests or doesn't fit patient's picture; our lab and nursing policy. Out mantra is treat & repeat.
Results >400 mg/dL require a lab draw unless the physicians decides it's not necessary also part of the lab/nursing policy.
When I perform my monthly audit of critical values, I review:
I have TJC, CAP and CLIA regulatory agencies in my POC practices and it's basically the same: DO WHAT THE POLICY STATES.
Jessica R. - They were initially under the impression that when you had a lab recheck on a low value you were doing so to confirm its accuracy.
I appreciate the great responses! I'll hopefully have more time tomorrow to fully read through them all.
If you are running your glucose test under waived testing category; check manufacturer's instructions. If the manufacturer recommends repeating out of reportable range values, then you must do so. Otherwise, your glucose test becomes a high complexity test.