i-STAT Critical Results - New CAP Language
Hello POC Champions,
I was working on a process improvement project and discovered an issue I REALLY need advice on.
Our ED i-STATs are operated by laboratory assistants, and therefore the results they report to physicians are not interpreted by them. They essentially print the results, staple them to a form which has reference ranges and patient information/labels. It is written in our policy and i-STAT procedure that we promptly give results to the physician and it is up to their discretion on how to handle the results- including criticals.
The newly revised COM.30000 checklist item states that "records must be retained showing prompt notification of the appropriate clinical individual after obtaining results in the critical range. These records must include the following.
- Date of communication
- Time of communication
- Responsible laboratory individual
- Person notified
- Test results
I do believe that my predecessor was compliant with the older version of this checklist item which said should include the aforementioned items, however I don't believe we are documenting to CAP standards at this point.
Does anyone else have lab assistants, EMTs, ED techs, that perform testing, and how do you handle the critical result reporting and documentation aspect? Especially if it is outside of their scope of knowledge. Additionally I am trying to move to a paper free process, so electronic documentation is preferable.
I appreciate all of your knowledge, assistance, and dedication to promoting fantastic POC service.
Thank you,
Dean Derhaag MS, MLS(ASCP)
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I'm not sure this is helpful but our medical assistants and nursing staff (collect specimens as well as perform POCT) are required to use our EMR to document 'communication' of the critical lab results' in the same manner that the RNs are required to upon receipt of the lab calling critical values. The electronic record of communication must include what you describe above although our waived testing is not inspected by CAP. Our nonWT is inspected by CAP.
On fingerstick/POC glucose, the meter is set up to not allow 'accepting' a critical result until a comment code is entered. But Operators are taught that is not the acceptable communication documentation to meet 'communicating' the result to the provider so they must still go into the EMR and do so.
I have been working for several years to have nursing staff including PCTs document critical notifications of Point of Care tests on the Provider Notification flow sheet in EPIC. We have gone from 20% documentation on flow sheet to 78%. One month we were at 92% and I did a happy dance. Staff either wasn't documenting notifications (the majority) or they were charting in Notes, which are difficult to review and pull data for reports. It has been a very long struggle to change the culture, but I'm very proud of our progress. Thankfully, I have the backing of our CMO and Quality Department and I report quarterly on our progress at our Performance Improvement meetings. It is a lot of work on my part. I audit charts every day that I work. At least I can show years of data and steady improvement over time to my inspectors. One day we'll make 100%!
our go live Epic date is set for early November. Can you provide a screen shot of POC documentation in Epic and the steps needed to do this.
Below is a screenshot of our EPIC Provider Notification flow sheet. I remind everyone that they should have EPIC up to confirm the test order and to perform proper Patient ID, so it should be easy to get to Provider Notification if they obtain a critical. All they have to do then is pull up the flow sheet and complete it once the call is obtained. On the critical result line, they have multiple choices. Remember this is based on our current critical notification SOP. Your build may be different. I hope this helps.