iSTAT Critical Results
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Good Morning Everyone!
Question for you all:
When TJC was here they told us we needed to monitor critical results from the iSTAT. How are you all doing this? and how do you document your review? The nursing/respiratory staff are trained to document and acknowledge their critical results but apparently we are supposed to be monitoring that as well.
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Hi Amanda,
I use a Cerner “Exception Report” which captures RALS for Accu-Check and I-Stat results. It captures Rapid Conn for our Rapid Point 500 blood gas analyzers.
The Respiratory therapists have Cerner lab access so they enter comments. For RN’s, I have to review Powerchart for notifications or look for a nursing note.
Definitely more time consuming!
Thanks, Dawn
Because all near-patient/POC results go through the lab's LIS (Sunquest), those values all pull to a report of critical values from all hospital areas which are then distributed back to the responsible patient care unit. They audit a certain percentage of critical values for follow-up care/documentation and TJC has always seemed to be satisfied with that, and we've been doing it a number of years.
Did TJC reference a standard or was this just a recommendation?
OK, as far as I know and with Laboratory director's clarification. ISTAT doesn't allow for comments to be added as patients results are give. Because the person running the test and getting the results are in direct care of the patient a comment and our review is not needed. If a critical comes off an ISTAT the nurse will treat patient at the bedside. How that patient is treated is up to the caregiver and therefore not in our control. We do have a comment that uploads with the patient's result stating that critical result was received and patient treated at the bedside. It is then up to the nurse to chart their treatment...also not something we need to monitor.
Just clarify your process in your policy.
Whatever your policy states is what the TJC or inspector expected you to do.
Thank you Everyone for your comments.
To answer your questions Linda and Kammy:
TJC came for our initial inspection and therefor did not write us up for it, they just told us that we should be doing it just like the lab does it in order to prove we are monitoring how the nurses are interpreting and respond to said critical results. They told us we will need to show them next time what our process it. Our iSTATs do not have a comment section but it is built in our LIS for the operators to go to the lab results in their patients chart and make comments after the fact.
You are correct Kammy that it is up to the nurses to make immediate treatment decision and that is ok, but we the lab should still be monitoring this as it is lab testing. We should also be monitoring so that we can verify or recognize if results are not accurate.
Chapter: Quality System Assessment for Nonwaived Testing
Introduction: N/A
Rationale: N/A
Elements of Performance:
1. The laboratory has written policies and procedures for surveillance activities that include a coordinated review of the following:
- Patient test results
- Work records
- Equipment performance testing records
- Quality control results
(See also QSA.02.02.01, EP 5)
2. The policies and procedures include criteria to determine acceptability of patient results before they are released. (See also QSA.02.02.01, EP 5)
3. The general supervisor performs or delegates to technical staff the daily supervisory review of patient results. The supervisory review is documented. (See also LD.04.05.01, EP 1; QSA.02.02.01, EP 5)
Note: Technical staff performing the review use specific criteria or computer algorithms to identify outlier results for manual review. Examples of criteria include the following:
- Unacceptable quality control results
- Test results that do not correlate with a patient's known condition, age, sex, diagnosis, or pertinent clinical data; distribution of patient test results; and relationship with other test parameters
- Incongruent test results on one patient
- Abnormal test results
- Critical values
4. For high-complexity testing performed by trained high school graduates qualified under 42 CFR 493.1489(b)(5), the laboratory director, general supervisor, or technical supervisor reviews all results within 24 hours of patient testing. (See also QSA.02.02.01, EP 5)
5. The laboratory performs daily screening for errors in patient test results due to handwritten or manual data entry (for example, clerical errors). The daily screening is documented. (See also QSA.02.02.01, EP 5)
Note: Screening a sample of data is acceptable for compliance with this element of performance.
6. The laboratory performs screening for errors (for example, electronic transmission errors, formatting errors) in electronic and printed patient test results at a frequency defined by the laboratory. The screening is documented. (See also QSA.02.02.01, EP 5)
7. The laboratory performs review of other records (for example, work records, equipment records, quality control summaries) at a frequency defined by the laboratory, but at least monthly. The review is documented. (See also QSA.02.02.01, EP 5)
Thank you Amanda!