Implementation of RALS/i-Stat
We have just started using RALS with the I-Stat in the lab and ER. Since the ER only has one meter at this time, it is a challenge to keep the workflow going without compromising specimen quality since the tests have to be run immediately after collection. We have our CG4 set up in DE to only run lactates so they must run two different cartridges if they need to perform both a lactate and an ABG. Our trainer said that it should be set up this way to avoid doing tests without an order in the ER for patients who only have a lactate ordered. Does anyone have any ideas/experience with this issue? Outside of getting another meter or adding ABG to the sepsis protocol, I'm not sure how we could get around the issue of running a test without an order.
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We use Telcor, not RALS but DE is DE to my knowledge. When we train ISTAT users, we train them to select only the tests the HCP ordered. Our users have full access to the CG4 cartridge but only select lactate if that is what is ordered. If they have a brain burp (and we all do), they are to send a correction form to the lab letting us know that the ABG needs to be credited. We also train them on how to change the order in the ISTAT while it is still running if they realize their error during the 2 minute window. In this way, they avoid having to fill out the paperwork.
Have you thought of enabling test selection on the iSTAT?
Hello Diana. Who runs the ER's lactates in your facility, RNs or RTs? If it's RNs, does the lab maintain their competencies, and performs all IQCP on this test? Currently all lactates are done in the lab at our facility.
Hi Melissa, RNs and ER techs perform lactates in the ER. Lab maintains all of their competencies and IQCP for the test.
I wasn't aware that test selection on the I-Stat was available until yesterday. I think that's going to be the best option for us, along with adding ABG to our sepsis protocol.
Hi Debra,
I was unaware that you could select analytes on the ISTAT. I know that you can enable test using DE. Do you mind sharing how you do that on the meter?
Thanks!
Hi Shea,
I actually was unaware that not everyone was utilizing this ability. In DE customization, we have all of the analytes checked under "Apply Globally". We also have everything checked in "Apply by Panel". When running a cartridge, after the cartridge has been placed in the analyzer, a screen will come up offering us test selection. We have the choice of selecting "All" or individual test(s) on that screen. We then right arrow over to the sample source screen to complete. The operator must order the test(s) before leaving the analyzer or nothing will report at the end of the test cycle. I warn everyone I train of this. I also tell them that if they discover that they are running the wrong cartridge/test to return to this page and zero out the order-no order, no results, no credits. Hope this helps.
Debra,
Thanks so much for explaining! I can't believe that Abbott doesn't educate customers about this.
Still trying to work through some issues with the start-up of RALS and I wondered how everyone handles critical values. It's our policy to call critical values and document the results in Meditech, but if we set up critical values in RALS, the results will stop there and won't be released. We've been told by our trainer that we should limit access to RALS to a couple of people in the lab, but what do you do on weekends/holidays, etc. when those people aren't there to release results in RALS? Any other tips about how to get the most out of RALS/I-STAT would be greatly appreciated!
Diana-
We use I-STAT heavily in our multiple ED's with NT's, EMT's and ED Techs performing the majority of testing. We have our lab critical ranges programed into RALS so each critical is flagged on the istat result. I-STAT then asks for a comment code which we built (300=MD notified). Operator enters the code, downloads the result and then result flows to chart. We do not hold critical values--they have already seen the result and will act upon the result. The operators are then trained to document into Epic (HIS not the LIS) who they called the critical value to. We do not allow anyone RALS access other then the POC team. We do not monitor results 24/7.
Kim Ballister
336-832-8134-Cone Health, Greensboro NC
At our facility, the nurses in ER have to notify the doctor of any critical value. The critical value is noted in Paragon, hospitals system, in the patient's continuation notes. Paragon built a critical value section in the notes for the nurses. So all they have to do is put the value and the doctor's name. The value is automatically uploaded. Every morning a report prints out of yesterdays critical values, which I check in Paragon. I check the value and the doctor's name. Technically, I am the only one in the whole hospital that has access, which leaves a lot of problems to occur. It would be nice to use RALS to its full potential one day. Weekends/holidays wait until Monday morning.
We also allow critical results to go through to Epic since the results have already been acted upon. This is configured in RALS in your Flag Configuration.