Critical Glucose Documentation

Good question!  This has long been an issue for us as well.

This is what our facility has done in regards to the Critical Glucose. 

All results when they upload via our middleware have this statement that uploads with the result.

Performed at POCT testing site: immediate action taken.

That comment put the responsibility back to the nursing side.  It is their responsibility to Chart what they are doing to treat their patient.  The nursing staff will chart what they have done in Notes in patients chart.  All critical results are flagged by our POC devices and we have built in comments the nursing staff may use to help document the actions taken. 

if you have any further questions ask away.

We feel it is not our responsibility to "babysit" the nursing staff.  If a nurse sees a critical result they WILL treat that patient.  It is the nurses job do document the treatment.  I know they don't like the extra steps but they just have to deal with inconveniences sometimes. 

Hi Kelly,

In our emergency department, we limit the use of glucometers to Nurses only so that we don't have to record the critical result notification. This complies with CAP, which states: "In the point of care setting, the identity of testing individual and person notified need not be recorded when the individual performing the test is the same person who treats the patient."

We have been working on this for years also. We have Epic and they have built Clinician Notification in many flowsheets.  Critical result notification is built there, so if lab calls the nurse with a critical value, it is documented there which provider was notified.  They also document critical POC test notification as well.  Even our EDTC has to document.  We recently (last month) went live with an Epic BPA (Best Practice Alert), that fires off if there is no documentation in Clinician Notification after 1 hour. There's a hyperlink in the BPA that takes them directly to Clinician Notification to document who was given the critical result.  Last month, we had 95% documentation compliance for POC glucoses.

Kammy - The comment that you append, is that to criticals only or all POC glucoses? We right now require the comment be put in the meter by all users even if they are RNs. We have always required everyone to enter the comment because at one time we had CSAs using meters(not anymore) and we do have EMTs in one of our ERs so they are not considered the one treating the patient. If I had that comment appended, that qualifies as the "critical result comment" for regulatory purposes?

We have Epic and at one time we were told by the TJC folks that there had to be specific elements in the critical results notification. Who, when and how provider was notified w/ Read/Readback etc. So they build Clinician Notification on several flow sheets. All critical lab results are documented there. There's drop down elements and free text.

We have been monitoring POCT critical result notification for years. We have an Epic report that runs daily that captures the critical result and the fields from Clinician notification so we can see if the documentation is there (if the fields are blank, then no documentation).

Last month we went live with an Epic BPA (Best Practice Alert) that fires 1 hour after the critical result as a reminder to document. There's a hyperlink in the alert that takes them directly to Clinician Notification to document. If they ignore the BPA, it will appear every time they open the patient's chart. If they document before the hour, then the BPA doesn't appear at all. Last month compliance was 95% for POC glucoses.

That comment is appended to only the critical glucose results.  Comments are required on all critical results no other results require a comment.  Nurses need to comment "results noted" and are free to do what they choose with other comments they'd like to enter, but comments are not required by nursing staff.  

CNA's on the other hand are required to comment RN Notified and the nurses first name last initial.  I have it set up in my middleware who my nurses are vs. my CNA's to help ease monitoring.  The CNA's are alerted of how many critical comment they have missed after 3 they loose their access and need to have a conversation with my self or their educator to get it back.  Those error are kept tract of on a spread sheet.  I send out warnings every month with instruction on how to correct document a critical in the meter so it upload correctly. 

 I keep track of what they are doing on the meter.  What happens after that I honestly have no control over and hope the Nurse/CNA do what is required by their department procedures.

I wanted to thank everyone for all of the useful information. I greatly appreciate it.

Nursing Assistants throughout our inpatient setting, enter a comment in the Epic flowsheet.

My issue is trying to figure out how to handle this in our emergency room's triage, where we do not have RN's or Physicians yet assigned to the patient, so entering a comment into the meter at the time of testing will not work. And NCAs often forget to go into the flowsheet to enter comments once the patient is assigned a room and a RN/Physician. Because of this compliance has been a nightmare.

Reine,

Do you have a separate row in Epic for Clinician Notification or is it a comment attached to the result? When you are using the BPA who gets this notification? Any additional details on how this works for you would be greatly appreciated.

Thanks Again,

Kelly

Kelly,

Email me.  rmakiya@chw.org

I can't post screen shots here.  Thanks.

Could the ER director have an assignment of RN triage that would be available and responsible for glucose results that are critical?  That RN would be responsible for treatment until a RN is assigned to the visit.  The NA would then have a specific person to contact and could make their notes in EPIC.  We have the Inform 2 meter and we document the full name of the RN when results fall into our "action range".

Thank You Stephanie.

This is exactly what I am thinking. Now I just need to figure out how to make sure that the NAs actually document the notification. We use the Nova Statstrips through Telcor QML with EPIC as our EMR. Has anyone used the free text function in the Statstrip? Any suggestions or ideas would be greatly appreciated.

Thanks Again,

Kelly

We looked at the Nova a few years back and one of the deal breakers for us was the fact that the free text function was not user friendly.  The technology was like texting on a flip phone.   We were already used to using custom comments in our Inform 2 and could not go backwards as it would make it much harder on our staff. Not sure if they have updated that technology.