pH and Point of Care

Hello,
We are having a time trying to get providers to Order and then enter these waived Provider Performed test.  At this time I am tackling the fecal occult blood provider performed.  They just want to make a procedural note.  Next I will tackle the eye pH.  For CAP, it is a lab result so it does need to be ordered and entered.  For Joint Commission the provider can be credentialed (still need initial training, but not annually).  CAP requires annual competency.  We do not use our POC testing for diagnostic, but as an aid.  We are located in the state of Md. and do not bill for these tests.

Hi Kayla,  there are a few options to how you want to approach pH paper at your facility. While I've seen a single SOP for pH, and a single reporting method in the HIS, you should also address the differences between those two uses. NG tube placement is a procedure that requires the measurement of pH to ensure the tube has reached the stomach. In the pediatric setting, this was so common that we simply issued a roll of pH paper to the patient care team, as it would be used again and again for that patient.  We did not monitor expiration of the rolls, but they were marked with expiration dates before they were stocked on the unit. Rolls were issued similar to medication in Epic, and results were entered under the NG tube workflow as part of the nursing documentation.  This was more of a "check the box if the pH was <4" or something like that. 

On the other hand, eye pH was a test performed in the ER to determine the type of chemical exposure to the eye (acid or base) and when the eye is clear of the irritant after irrigation. Since this was done by physicians,  we limited its use in the ED to PPM. We did QC the rolls, as they often sat in a drawer for months or even years. 

We also used pH paper in Labor and Delivery for detecting ROM at one point. But discontinued that practice with implementation of Amnisure. 

We had an intervention built in Epic for manual entry of results, that included a drop down for specimen type (gastric, urine, amniotic fluid, eye fluid) and the corresponding normal range for each specimen type. We had an order for each of those tests in Epic that linked to that intervention. The intervention had a hard stop for the pH expiration date in addition to the result. 

We perform both pH tests here as POC tests. NG pH is to verify placement whereas ocular pH is used to verify pH of eyes that were exposed to some chemical. This can be performed prior to rinsing and then after to confirm the pH had returned to normal. 
We maintain training/competency records in MediaLab. Results are entered into the EMR via PowerForms (we use Cerner). Charges post to the patient's account upon completion of the PowerForm. No test can be resulted if an order by a provider was not placed. The PowerForm is driven by the provider's order.
PT is performed internally since pH testing is performed main lab. They perform/complete the formal PT.

We do pH as POC on NG tubes similar to Deb.  We do the pH portion of the CAP survey with Micro, they do the other gastric stuff and we do the pH.  We have the test orderable as a POCT and the result is documented in our Nova Statstrip MTE section which populates to EPIC.  
They are supposed to order the test before they perform it and most of the time they have a PRN order entered by the doc but there is not a charge, it's included in the room charge.  The record their QC upon opening and every 3 months on a manual logsheet on the units and we provide the pH buffers for them to QC with.
Since we have it as a MTE they have to do their initial training and annual comps or they get locked out of the meter.

Do anyone use Rightspot for gastric pH?  If so, could you please send me their contact info for your rep?

Shana -  RightSpot rep. Cleveland OH area: Don Marcello <DMarcello@clinical-tech.com>

We are currently implementing the NG placement using pH paper in our Special Care Nursery as well as Pediatric units and been having difficulty finding pH buffer solutions (4 and 7). I am wondering if anyone else is having issues ordering buffers as well? This does not need to be solely for this testing, just hoping for some guidance on where to search for the items so that they can arrive in a timely fashion. I've reached out to reps but no such luck. Thank you!