POC Glucose Orders

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Looking to see how other facilities accomplish this. How do you accomplish a provider order for a glucose performed using a glucose meter through and unsolicited interface? Are orders that are placed a couple minutes after the test was performed acceptable? Can staff go back and put an order in after the fact as long as it is within the past 30 days?

We currently use care orders or order sets, however we are running into the issue in our ED where the order may be put in after the test has already been performed, or the provider is unchecking the glucose from the order set. We have Meditech for our LIS system.

Any feedback you can provide would be greatly appreciated!

11 Replies

Kayla Cooper

Wed Sep 27, 2023 at 3:30PM

If I am understanding the question correctly...you are asking how provider orders work with an unsolicited interface...

We are currently using MediTech and QML as our middleware.

If you are using an unsolicited interface, providers should not need to place orders at all. The order will be automatically generated when the results are processed through the middleware and communicated to the LIS.

Cindy Engbert

Wed Sep 27, 2023 at 3:34PM

Thank you Kayla. We had a JC inspector that asked to see the order for a glucose test before the staff member performed the test because we had to have an order to do the test.

Kayla Cooper

Wed Sep 27, 2023 at 3:39PM

Interesting! I have never heard that before. Although, I am not overly familiar with JC, yet...

Karla Frink

Wed Sep 27, 2023 at 3:46PM

Don't quote me but I think it is up to your state and/or institution whether or not providers need to place an order for a waived test. Joint Commission does not state either way if an order is required or not, so defers to your state rules for that. Our state of Iowa does not require a provider order, but our institution does.
To answer the initial question, we don't really place a physical order as long as there is a protocol in place. If they are ordering without a protocol, then a provider order should be placed in Epic before the test is done.

Cindy Engbert

Wed Sep 27, 2023 at 3:52PM

Thank you Karla. There is actually a Standard in regards to lab test orders. I am assuming this applies to all laboratory testing even if it is waived?

Standard: DC.01.02.01 : The laboratory performs testing based on written (paper or electronic) laboratory test orders.

Karla Frink

Wed Sep 27, 2023 at 3:56PM

No, if you look at the Standard Applicability Grid for Joint Commission, it does not apply to waived testing. I've even confirmed with Joint that there is no requirement from them to have orders on waived testing.

Silka Clark

Wed Sep 27, 2023 at 3:58PM

Typically a provider order for glucose testing would be written to cover future testing, such as "Glucose Monitoring Q6 until stable via glucometer..." It does not have to be a 1:1 order, meaning they don't need to order every single one in the computer for it to count as ordered.

DEB EBERHART

Wed Sep 27, 2023 at 3:59PM

In most of the environments that I have worked, the physician will place a "Nursing Order" or select an orderset for Nursing to perform the test. The test is performed and is transferred to the middleware or HIM unsolicited which then generates the billable actual POC Glucose lab test which autoresults (with certain exceptions) in the chart.

Kathleen David

Thu Sep 28, 2023 at 9:18AM

One of the issues here is whether or not a glucose can be billed, and I believe an order needs to be in place before billing can happen. There does need to be some kind of "order" to perform any lab test--it's not up to a nursing tech or MA to just go ahead and do a glucose. We do have protocols and order sets in place, and also have POC orders that are "MD to nurse" orders, to perform a glucose or other test. At some point, a provider needs to say that a certain test is needed for a patient, it just depends on how it's done.

Jeremy MacDonald

Thu Sep 28, 2023 at 10:13AM

I completely agree with Kathleen.

To add complexity to this issue, additional caveats:

Most test ran an on inpatients fall under the DRG for the patient, thus the tests don't get charged individually.
For those patients that it does not, we have to deal with the limit of how many tests of a specific type of a per day can be charged. Many tests are performed in duplicate: a POC BMP and a lab BMP are performed on the patient... example: ER patient. One of these tests can be charged and frequently the duplicate can not.

Danyel Olson

Mon Oct 02, 2023 at 12:34PM

Looks like this can be different for how a program is set up/state laws/institutional policies, etc. We do bill for all our POC tests so therefore there needs to be an order or protocol documented by a provider for all billed tests. We use unsolicited orders as well and POC orders are placed as a "patient care order", as opposed to a regular lab test order. I've always wanted to audit this but just do not have the bandwidth. Our billing department actually just did an audit and came across a POC glucose run in our ER that had no POC order or protocol associated with it. I'm hoping that this will drive more audits and education on their end, both provider and nursing.

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POC Glucose Orders