Critical Result Documentation

Danielle...we are CAP. We have PCA's (Patient Care Associates) who have been trained on the NOVA to run glucose. It's not always an RN. I think that might be the issue with our documentation. 

Danielle,  We have a very similarly worded statement in our POC policies.  The floor staff are still responsible for notifying the physician of criticals dependant on their own protocols.

Lab ran test:   lab obtains result --> lab calls floor to inform patient's RN (and documents this with lab result) --> RN notifies physician, documents in their RN records.
POC ran test:                                --> Floor obtains results -->RN notifies physician, documents in their RN records.

Jeremy...do you have non-credentialed personnel performing glucose checks?

I am dealing with the same issue.  Our POC until recently was under JC not CAP, so my first inspection 3 months after going under CAP I was cited for the Critical notification.  I had the CAP statement almost verbatim about bedside however, it didnt fly.  I even went as far as reaching out to CAP and was told my statement was not enough.  A year later and I am still working on this issue and hope to have it resolved by the next inspection.  I did reach out to CAP and ask about a statement for the i-stats in ICU.  The nurses can put the comment DKA protocol utilized for the Glu, Na 
and K however, they must call and document any other criticals from the Chem8+.  We have worked with the IT department to make it as simple as possible with drop downs.  The Statstrips are 
a work in progress.  I am doing comments that state DKA protocol, Mother Infant Unit protocol utilized
and training nurses that they can put up to three comments in the statstrip. I am open to any and all help on this.

I'm not familiar with Nova but our Accuchek allows us to free text the name of the RN or practitioner notified, along with the canned comment (RN or PRAC Notified).  Our policy says to document the first initial and full last name of who was notified, if the operator was not a RN/Provider.  As for iSTAT, we created codes that our I.T was able to get transmitted to the patients' chart (1= MD notified; 2= Operator Error, 3= Test repeated, etc.).  Staff who don't comply with the documentation policy, get locked out after 3 noncompliance incidents, and must attend a re-training to get re-instated. 

Liz,   we have CNAs (certified nursing assistants) performing glucoses which would be our lowest credentialed staff.

Shaneece - did your IT department use the i-Stat Stat Notes function to set up the documentation codes?

There are exceptions as pointed out above where if the person performing the test is the same one treating they dont have to document the tester or who was notified. That get's iffy since the nurse performing the test is not always the nurse treating that patient. One CLIA inspector did not think "notifying the physician and waiting for orders is  the same as treating" so the nurse would need to document fully. As you can see it gets iffy, so we have in policy that other than when a test is personally performed by a  provider (doctor, NP, PA, midwives etc) every critical must show who performed the test and also who was notified. So we enter that information directly in our glucometer (Roche Accuchek Inform), and use a paper log for instruments like iSTAT and Clinitek UA. So we can easily see in every case: who performed test and which provider was notified.