Adding critical comment in patient chart in Epic

You may want to look into the flowsheets? Our RT team utilizes the flowsheets to provide critical documentation/notification. As far as adding directly to the result itself, I have not seen that yet!

Our teams also use the Flowsheets --> Notifications for critical result notification documentation.

My RN/RT staff use the Nurse Flowsheets under the Provider Notification/Critical Test Results. 

The LVN/MA staff do not have access to this feature in Epic. This is not ideal, but the following is what we have come up with. They enter the critical in the Encounter, then use the Report Viewer tab, click on the upside-down arrow in the upper right corner, then in the drop down there is a flowsheet. Once the flowsheet is clicked, they need to search Vital Signs, and this allows them to click on the facility and enter the critical.

This doesn’t directly answer your question, but I’m curious how you’re able to capture critical comments on the i‑STAT. At my organization, we were told that wasn’t feasible because the device only allows numeric comment entries.

In EPIC there are several ways to comply with documenting that the provider was notified of the critical lab value. It's different for Inpatient versus Ambulatory. For Ambulatory, you access it from the Flowsheet activity tab, then search for the Provider Notification Flowsheet (it can be found under the Facility tab) then click Accept. If the lab component you're looking for isn't included in the list to select from, you can select Other and then add the component as a comment. Have your IT dept. assist you if needed, adding Critical Lab Result Name, Provider Credentials, and Provider Read Back and Verified.

Just for some background we use EPIC and Telcor as our Middleware and most of our devices use an unsolicited interface. Our LIS team has recently got the prebuilt glucose meter comments from the Nova meter to cross over to EPIC along with the operator information. You can view the comments in Specimen Inquiry and are visible to the lab only. We didn't want comments or user info to cross over into the patient's portal when they view their results. Currently for the blood gas analyzers respiratory uses a flow sheet (provider communication or notification). We have just recently figured out how to hold the results in the GEM and have documentation done on the GEM before results are released. We are working to have this documentation go the same place as the glucose comments.  
 

We have been working on this since being cited by CAP. 
Nova- use of prebuilt comments on the meter but then unlicensed personnel/non treating personnel have to type in the name on the Nova.  Everything crosses to Epic. It is not easy to type in a name, but we are told the next generation of meters has a better, texting keyboard. We are looking into the Epic documentation with Flowsheets that the others have mentioned above. A few of our hospital locations have decided to just not let unlicensed/non treating caregivers to use the device.

GEM- use of prebuilt comments and also type in treating caregiver notified. Of all the devices, this one is probably the easiest, but still has become a growing pain for Respiratory to comply.

ISTAT- we have a prebuilt comment where they type in a number into Field 1 (for us it is #101). When it goes to Epic through Telcor, it changes that to "Licensed Caregiver notified". No way to add a name. However, we only have Respiratory Therapists that need to document on it, so I called CAP and for our workflow the ISTAT blood gases are done in the patient room due to a code situation with many other treating caregivers and the results are given to the physician in the moment. CAP said that because of this that our documentation setup is ok. However, since we got a recent notice from the FDA about no capillary gases on ISTAT, we are going to move to EPOC and from what I have seen, documenting appears to be much easier.

Like a few others have already mentioned, we also use Flowsheets to document critical calls. The only one that has a critical comment that crosses with specific results is for EPOC. 

We do still have the operator use the Nova comments in the device if they don't rush through that step for failed QC, criticals, etc but it doesn't go anywhere. 

For the StatStrip, we used canned comments in the meter for 9 years - "Charge RN told", "Primary nurse told" as that was traceable information. Our last CAP inspector disagreed and wanted a name.  As someone mentioned, free texting on the StatStrip meter is cumbersome.  We then implemented the staff documenting on the Provider/Clinician Flowsheet.  To audit, the POC staff identify the non-nurse performed critical Glucoses in Telcor and then look for the corresponding documentation on the Flowsheet.

For i-STAT, the Respiratory Therapists change context from EpicCare to Beaker, find their critical result and complete the Comm Log.  They find their critical results 1 of 2 ways, they can go to the Outstanding List > Recent, filter by test and find their specimen, or, the Charge Therapist prints a "Critical Documentation Pending" report each shift and lets the therapist know the Specimen #.  Then the therapist goes to Result Entry Verification > Comm Log.