BGM critical result reporting documentation
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Hello All,
Currently our statistics for RNs documenting critical glucose values communicated to the provider are in need of improvement. I am hoping the community has some suggestions. My current train of thought is there are two environments for which a critical glucose can occur, trauma or non-trauma. In a trauma the patient is rushed into the ED or L&D, the Provider requests a POC glucose, the result is immediately read to the Provider and with everything going on documentation of that critical is not occurring in the moment or later. Second, non-trauma patients who usually have an order set that RN's follow in regards to a patient's glucose value. An order set may be leading to a more lax attitude towards documenting critical values because the need to talk with a Provider seems unnecessary??
In either situation our RNs need to be better about documenting critical values per TJC requirements. Currently, we have a reflex order that pops up for RNs to call Providers with critical values, but this isn't working nearly as well as it should. Reeducation is necessary to stress the importance of documenting these critical values. However, my question to the community is how are you going about getting your critical values communicated and properly documented to meet accreditation requirements? Have you struggled in the past and found a path that leads to higher compliance? Please share your thoughts! Thanks!!
Currently our statistics for RNs documenting critical glucose values communicated to the provider are in need of improvement. I am hoping the community has some suggestions. My current train of thought is there are two environments for which a critical glucose can occur, trauma or non-trauma. In a trauma the patient is rushed into the ED or L&D, the Provider requests a POC glucose, the result is immediately read to the Provider and with everything going on documentation of that critical is not occurring in the moment or later. Second, non-trauma patients who usually have an order set that RN's follow in regards to a patient's glucose value. An order set may be leading to a more lax attitude towards documenting critical values because the need to talk with a Provider seems unnecessary??
In either situation our RNs need to be better about documenting critical values per TJC requirements. Currently, we have a reflex order that pops up for RNs to call Providers with critical values, but this isn't working nearly as well as it should. Reeducation is necessary to stress the importance of documenting these critical values. However, my question to the community is how are you going about getting your critical values communicated and properly documented to meet accreditation requirements? Have you struggled in the past and found a path that leads to higher compliance? Please share your thoughts! Thanks!!
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Also we are using Nova StatStrip 2nd gen, and one challenge we hear from nursing is the “old phone-style” keyboard, which makes documentation harder for them. We also brainstormed with nurisng informatic to see if Epic alerts can help, but nursing has been saying it is not effective since nurses often manage the critical at the bedside and don’t go back to their workstation to document right away so the timing for critical ends up being off as well.
Thank you for your response! We also have a dashboard showing compliance by department. Our metrics are compiled monthly and shared at our Quality meetings. Nursing leadership is made aware of the statistics for compliance and non-compliance, but I am unsure what, if anything, they do with the information.
I completely agree with Nursing that the T9 style of texting on the Nova StatStrip device (we also use this meter) is cumbersome and would increase frustration in regards to having to document critical communication using this dated technology.
Our EPIC team created a reflex order for critical values. The order is titled "RN Communicate Critical Value". This may be an order for all Lab critical values that fires off to the patient's RN alerting them to the fact they have a critical value that needs to be reported. I was alerted this morning that the order previously was not firing appropriately for our POC glucose critical results and that they have fixed the issue. I am in the midst of trying to learn how RNs will receive the order and any friction points that occur when documenting the critical. Once I see greater compliance in calling the critical I can see how long it takes for them to do so.
Again, thank you for sharing your experience!