Critical Values - Mayo Medical Laboratories

POLICIES/PROCEDURES
TITLE:
SECTION:
CRITICAL LAB RESULTS NOTIFICATION
General Nursing (Organization-Wide)
JC STANDARD REFERENCE: NPSG.02.03.01 CURRENT DATE: 5/12
INITIATED BY: Nursing REPLACES: 2/06, 3/08, 6/11, 11/11, 2/12
APPROVED BY: COO/CLO REVIEWED:
PURPOSE: To provide guidelines for reporting critical test results to ordering provider (Physician / PA / APRN) in a timely
manner.
DEFINITIONS:
Critical test results: Critical results are those findings (even if from routine tests), which will always require rapid
communication of the results. While a variety of clinical tests or procedures may produce results that, in the judgment of the
ordering provider are deemed critical in a particular patient situation, for the purpose of standardization, the test results/values
listed in this policy are considered critical. This definition will also include results that are determined by a laboratorian or other
diagnostician to be critical to the patient's subsequent treatment decisions. The critical test result reporting time-frame is from
the time the result is available to the time the result is received by the ordering provider. Our goal for reporting of critical test
results is 30 minutes from the time of availability to the reporting of critical results.
POLICY:
I. Critical test results will be reported and received in a timely manner.
A. Critical test results are preferably reported verbally to the ordering provider.
B. Critical test results may never be left on answering machines.
II. When a particular provider elects not to be notified of a critical result, they must provide a written or telephone order
outlining the parameters for when they should otherwise be called. Example order: “Do not notify provider of stat
potassium level if improved from previous level of 6.2”.
PROCEDURE:
I. Once the results of clinical testing are available, and are determined to be critical they must be reported as soon as
possible.
A. For outpatient laboratory critical tests/results, laboratory staff is responsible for making contact with the ordering
provider or designee. In the event that an outpatient EKG meets the critical criteria the technician will ask the patient
to stay in the department until the provider has been contacted.
B. For inpatient laboratory critical tests/results, a staff RN/LPN is responsible for making contact with the ordering
provider on behalf of an inpatient.
II. Laboratory staff calling the results to the patient’s RN/LPN or a pharmacist must:
1. State that this is a critical result
2. Ask to speak to the patient’s own nurse, if possible, or a pharmacist
3. Identify the patient with name and date of birth or account if DOB not available.
4. Give the critical result to a nurse/pharmacist.
5. Results must not be communicated to an answering machine.
6. Request “readback” verification from the nurse/pharmacist receiving the test result. This should include:
Patient Name
Test Name and Critical Result
Name of nurse/pharmacist receiving critical lab value.
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7. If this information is not included in the “readback”, specifically request it.
III. Communication and Documentation of Critical Test Results to the ordering provider or designee
A. Every attempt is made to speak to the ordering provider or designee. If the ordering provider is not available the
result may be given to another Physician/PA/APRN or his/her designee.
1. A phone call is immediately placed to the ordering provider for notification. An RN/LPN must communicate the
result directly to the ordering provider or his/her designee.
2. Document the time and the name of the caregiver to whom the result was reported in the patient record.
3. Any telephone orders that result from the report of a critical test result to the Physician/PA/APRN should use the
“readback” verification process.
B. If there is an existing physician order for a protocol (ex. Insulin, Heparin) that provides direction for nursing or
pharmacist intervention in response to a critical result, or treatment has already been initiated by the
Physician/PA/APRN, that action is taken and/or information documented in the patient’s medical record.
IV. Information to be documented includes the:
A. Test name and test value/result
B. Date and time the test result was received
C. Date and time the test result was reported to the ordering provider or his/her designee.
D. Name of the person receiving the results
V. If the critical result reported is part of series (ex. Cardiac enzymes) but is moving toward the reference range, the results
do not need to be reported to the ordering provider.
VI. When lab staff encounter critical ED or inpatient test results that they believe are likely inaccurate (e.g. results are widely
outside of expected from recent previous results; are incompatible with life; or are consistent with contamination from IV
fluids), lab staff will:
A. Automatically initiate a redraw for those tests
B. Notify the patient’s RN that this is being done and instruct the RN to immediately inform the patient’s practitioner:
1. Of the present critical result
2. That those results are suspect (including rationale as to why the results are suspect); and
3. That a redraw will be completed for those tests
C. An exception report will be filed in Meditech documenting the suspect values, verbal read-back notification of the
nurse or physician, and the follow-up action being taken.
Values
TEST Less than Greater than
Alcohol
400 mg/dl
Calcium 6.0 mg/dl 14.0 mg/dl
CO2 10.0 mmol/L 40.0 mmol/L
Carbon Monoxide 10 %
Fibrinogen
80 mg/dl
Glucose 50 mg/dl 400 mg/dl
Hematocrit 21% 60%
Hemoglobin 7.0 gm/dl 20 gm/dl
HIV
New positive results
INR 5.0
Magnesuim 1.0 mg/dl 4.9 mg/dl
Blood Film for Parasites
Any organism seen
Neonatal bilirubin
VARIES BY AGE
Neonatal urine glucose 3+
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Phosphorus 1.0 mg/dl 8.0 mg/dl
Platelets 30,000
Potassium 3.0 mmol/l 6.5 mmol/l
P t t
100 seconds
Sodium 120 mmol/l 160 mmol/l
Troponin >0.6
White blood count 30,000
TOXICOLOGY
Acetaminophen
150 ug/ml
Carbamazepine
12.0 ug/ml
Digoxin
2.1 ug/ml
Gentamicin
2.0 ug/ml (trough)
12.0 ug/ml (peak)
Lithium
Phenobarbital
Phenytoin
Salicylate
Theophylline
Valproic Acid
Vancomycin
1.3 mEq/L
50 ug/ml
30 ug/ml
20 mg/dl
20 ug/ml
120 ug/ml
20.0 ug/ml (trough)
40.0 ug/ml (peak)
TEST
Microbiology
Blood Cultures
CSF
Sterile body Fluids
Initial Stool Isolates
Inpatient Stool Isolates
TB cultures
Systemic Fungal Culture
Multi-drug Resistant
Organisms
Pediatric Critical Values vary
Blood Bank
Crossmatch
Transfusion reaction
EKGs (Outpatient only)
Gram Stain
Critical result
Positive
Pos gram stain and/or culture
Pos gram stain and/or culture
Salmonella, Shigella, Campylobacter, and Yersinia, E coli 0157, vibrio
Clostridium difficile
Pos smear or Culture
Positive
Vancomycin Resistant S. aureus
Vancomycin Intermediate S. aureus
Methicillin Resistant S. aureus
Penicillin resistant S. pneumoniae
Flagged as critical in Meditech
Inability to provide crossmatch compatible blood
Any evidence of a hemolytic transfusion reaction
Heart rate 150 or Acute MI
Corrected Gram Stain
REFERENCES: National Patient Safety Goal 02.03.01
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