Critical Values - Mayo Medical Laboratories

More documents

Recommendations

Info

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+ \\Fs_2\Compliance\Policies & Procedures\Organizational Wide\General Nursing - Section 4\CURRENT\Critical Lab Results Notification [5- 12].Doc Page 2 of 3
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 \\Fs_2\Compliance\Policies & Procedures\Organizational Wide\General Nursing - Section 4\CURRENT\Critical Lab Results Notification [5- 12].Doc Page 3 of 3
Page 1: POLICIES/PROCEDURES TITLE: SECTION:

Critical Values - Mayo Medical Laboratories

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?