| University of Arkansas for Medical Sciences Department of Pathology and Laboratory Services Little Rock, Arkansas |
|
Clinical
Callback of Critical Values |
Purpose
To assure that laboratory critical values are directly reported to the
patient’s nurse and/or physician.
Definition
A critical or panic value is any value defined by the Medical Director
of the Laboratory to be outside the
normal range for the patient’s age and sex
for which lack of intervention and control may result in harm to the patient.
Inpatient Procedures:
1. Lab will rerun all critical clinical results when appropriate.
2. If the validity of the sample is in question, the lab will contact the nurse to confirm.
3.
A redraw may be requested of the nurse to confirm the results.
The Pathology resident may be consulted to help
resolve issues in confirming results.
4. As
soon as the critical results are confirmed, the lab will release the results
in the computer, call the patient's
nurse, identify the patient using two identifiers and give the results to
the nurse.
5. The patient’s nurse
will be asked to document and read back the critical
values to the technologist to verify correct
communication.
6. If the
patients' nurse is unavailable, the lab will contact the CDF or another RN
on the unit. In the event that the
lab is unable to contact a unit nurse after a reasonable period of time
(within 30 minutes), the lab will contact
the ADON.
7. It will be the responsibility of the nurse to contact the physician to convey the critical value and request orders.
8. Critical values will not be communicated to a non-licensed individual.
Outpatient Procedures:
1. Lab will rerun all critical clinical results when appropriate.
2. If the validity of the sample is in question, the lab will contact the nurse to confirm.
3. As soon as the critical results are confirmed, the lab will release the results in the computer.
4. During clinic hours: A licensed nurse in the clinic where the
patient was seen will be contacted.
The patient will be identified
using
two identifiers and the results will be given to the nurse along with the name of the attending physician. The nurse will be asked to
document and read back the critical value to the technologists to confirm
correct communication.
5. It will be the responsibility of the nurse to contact the physician to convey the critical value and request orders.
6. After clinic hours: The lab will call the hospital operator and ask that they page the physician who is taking call for that service.
7. If the physician on-call fails to respond within a 30 minute time frame, the lab will contact the Lab Manager-On-Call and the Pathology Resident. The Pathology Resident may notify the Attending Pathologist and/or the Laboratory Medical Director, if necessary. The Resident will notify the initiating technologist when they can release the result in the computer. The Pathology Attending or Laboratory Medical Director may, in certain circumstances, notify the ED and contact the patient and recommend they come to the ED. Any such instance as this will also be reported by the Attending Pathologist to the UAMS Medical Director.
All such examples of non-response will be documented in Patient Safety Net.
8. Critical values will not be communicated to a non-licensed individual.
NOTE: The hospital operator, via the Amtelco system (online call schedule), has a list of all on-call physicians for each service.
Emergency Department Procedures:
1. Lab will rerun all critical clinical results when appropriate.
2. If the validity of the sample is in question, the lab will contact the nurse to confirm.
3. A redraw may be requested of the nurse to confirm the results.
The Pathology resident may be consulted to help resolve issues in
confirming results.
4. As
soon as the critical results are confirmed, the lab will release the results
in the computer, call the specific cell phone of the ED
charge nurse, identify the patient using two identifiers and give the
results to the nurse.
5. The ED charge nurse will be asked to document and read back the critical value to verify correct communication.
6. If the ED charge nurse is unavailable by cell phone, the lab will contact the CDF or another RN in the ED.
7. It will be the responsibility of the nurse to contact the physician to convey the critical value and request orders.
8. The laboratory will not call the ED charge nurse cell phone unless it is to give a critical value result. All other calls to the ED will be called to the main ED telephone number.
a) Full Name and location (if applicable) of physician and/or nurse called or paged.
b) Time the physician/nurse was called or paged.
c) Time of response and
documentation of read back of critical value including
identification of person making the call.
(ex. “Called to and read back
by John Smith,
RN at 16:30.BLW”)
d) Resolution if applicable.
e) Documented comments regarding specimen quality should be limited to factual information.
Refusal to accept critical values by the appropriate MD or RN will result in a Lab variance and entered into Patient Safety Net.
Signatures
Original signatures are on file in the Clinical Laboratory.