notification of critical laboratory result
TRANSCRIPT
Notification of critical
laboratory result
DR LEE OI WAH
PENGARAH HOSPITAL CHANGKAT MELINTANG
NOTIFICATION OF CRITICAL LABORATORY RESULT
• An important aspect of patient safety.• Hospital accreditors are placing increased emphasis
on the timeliness with which critical laboratory results are reported to caregivers.
• Failure to report critical lab results in a timely and reliable way is a threat to patient safety and healthcare quality.
• For Accreditation purpose, all Labs must have a list of critical limits, formulate notification procedures, document critical results and notify clinicians immediately.
DEFINITIONS• Critical result• A test result that was generated by the chemistry or hematology section of a laboratory, that concerned an inpatient or emergency department patient and that met a laboratory’s local threshold for a
critical result that must be rapidly communicated.• Critical results are defined as results that, if left untreated, could be life threatening or place the patient at serious risk
• Physician A licensed doctor of medicine.• Licensed caregiver• A physician, registered nurse or PPP (an individual the JC considers to be someone who is authorized to take action on the results or an agent who can immediately notify someone authorized to take action. )
Execution of notification of critical lab results
• Defining lists of critical values to be communicated
• Identifying who to call.• Establishing explicit time frame to call.• Documentation
LIST OF CRITICAL LAB TEST
• 10 TESTSo Serum Potassiumo Serum Nao RBSo Hbo Blood Ureao Calciumo Plateleto PTo APTTo Serum amylase
MECHANISM OF NOTIFICATION• Responsibility of MLT.• Responsibility of licensed caregiver• Flowchart of communication process• Documentation
~ laboratory
~ receiving unit
RESPONSIBILITY OF MLT
• Check the test request form whether test is in the list of critical lab result(CLR).
• Perform the test.• If CLR list, check and validate result. If results
in the critical range, immediately call the unit requesting test.(Licensed care provider).
• Communicate result to licensed care provider using read back method.
• Document the process in “Borang Notifikasi CLR”.
RESPONSIBILITY OF LICENSED CARE PROVIDER
• Receive notification from MLT and record information in “ Borang Penerimaan CLR”.
• Read back result to MLT to confirm correct result.
• Inform Medical Officer for further actions.• Collect hardcopy of lab result and filed in
patient’s notes.
FLOW CHART FOR NOTIFICATION OF CRITICAL LAB RESULT
Start
MLT receive request for lab test
MLT check whether in the list of CLR
No
Process as routine
END
Yes
Process speciment and record result
2nd MLT validate result and check result whether in critical range
No
Record result and dispatch to requesting unit
END
Yes
Inform result to licensed care provider & record in Borang Notifikasi CLR
NOTIFICATION VIA TELEPHONE
• Informer name and designation• Confirm patient location• Patient ID : name, IC no, MRN• Sample date & time• Test name & result• Result read back by recipient• Document recipient name & designation• Document date & time of notification
BORANG NOTIFIKASI CRITICAL LAB RESULT BIODATA PESAKIT
Nama : No KP : MRN : Unit : Tarikh ujian : Jenis ujian :
KEGUNAAN MAKMAL Tarikh & masa terima specimen : Tarikh & masa ujian siap : Validation : Masa : Peg. : Masa CLR diberitahu :
UJIAN MAKMAL 1. Nama ujian : Keputusan : 2. Nama ujian : Keputusan : 3. Nama ujian : Keputusan : 4. Nama ujian : Keputusan : 5. Nama ujian : Keputusan : PENERIMAAN CLR Pegawai yang menerima notifikasi telefon : Pegawai yang menerima salinan hardcopy CLR : Tarikh dan masa dispatch keputusan : Tandatangan MLT yang bertugas :
Critical Result 5 Steps Reminder(MLT)
• Check for any critical result• Confirm critical result• Call ward immediately• Asked for a read-back• Record the notification
FLOWCHART FOR RECEIVING CRITICAL LAB RESULT
Collect hardcopy from lab and filed in patient’s record
END
Start
SN or PPP receive notification of CLR from MLT
Record result in Borang Penerimaan CLR
Notify CLR to Medical Officer
RECEIVING CLR• Information to record :Patient ID : name, IC No, MRNSample date and timeTest and resultLab staff nameDate & time of notificationName of recipient
LAMPIRAN 5 : BORANG PENERIMAAN CLR
BIODATA PESAKIT Nama : No KP : MRN : Unit : Tarikh ujian : Jenis ujian :
KEGUNAAN UNIT Tarikh & masa terima CLR: SN /PPP yang bertugas : Pegawai yang notifikasi CLR :
UJIAN MAKMAL 1. Nama ujian : Keputusan : 2. Nama ujian : Keputusan : 3. Nama ujian : Keputusan : 4. Nama ujian : Keputusan : 5. Nama ujian : Keputusan : PENERIMAAN CLR Pegawai yangdispatch hardcopy CLR : Pegawai yang menerima salinan hardcopy CLR : Tarikh dan masa terima keputusan : Tandatangan pegawai yang menerima CLR :
MAKLUMAN KEPADA PEGAWAI PERUBATAN Pegawai perubatan yang menerima keputusan : Tarikh dan masa dimaklumkan :
Critical Result (WARD)6 STEPS REMINDER
• Receive Notification Of Critical Results From Lab
• Read Back Results• Record Results In The Form • Inform Dr Immediately• Get Hard Copy Of Results From Lab• Attach Results In BHT
PRACTICAL SESSION• SCENARIO 1 : Patient’ s FBC : Hb - 5.5gm% TWDC - 24000/ml3
Platelet – 15000/ml3
• SCENARIO 2 : Patient’s BUSE : BU – 13.4 mmol Na - 110 K - 2.3 mmol Cl - 99 mmol