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3 Louisiana State University Health Sciences Center Results of specimen that is out of normal range and probably is associated with high mortality It is require to informed

4 The Joint Commission Perspective on Patient Safety December2011 The Joint Commission defines critical results as: The test results that are abnormal to a degree that may indicate a life-threatening situation

5 LSUHSC- Clinical Laboratory Policy and Information Manual Result of tests that according to the clinical decision by physician must be do effective action

6 Eight Recommendations for Policies for Communicating Abnormal Test Results 1 Policies Should Be Introduced with Clear Definitions of Key Terms 2 Policies Should Clearly Outline Provider Responsibilities 3 Policies Should Specify Procedures for Fail-Safe Communication of Abnormal Test Results 4 Policies Must Define Verbal and/or Electronic Reporting Procedures for Both Critical and Significantly Abnormal Laboratory, Imaging, and Other Test Values

7 Eight Recommendations for Policies Cont 5 Policies Should Specify Critical Tests and Acceptable Length of Time Between Their Ordering and Reporting 6 Policies Should Define Time Lines Between the Availability of Test Results and Patient Notification, and Institutions Should Specify Preferred Mechanisms for Patient Notification 7 Policies Must Be of Real World Value and Written with Feedback from Key Stakeholders 8 Policies Should Establish Responsibilities for Monitoring and Evaluating Communication Procedures

8 Critical or panic Values of Laboratory Test Units Lower Limit Upper Limit comments Test Units BLOOD GASES PH mm Hg Arterial, Capillary Hematocrit Lower Limit HEMATOLOGY Upper Limit comments PCO2 mm Hg Arterial, Capillary Adult % First report only PO2 mm Hg Arterial Newborn % First report only PO2 (children) mm Hg Arterial Hemoglobin PO2 (newborn) mm Hg Arterial Adult g/dl 7 20 First report only CHEMISTRY Newborn g/dl First report only Albumin (children) g/dl Serum or Plasma WBCS Ammonia (children) μmol/l Plasma Adult 10³/μl First report only Bilirubin (newborn) mg/dl Serum or Plasma Children 10³/μl First report only Calcium mg/dl Serum or Plasma Plateles 10³/μl First report only Calcium (children) mg/dl Serum or Plasma Blasts Any seen ( first report only ) Calcium, ionized mmol/l Plasma Drepanocytes Presence of sickle cells or plastic crisis Carbon dioxide,total mmol/l Serum or Plasma COAGULATION Chloride mmol/l Serum or Plasma Fibrinogen mg/dl Creatinine mg/dl Serum or Plasma PT(Prothrombin time) S Creatinine (children) mg/dl Serum or Plasma PTT (Partial thromboplastin time) S Glucose mg/dl Serum or Plasma URINALYSIS Presence of pathological crystals Glucose (children) mg/dl Serum or Plasma Microscopic (urate,cysteine,leucine or tyrosine) Glucose (newborn) mg/dl Serum or Plasma Chemical Strongly positive glucose and ketones Glucose,CSF mg/dl CSF CEREBROSPINAL FLUID Cells per Glucose,CSF(children) mg/dl CSF WBCS (0-1yr) μl ---- > Cells per Lactate mmol/l Plasma WBCS (1-4yr) μl ---- > Cells per Lactate (children) mmol/l Plasma WBCS (5-17yr) μl ---- > Cells per Magnesium mg/dl Serum or Plasma WBCS (>17yr) μl ---- > Osmolality mosm/kg Serum or Plasma Malignant cells, blasts Applies to other or microorganisms Any Phosphorus mg/dl Serum or Plasma sterile body fluids Potassium mmol/l Serum or Plasma Potassium (newborn) mmol/l Serum or Plasma Protein (children) g/dl Serum or Plasma Protein,CSF (children) mg/dl CSF Sodium mmol/l Serum or Plasma Urea nitrogen mg/dl Serum or Plasma Urea nitrogen (children) mg/dl Serum or Plasma Uric acid mg/dl Serum or Plasma Uric acid (children) mg/dl Serum or Plasma HIS ) ( HIS / ************************************************ *** /

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14 Most common critical value 1300 Calls 93% due to 8 tests Hematocrit ( 318, 24 % ) Potassium ( 230, 18% ) Hemoglobin ( 201, 15% ) Troponin ( 167, 13% ) Platelet Count ( 134, 10%) WBC Count ( 117, 9% ) Glucose ( 78, 6% ) Calcium ( 64, 5% ) In 2012, the studies of Mayoclinic Laboratories (MCL)

15 Clinician (Doctors) Residents Nursing (Nursing team) Para clinic consultants and technologist such as: Laboratory, Pathology, Radiology, CT scan, MRI, Sonography, Mammography and Nuclear medicine

16 1 Critical value table must be provide according to valid references and revised annually 2 Critical value table must be archive in all of clinic and para clinic departments 3 Patient care team must be full conversancy about the critical value table contents 4 Hotline is the best practice for inform risk 5 Simultaneously (at the same time), the presence of Alternative pathway are required 6 Hot line must be exist in para clinic Dep and mobile systems (such as pager) must be exist in Nursing section

17 7 Before rechecked of tests, inform risk must be done 8 Rechecked of results (if needed) could be done after inform 9 In special and necessary condition and if Laboratory consultant (Lab Director) requires to have specific information, Lab consultant (Lab Director) should be contact to doctor 10 Documentation of panic value will be recorded in HIS (Hospital Information System) 7 Nursing supervisor is responsible for tracking

18 Laboratory Laboratory consultant or technologist Pathology Pathologist or cytoscreener Radiology Radiologist or technologist Nuclear Medicine Sonogerphy Nuclear Medicine consultant or Sonogerphist technologist

19 1 All of patient care team trained specifically for panic value according to the guideline for informing to patient and their family 2 When laboratory technician finds out panic value, he/she informs risk to Lab Consultant and admission supervisor 3 In Para clinic admission supervisor contacts to patient : In critical value (hazard condition), strongly advice to patient that call to emergency services In emergency case, advice to patient that goes to the nearest medical care center In other cases, contacts to patient during 9 am until 7 pm and advice them that come to our center 4 In special cases (when it is need to give specific information), Lab Consultant contacts to patient or their family and informed them about next steps of treatment

20 1 Laboratory consultant (Lab Director) should be prepared panic value according to the valid references and is updated annually 2 All of technologist must be educated and guided via training supervisor of Nursing and Para clinic Dep 3 When Clinical laboratory technologist finds out critical value, before test rechecked, as soon as possible must be contact to Hotline and also laboratory consultant and informed about it

21 4 After informing, Nurse who received message (panic value) must be read-back (patient name, unique patient numeric identification, the critical test result) 5 If the Lab consultant (Lab Director) needs to have more information, he/she contacts to doctor 6 Clinical laboratory technician rechecks the laboratory test on the exist sample or request new sample 7 If the test was rechecked and fined out different result, Lab consultant and nursing supervisor must be informed by clinical laboratory technician, then this result will be recorded in HIS

22 7 during reporting Panic Value, time and the name of person receiving the call will be recorded by laboratory technician 8 In case of missed calls, reports of Panic value will be announced to the nursing supervisor 9 When nursing supervisor was informed, he/she will be Read Back of Critical Value and done emergency care and contacts to doctor

23 Challenges 1 The repeated results of one known patient that are boring for patient care team 2 Result of known patients such as: Cirrhosis, Leukemia, ATN 3 Repeat of result in during change of time shift 4 When the results of tests are not in critical value but range of variation are not acceptable 5 How many of panic value results are sufficient??

24 Conclusion & suggestion Improved of hospital information systems Designed of digital alarm systems Designed of smart systems that are available to detecting of variation Improved of connection systems such as: head set, pager, mobile

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27 Louisiana State University Health Sciences Center ی ک ال ی ز گ ی ی ی ع ی Results of specimen that is out of normal range and probably is associated with high mortality It is require to informed Alert value, critical value of Laboratory results from a specimen that must be reported immediately to a clinician, of such severity as to mandate urgent therapy این متن مربوط به اینترنت و تعریف ویکیپدیا در مورد نتایج بحرانی است البته چون فرمود متن اصلی انگلیسی را دارید منتظر متن اصلی می مانیم!!!!!

28 The Joint Commission Perspective on Patient Safety, December2011 ک ک ک ک ی غ ی ک ی ج Irregular (unusual) Laboratory results that could be threated patient s life

29 LSUHSC- Clinical Laboratory Policy and Inforation Manual ی ک ط ز ک س ض ی ی ص ب Result of tests that according to the medicine decision must be consider معذرت مفهوم را درست نفهمیدم!!!!!

30 ز ک ی ز ک ی ک ک ک ک ژی ژیMRI CTScan, ی ی ز کی ی) (

31 ط ی 1- ق ی ع ی ی ی ک ک ک عض ء ی ف ی ک 4- ش ز ی ط ژ (Hotline) 5- ک ی ی ز ف Pager ط ژ ء Hotline قص -6

32 )Rechecked ( ی چک ج -7 ) چک ( ج ی -8 ص ع صصی ی ز ک ج ط ز ک ی -9 HIS ز ش Panic Value -10 ی ی ی -11

33 ص ق ی س ک ی ز ک ژی س ک ی ز ک ژی س ص ی ک ی ز ک ی ص س ص ی ک ی ز ک ی ز کی

34 ی )OPD( ژ ی ک ک ص ص ی ج ی -1 ق ش 2 -ک س ی ض ی ی ز ک ی ک ع ش ک ک ی ط ش ع ش 9 س ی -4 ز ک ی ک ی صصی ع ئ -5 س ی ص ص ی ال ی

35 ی ش Panic Value ( ع 1- ی ی ک ک ق ی ) ز ی ی ک ک ک ط ی -2 ک س ی ض چک ی س -3

36 صصی ی س ج ز ک ع ئ -4 ک س ی ی ک -5 ی س ک ف ک ی -6 ع )HIS(

37 -7 ز ش Panic Value ز ش س ی HIS ی ز ش س ع ق ی ز ش ی -8 ز ش ی ظ ف ک ی ک ب ز ال ع ی -9