PEACEHEALTH LABORATORIES

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2 Critical Values Call List - Longview Critical values are reported per the criteria published below. Laboratory results meeting these criteria indicate potential life-threatening conditions and are promptly communicated to a provider who can initiate appropriate therapy. Test Critical Value HEMATOLOGY / COAGULATION / URINALYSIS APTT (PTT) CSF, Nucleated Cell Count Differential Fibrinogen Hematocrit Hemoglobin Heparin, Unfractionated >125 seconds >10 <30 days old: >30/µL Blasts, presence of microorganisms <80 mg/dl Pediatric, adult, renal failure: <20.0% <30 days old: <24.0% or >65.0% <6.5 or 20.0 g/dl <30 days old: <7.5 or 22.5 g/dl Hemodyalisis patients: <8.5 gm/dl >1.5 U/mL Neutrophil Absolute (ANC, N#) Platelet Count <0.50K <30.0K <30 days old: <60.0K Prothrombin Time (PT/INR) >5.4 Urine Reducing Sugars (<2 years old) White Blood Count Any positive value <1.0K or >50.0K <30 days old: <2.0K NOTES: 1. INPATIENTS: Critical laboratory values will be called by the reporting technologist to the patient care unit. 2. OUTPATIENTS: The reporting technologist will call the critical results directly to the physician office, physician on call after hours or referral client. 3. Documentation of critical value notification is maintained with the LIS call log. Include name of person taking results and read back (RB) or no read back (NRB). 4. The laboratory LIS has all critical limits set. When a result is flagged as critical, the call log is initiated prior to releasing the results. 5 For critical values which are not flagged by the LIS, use the call log to document calls. 14-LABO

3 Test Critical Value CLINICAL Ammonia Bilirubin, Total (all ages) Calcium, Serum CO2, Total Glucose Iron Magnesium Potassium Sodium Troponin I >200 µmol/ml >15.0 mg/dl <6.0 or >12.0 mg/dl <11 mmol/l 1 year: <50 or >500 mg/dl <1 year: <40 or >300 mg/dl 250 µg/dl <1.1 or >7.9 mg/dl Obstetric patients on magnesium therapy: >7.0 mg/dl Older than 7 days: <3.0 or >6.0 mmol/l 0 7 days old: <2.8 or >6.5 mmol/l Outpatient hemodialysis: <2.7 or 6.9 mmol/l Older than 7 days: <120 or >155 mmol/l 0 7 days old: <125 or >155 mmol/l 0.50 ng/ml (new finding only) BLOOD GASES pco2 <16 or >70 ph <7.20 or >7.60 po2 <60 CSF Glucose <20 or >500 mg/dl THERAPEUTIC DRUGS Acetaminophen Alcohol, Medical Carbamazepine Digoxin Gentamicin Lithium Phenobarbital Phenytoin (Dilantin) Salicylate Theophylline Tobramycin Valproic acid Vancomicin (peak, trough, random) >50 µg/ml >0.35 g/dl >15.0 µg/ml >3.0 ng/ml Peak/Random: >10.0 µg/ml Trough: >2.0 µg/ml >1.2 mmol/l >60 µg/ml >30 µg/ml >40 mg/dl >25 µg/ml Peak/Random: >10.0 µg/ml Trough: >3.0 µg/ml >175 µg/ml >50 µg/ml Call all critical results to the patient floor (on inpatients) or to the physician/nurse (on outpatients)

4 BLOOD BANK Incompatible crossmatches or delay in transfusion due to irresolvable situations or a warm autoantibody. Pre-surgical patient with a positive antibody screen. Transfusion reaction possibly due to TRALI An acute hemolytic or possible delayed transfusion reaction Kleihauer-Betke positive results Positive DAT result on an infant MICROBIOLOGY Physician Client or Nursing Unit Non-Critical Convenience Call, Print or Fax to Client or ED as appropriate If inpatient: Infection Preventionist (Ext or ) Positive blood cultures Positive CSF culture and Gram stain Positive sterile body fluid (pleural, peritoneal, pericardial or joint) culture or stain. Except for dialysis fluids and known joint fluids involving prosthetic devices, do not phone light growth of coagulase negative staph., Bacillus spp. and Corynebacterium spp. Positive cornea culture for Acid-fast bacilli (AFB) rapid growers, Bacillus species, enteric gram negative bacilli, Haemophilus influenzae, herpes simplex virus, molds, Moraxella species, Nocardia species, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, varicella virus, viridans streptococcus including Streptococcus anginosus group. Positive pertussis culture or stain Positive stool for enteric bacterial pathogens including E. coli O157 and positive shiga toxin Newly discovered methicillin resistant Staphylococcus aureus (MRSA) (inpatients) Newly discovered methicillin resistant Staphylococcus aureus (MRSA) (outpatients and ED) Positive for Mycobacterium tuberculosis Positive Neisseria gonorrhoeae or Chlamydia trachomatis Positive HIV antibody screen

5 MICROBIOLOGY Physician Client or Nursing Unit Non-Critical Convenience Call, Print or Fax to Client or ED as appropriate If inpatient: Infection Preventionist (Ext or ) Positive Clostridium difficile (inpatients) Positive Clostridium difficile (outpatients) Positive group A streptococcus antigen screen Positive stool for Rotavirus Positive stool for Giardia or Cryptosporidium Positive RSV Positive influenza antigen test Carbapenem (e.g. Meropenem) Resistant Acinetobacter baumannii (CRAB) Carbapenem (e.g. Meropenem) Resistant Klebsiella pneumoniae (CRKP) Linezolid Resistant Vancymycin Resistant Enterococcus (VRE) A confirmed, by reference laboratory, Vancomycin Intermediate (VISA) or Vancomycin Resistant (VRSA) Staphylococcus aureus Reportable organism isolated