Notification of critical laboratory result

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