i.STAT Orders in Cerner

We don't use iSTAT  in the OR setting, but the issue of the 'lab order' is the same with whatever POC platform you use.  When we were challenged on this, basically our Anesthesia Director replied with "the entire anesthesia record (including any testing needs) is prescriptive by nature and is designed to cover any emergent need during anesthesia."  Right or wrong, the conversation pretty much stopped there and was not challenged further.  At its root, that question is based in CLIA/State standards that want to make sure lab testing is backed up with physician authorization and that labs aren't doing testing just so they can be reimbursed.  Most POC/non-lab testing turns that on its head slightly, in that the physician authorization sometimes isn't in the format we used to expect but it's still there.

I agree James. I can't say that I ever track or follow this in any way but we have tried to push for some kind of order to be placed at least on the unit. But you know in ED, OR, ECMO, emergent situations that it is not being done - the response above makes sense. 

I agree with both James and Danyel. Our rational is similar in that POC orders are part of our "Standard Protocol" and written as such. "OR Lab testing performed as needed per protocol". Usually that ends the conversation.

Thanks everyone for your replies.  We were challenged with this standard with our recent inspection.  The surveyor would not accept "Per protocol" as an acceptable order.  We are taking a closer look at our anesthesia log to see if it includes all the required elements of a lab order.  Thank you! 

I think I might push back on that.  It's one of those areas where POC does not meet the exact lab model and it never will.  Those of us working in the field understand that, but some take it to the letter of the law and apply the "exact" lab model, which is (inpatient or outpatient) - physician places an order, lab carries it out via an LIS that checks all the boxes of the regulation.  The regulations have simply not caught up with the reality of POC, and as it continues to grow and grow, they need to.  Doesn't help you much now, I understand, but I think I would have more discussions, especially with the accreditor themselves, rather than just your surveyor.