Critical Values in POCT

Critical results for the Glucometer - Adult patients if the result is 45 or less or greater than 500 they send send a sample to the lab for verification

Pediatric patients they follow department specific protocol for glucose.

iStat - all critical results are verified by the lab

Sorry we do not have a hemocue

Our glucose SOP says they may consider sending a confirmation to the lab but it is not required.  If they get a critical result, they repeat it on the meter.  They choose a comment on the meter Notify RN or Notify MD that goes into the chart with the result.  We pull a critical value report daily (looks back to the previous day or days if w/end or holiday) and look to see how soon after did an RN or MD review the result.  Be aware of any rules in your middleware that may hold up result(s) because you have to review them first, then send to the chart if appropriate.  

For critical i-STAT results, a sample is usually sent to the lab especially if it is a high K+.  We follow up on any results that seem like an outlier.  We do not use the Hemocue.

Hope this helps!   

Cindy,

Are confirmations on critical i-STAT results required or recommended?

Thanks so much for sharing.

We recommend.  

Our policy for critical BGMs is:
For high (401 and up):  Repeat BGM within 5 minutes to rule out technical error. If still critical, order a lab confirmation within 30 minutes-- the FIRST time critical BGM results are obtained. For subsequent critically high BGMs, they still have to do a repeat test within 5 minutes, but do not need another lab draw. If they go below 400 and then over 400 again later, it's a new episode, and they start over with the repeat and the lab confirmation.
For low: (49 and less) Repeat BGM within 5 minutes to rule out technical error. If still critical, treat using hypoglycemic protocol and then re-test 15 minutes post treatment. No lab confirmation required for low results. 
For Neonates: Critical BGMs are not repeated (unless there is some unusual circumstance that leads the nurse to believe the result is not accurate), but ALL are confirmed with a lab specimen. 
We don't use iSTATs for anything but creatinines.
We don't have HemoCues.
Critical values on the EPOC, however, are usually assessed by the clinical picture and usually a lab draw. In some cases, like with critical Lactic Acid 
results, they generate a reflex order for a repeat test 4 hours later, per our Sepsis Protocol. 

Thank you Gloria!