Documentation of POC GLUCOSE criticals

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We use Abbott freestyle precision pro meters. PCA’s document critical glucoses with a code that translates as “ critical POC glucose shared with provider“. CAP inspectors want a name and time of who received value. Any thoughts? I do not wish to initiate a log book to have to track.
Thank you!

14 Replies

Jonathan Lee

Thu Sep 08, 2022 at 8:04PM

COM.30000 Critical Result Notification has an exception for POC if the person performing the test is treating the patient. Not sure if this is always the case at your site.

James Beck

Thu Sep 08, 2022 at 8:09PM

Jonathan - I think the argument here is that a PCA (not a nurse) is not the one treating the patient, hence the need to document the hand-off communication between PCA and the person that is ultimately treating the patient.

James Beck

Thu Sep 08, 2022 at 8:24PM

This is a question I always pray I'm never challenged with because it is a logistical nightmare, given the volume/frequency of occurrences as well as the non-laboratory setting. I had Barbara's process (entering a numbered code that translated to generic provider communication comment) but as of a few years ago, we even dropped that. Because the Abbott meter technology has no easy way to capture a free-text type of comment like that, I think the only solution to accomplish that is documentation within your HIS (not LIS), with appropriate monitoring for compliance by the nursing location where the test was performed. Although we utilize CAP, only Joint Commission has challenged us on this, but they were satisfied with our process of including critical bedside glucose results in our total tally of all critical results (lab and POC), and nursing staff doing a chart sampling for compliance (not every critical result was researched). Not sure whether CAP would see that as sufficiently compliant.

Adonica Wilson

Fri Sep 09, 2022 at 8:19AM

This is an ongoing issue for alot of us I think. We have the non-nurses (MA's, ED techs, NA's etc) enter the results into EPIC in the flowsheet. Our EPIC team created a spot for them to enter the documentation (name the result was given to, date and time) and we have been doing audits to check compliance. When we do unit audits with the Nurse Managers that's one of the items on our audit form.
We also started using a middle initial in QML for non nurse operators so we can sort the criticals when we audit. Since as James said, CAP doesn't require as much documentation for the nurses that treat the patient we only audit the non nurses documentation. We started putting M for MA's, N for NA's, E for ED techs etc. and that made it alot easier to sort.

Reine Makiya

Fri Sep 09, 2022 at 9:27AM

Our Epic team built a spot in Clinician Notification for charting different critical results including lab called criticals and POCT criticals. I have a report that runs all the critical POCT glucoses and the flowsheet fields from Clinician Notification. If the fields are blank, then there was no documentation. It's still a work in progress but we are just under 90% compliance.

Vivian Tenuta

Fri Sep 09, 2022 at 9:30AM

Our Patient Care Techs are required to document in EPIC that they notified a licensed patient caregiver if they obtained a critical value. I audit 100% of critical results performed by them by manually looking up each one in EPIC. Required documentation is taught in initial training and I send out monthly reminders to all PCTs. I do document within our Learning system if documentation was not performed. Administration and Quality back me up on this. Overall compliance is still not great. I swear if I ever get 100% one month, I'm going to go out and celebrate. We were asked on our last inspection about how we meet this standard and I was ready for that one. At least I showed that I was trying. You can lead a horse to water, but you can't make them document.

Jillian Cooper

Fri Sep 09, 2022 at 10:31AM

I have the nurse that was notified make a nursing note, patient care note, or a comment on medication given what the result is so that it reflects that the nurse was notified. It also is sent to the mobile heartbeat number for the nurse taking care of the patient.

Amanda Casavant

Fri Sep 09, 2022 at 11:21AM

Hi
I review all the critical values. We are a small community hospital with <100 beds and have about 0-5 critical values/day.
I am checking against our Policy:

All critical values have a comment - canned comment Notify RN/MD
Lab Draw or Decline by provider >400
Treatment for our critical low <40 :This is always 100% compliant!

LIS/MIS - Meditech, NOVA glucometers, RALS middleware.
If staff don't add the canned comment I make sure it was reported but the name of the staff member taking critical isn't recorded anywhere.

Each month Clinical Leaders receive a compliance report and staff that haven't used the glucometer canned code are sent a read and sign.

Total compliance back in 2017- 66% but each year it got better but we've plateaued in the low 80s for the last couple of years!

I will celebrate too if I every see a 100% ;)
Anyone out there using Meditech that have found a way to document the name???

Cindy Sorensen

Fri Sep 09, 2022 at 12:36PM

We have Cerner, so not sure if this will help anyone. In Powerchart, we find the critical result, and look at the action history. It shows who performed the test, who reviewed result and who/if any ordered any followup testing/actions with date/time.

Barbara Loftus Nelson

Fri Sep 09, 2022 at 1:47PM

We currently are Meditech but Epic in a few years so looking fo a temp solution and how to build Epic to satisfy in future.
Has anyone done the Abbott freestyle solftware upgrade that allows you to free text comments? I wonder if RN or MD first initial and as much as last name as allowed by character limitations would satisfy CAP.

thank you everyone for input!!!!!!

Brittany Peavler

Thu Sep 22, 2022 at 11:11AM

We are currently in the process of updating the BPA in Epic that triggers when a NCT (nursing care tech) enters a critical low glucose. In hopes that this BPA goes through, it would require them to enter the date, time, and name of nurse notified. This documentation would autofill into the flowsheet within Epic. Does anyone else happen to use BPA in their advantage in Epic?

Thanks!

James Beck

Thu Sep 22, 2022 at 11:20AM

Brittany - when you say the NCT "enters" the result - do you mean manual entry, as in the result is not interfaced through your LIS? Doesn't that open up the whole can of worms of having to be responsible/track manual entry of results to audit for transcription errors - even if the result is also there as an uploaded value?

Brittany Peavler

Thu Sep 22, 2022 at 11:25AM

Sorry guess I should have clarified better - POC Glucose results are interfaced into Epic, but NCT's still have to manually document in the patients flowsheet area, this is part of their procedure. So technically they are not manually entering the result so we can pull reports of all critical values but its the documentation piece in the flowsheet they are not preforming.

Michelle Vojtkofsky

Thu Oct 27, 2022 at 4:37PM

For those of you using Epic Clinician/Provider Notification in the flowsheets, where do you have them document the read-back? I'm trying to add a "“Lab: verbal result notification read-back" option to the "response" field options, but I'm getting push back from the nursing department. They feel that's not the right place for it, and that expecting the nursing staff to remember to choose the right "response" isn't going to work out on the units.

Thanks!

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Documentation of POC GLUCOSE criticals