Lactic acid repeat reflex with poc

5 followers

0 Likes

Hi
Just wondering if anyone else out there has implemented a reflex order or repeat protocol for their lactic acids. Our lab has done this and any lactic with reflex will reflex to another lactic order if elevated within first 6 hours. Our issue comes up with adding this reflex to our poc blood gas+ lactic orders. There are numerous duplicate possibilities and our IT team has come up with nothing to deal with any potential duplicates. Just curious if any other labs out there have dealt with this. Preferably someone with Epic Onechart.

Thanks
Brian

5 Replies

Danielle Ennis

Tue Oct 11, 2022 at 10:10AM

I don't know if this is feasible for your team, but we have a separate "Lactic Acid ED" test that is being built for this same reflex order workflow. This stand-alone stat lactic acid order is the only one that will reflex to another lactic order.

Monica Kaufman

Tue Oct 11, 2022 at 10:18AM

We use Cerner Millennium. If we have an elevated POC lactic, we have a nursing task reflex built to repeat another POC lactic in 2 hours. Our lab lactic tests do not reflex to a POC lactic and our POC lactic does not reflex to the lab.

Ken Charpie

Wed Oct 12, 2022 at 11:54AM

This is to satisfy the CMS sepsis goals...
We've fought with this very exact same issue with ABG lactics for years (and other lactic reflex issues). It took a long long time and much persistence for our IT to figure this out. Unfortunately we're not on EPIC. But we will be, so I want to know the answer to this when you find out as well. I imagine I will be fighting this fight all over again when we switch EHR/LIS

Brian Wittkop

Wed Oct 12, 2022 at 12:45PM

Thank you all for your responses. Currently we have the Lab lactic reflexing to another lab lactic if elevated. We are wanting to add POC lactics to this process where the POC lactics would reflex to the lab lactic if elevated.

Ken- would you mind sharing how IT was able to figure this out with your previous system. Even though we have a different LIS there must be some workflows or processes in place to reduce the duplicates. Thanks.

Ken Charpie

Wed Oct 12, 2022 at 12:55PM

We use MedHost Direct (MHD). Our big issue was IT figuring out how MHD rules could be used to reflex a lab drawn LAC when one of our respiratory panels had an elevated LAC. Rules in MHD are specific to their originating department, according to all the IT folks I spoke with, which is why we had problems getting a rule built. A genius former LIS admin figured out how to make the reflex rule programming work between depts. And then once we had a rule it was broken by an upgrade that changed the RT dept to CP dept in MHD (I theorize that the name designation change broke the rule but don't really know). Without our former LIS admin I was bounced around corporate IT and MHD IT and had almost given up when a corporate IT staff member tried something. I wish I could tell you exactly what they did, but imagine with it being a different system those technical details probably don't matter. I hope some of that may be helpful to you in your troubleshooting?

During that long period of time with the rule broken, I posted signs on all the blood gas analyzers directing RTs to order reflex LACs on all >2.0. But you know how effective signage on everything can be...

Subgroup Membership is required to post Replies

Join POCT Listserv now

Topic	Replies	Views	Participants	Last Reply
Piccolo express Deborah Martuch, MT(ASCP), CPP about 2 years ago	3	247		Deborah Martuch, MT(ASCP), CPP about 2 years ago
Quantra Ashlee Byquist about 2 years ago	5	326	+ 1 more	Ashlee Byquist about 2 years ago
PPM Procedures/Resources Jennifer Toncray about 2 years ago	5	242	+ 2 more	Jennifer Toncray about 2 years ago

Setup Information

Lactic acid repeat reflex with poc