Cath Lab - AVOX resulting

Stephen we have a build in EPIC for the AVOXimeter that allows the end user to order the test and result the O2 sat for each site that is tested.  Each site (AO, PA, RA, etc.) also has a reference range posted next to it.  In addition there is an area in the build that allows them to enter the lot of the cuvette.  All of the regulatory requirements for daily and weekly QC are recorded in a log that POC collects each month and reviews.  We also have a printer attached to each AVOXimeter which records the operator ID, patient ID, serial number of the device, and date/time of testing.  The printouts are collected each month as well.
We are not interfaced for a couple of reasons.  Sometimes the physician is checking to see if they are in the right location and don't want the result recorded.  In addition, there is no barcode reader to scan the patient ID.  Manual entry could result in a typographical error which would then either cause the result not to transmit or potentially transmit to the wrong record.   

Hi Andrea,

Is this Epic build a standing order that is released every time the nurse needs to record a result? Are they resulting in real time right from the AVOX or are they recording on an intermediate log first?

Thank you so much for your answer

Our Cath Lab uses MacLab for most of their documentation.  Our hospital uses Meditech and MacLab creates a procedure log that posts into Meditech with the Avox results on it.  We have our Cath Lab keep a paper log with patient results in order to audit monthly and ensure results are being documented in the charts since it is a manual entry.  The employee performing the testing is the one writing on the patient log sheet, however they too shout across the room to the other employee who is doing the documentation in MacLab.  Sometimes results are entered incorrectly into the MacLab and do not match the paper log sheet.  We also require them to keep the instrument printouts from the AVOX as another reassurance that the results are correctly entered if there is a discrepancy between the paper log sheet and the EMR.  If there are discrepancies we have them enter a note or an amended scanned report into the chart as a correction.  I audit about 5 patient tests each month for accuracy.  I would love for all of this to be interfaced, however that is a cost that the department is just not willing to pay for.   

Andrea,
What model Avoximeter do you guys use?

Leighea

Stephen the build is tied to the order.  The nurse enters a "verbal with repeat back, cosign required" which the doc later signs off on.  Once the test is ordered it allows them to enter each of the results in EPIC.  Just to clarify, they can enter multiple sites in one build/order.  Generally the POC builds are tied to a charge as well however I believe the billing for the AVOX is done manually with a separate charge for each site tested.

We use the AVOX 1000e.

Hi Stephen,
 
 We just got cited for our manual entry process by CAP.  We are not interfaced.  We created a form the monitor tech records as the circulating nurse calls it out into the room.  The RN running the testing must log in under her ID number (results must be traceable to operator who performed them-got cited for this) and then she writes the source code on printout.  The monitor tech records all the information on the form.  I’ll try to attach it.  The form has to have reference ranges (part of our citation) because the printout does not have any reference ranges.  The right heart cath reference ranges are different than normal patient testing depending on the site.  After the procedure is over, the circulating nurse takes the printouts to the monitor tech who tapes them on the back of the form.  The cardiologist signs the form to acknowledge the results.  And then it goes to the Manager of Cath Lab or other designee (this duty has to be delegated in writing by the Medical Director) to perform a manual entry check (another citation) confirming the values entered into the MergeHemo software match what was written on the form and the value on the printout.  The POC picks up the forms and stores them for 2 years.  To add, the inspector also told me we have to do a software validation, confirming Merge Hemo (Cath Lab software) and EPIC data transfer happens correctly, and the calculations being performed in MergeHemo (using Avox results) are accurate.  This is still on my list to get completed.  All of the information above is from my CAP inspector.

Hope this helps. 

Avox Manual Entry Form - Heart Cath Lab - Dec 2022.docx

 

We have out AVOX 1000e's interfaced to Telcor. We get the EQC, AQC, and patient results along with site. It's rare that the cath RNs make a mistake with site or other, so they just contact me to correct something if needed. 
If for some reason that Cath Lab wouldn't want results posted to the EMR in real time (if they question cath location, etc), the results could be set to hold in exceptions in a middleware and then released after the case by POC. I know that our cath lab documents most everything happening during the case on paper as well so an immediate posting to the EMR is not relied on. 

Hi there! We have our AVOX 1000E instruments interfaced through Telcor. This allows us to ensure the weekly liquid QC is ran and daily filters are ran. The AVOXs will lock out for missed daily filter but is not smart enough to know if it was in range or if weekly liquid QC was even ran. I can see all of that in real time and create a monthly report for trends in QC. We do interface our patient testing and our Cath Lab also uses XPER. There are many "sites" to choose from but we have limited our specimen "sites" to a venous or arterial representation.  We have found this to be very helpful in compliance for both patient results and with QC monitoring in real time & monthly trending.

Erika 

 We also have an AVOX 1000E interfaced, and have for about 11 years.  No real issues, other than occasionally staff forgetting to tag their LQC appropriately and it comes through as a patient.  The other 'glitch' is the patient ID does not purge after 15" like the manual says it's supposed to.  I would use Lori's example above to justify interfacing the device.  As most of you know, in the eyes of CAP, all manual documentation requirements go away when you interface a device, so it is well worth the expense, especially in the POC world.

Thank you everyone for the input. For those of you who interface, are the operators inputting the site/subsite through the AVOX? Are there issues with doing the entries with just a numpad? 

They enter the site directly on the AVOX. We have very few issues with errors - in general it's not the cath RN making a mistake, it's that someone has called out wrong site. They have this little chart hanging right over the meter. 

Stephen, the site/subsite codes coming from the AVOX would end up getting translated by middleware (we use Telcor) so that the site is identified in plain language.