The Delivery Of Critical Values Of Patients Nursing Essay

For at least twenty years, the process of reporting of critical laboratory test values of patients by the laboratory to clinicians has been the usual. A critical value has been defined by Lundberg [3] as a value which “represents a pathophysiological state at such variance with normal as to be life threatening unless something is done promptly and for which some corrective action could be taken.” Critical value reporting was first undertaken by Lundberg et al at the Los Angeles County/University of Southern California Medical Centre in the early 1970’s [1]. The concept was shortly adopted as part of requirements for the accreditation of laboratories by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the College of American Pathologists. Since 2005, the JCAHO has produced guidelines where is states that the reporting of laboratory critical values is now a National Patient Safety Goal.3 At an international level, the most widely accepted standard in the medical laboratory community, ISO EN 15189:2007, includes (in clause 5.8.7) the prompt warning of a critical value as a distinctive obligation.4 Consequently, the laboratory now undertakes the important function of reporting of critical values due to a major realization that quality within the laboratory clearly must extend past guaranteeing accurate lab test results. It should also encompass the appropriate delivery and use of results as only then is the work done in the lab reflected. The Delivery Of Critical Values Of Patients Nursing Essay.

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In general, a lab investigation begins when a clinician frames a question, in respect to a patient, which will require certain laboratory tests. It ends only upon the receipt of sufficient and clear results which determine the action or treatment the clinician will take. There are many parts to this process some of which take place not within the clinical laboratory and as such may be beyond the laboratory’s direct control. As listed by Bartlett [2], these include: 1) collection and transfer of specimens, 2) ordering of tests, 3) communicating of information to clinicians, 4) entering data of laboratory test result in patient charts, and 5) analysis and application of test results by clinicians.

Evidently a critical value is an indicator of a life threatening condition in a patient; therefore it is vital that the “communicating this information” and “the analysis and use of test results” to be achieved well and in a timely manner so as to deliver “quality” care to patients.

Economical -if critical value report is not done accurately, this might result in the repetition of tests or missing out parameters that might lead to engaging other processes which may not be required.

Environmental -As previously recognized, both the communication of information and the analysis and use of test results may depend on factors which are outside laboratory control. This leaves the success of the critical value reporting process relying on the effectiveness of crossing over departmental boundaries to communicate with clinicians, and on whether clinicians and laboratory staffs identify the critical nature of the test result and not fail to act upon it.

effective communication of results in a timely manner

The conventional method for critical value reporting has been as follows: laboratory staffs, having recognised a critical laboratory test result, contact the right nursing unit by making a phone call and relaying the information about critical value to the nurse caring for the “critical” patient. The Delivery Of Critical Values Of Patients Nursing Essay. The time of the despatch and the identity of the individual in receipt of the information through the call are then logged in the laboratory database. The responsibility of ensuring a suitable action is taken regarding the information falls on the individual who received the critical value telephone call.

Noticing there was a problem in the current conduction of activities, a research was conducted and the study results have been employed to plan and implement a computerized critical value reporting scheme to advance the quality of critical value reporting at our hospital making the work done in the laboratory more effective and also increasing the quality of patient care.

The clinical laboratory information system is consolidated with the Tandem Risc R mainframe which backs the HELP medical information system [4]. The HELP medical information system incorporates and regulates patient data from throughout the hospital.

The Computerized Lab Alert System (CLAS) for patient management offers a plain but effective resolution for displaying significant data that may guide decision making in clinical care (11).

CLAS is a single component in a larger computerized clinical records program called CLICKS (Clinical Records), which accentuates traditional chart configuration and routine work practices in the hospital ward (12).

Diligent physicians invest immense effort to keep up with medical progresses and professional literature, however unwilling to try a computerized system, which has the benefit to them of better patient management and care. Over 20 years ago, Mc-Donald (13) established that the individual practitioner is not indefectible in processing information because the quantity of information dealt with per unit of time is above what a person can process without error.

Nonetheless, McDonald offered that the structure of perfect care can be achieved by computers that have the ability to enhance the practitioner’s competences and thus decrease the error rate.

Computerized systems have some advantages over humans some of which are that they do not get tedious, never fail to recall, and there will be no inaccuracies if they are correctly programmed.

The practitioner requires equipment that are easily operated and that can effortlessly incorporate different sources of clinical information in one portfolio where patient data is accessible when needed (10). CLAS is one of many software units available for clinical patient management.

It can be applied in any dynamic clinical unit as long as the information data system is used synchronously in routine clinical practice.  The Delivery Of Critical Values Of Patients Nursing Essay.Ultimately, this simple practise may save patients’ lives.

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Following the identification of the interface between laboratory tests and critical value reporting, solutions were assessed to address this issue because it was detrimental to quality of patient care and was not meeting goals of laboratory services. The sought after denouement was to change delivery of patient information from laboratory. This was going to have a significant effect on service delivery and staff coordination, but the department was resolved in using it for positive change instead of accommodating a prolonged adverse condition for staff and patients. After CLAS was piloted [reference], services were transformed by tapping into technology and proficient staff, to standardise the use of CLAS as the delivery method for patient data records. This eliminates the manual review and reporting as CLAS is able to identify and notify of any critical value in patient record. This also provides a modern and effective service.

CLAS is a single component in a larger computerized clinical records program called CLICKS (Clinical Records), which accentuates traditional chart configuration and routine work practices in the hospital ward (12).The CLAS unit reviews laboratory test results and clinical information with treatments, detects abnormalities and elicits alert mandate. A practitioner may postpone laboratory results that do not appear clinically significant or may accidentally omit more important findings. CLAS offers a report technique which ensures that laboratory results will not bypass the surveillance of clinicians. All alert prompts will continue recur until they are handled by the clinician.

Our knowledge corroborates that the CLAS component contributes substantially to safe patient management. CLAS is appropriate for any dynamic clinical unit where programmed day-to-day screening of laboratory results is of great importance. The Delivery Of Critical Values Of Patients Nursing Essay.