ALERT VALUES IN LAB/ CRITICAL LAB VALUES.pptx

ALERT VALUES IN LAB

1. ALERT VALUES DR. ANIRUDH GUPTA MBBS, MD, PGDHHM, PGDCR CONSULTANT & HEAD, MICROBIOLOGY SCIENTIFIC PATHOLOGY, AGRA

2. ISO 15189:2022 CLAUSE – 7.4.1.3

3. DEFINITIONS critical values   - Any test result that may require rapid clinical attention to avert significant patient morbidity or mortality. - Critical values are defined by the medical director of each technical section. - Prompt verbal notification is provided to clients for results that are defined critical values and require the immediate attention of a clinician.

4. contD. Alert values  refer to any result that is not a critical value but that requires timely intervention (e.g., therapeutic drug monitoring, public health, infection control indication).

5. CRITICAL REPORT VALUES When examination results fall within established critical decision limits: a) the user or other authorized person is notified as soon as relevant, based on clinical information available; b) actions taken are documented, including date, time, responsible person, person notified, results conveyed, verification of accuracy of communication, and any difficulties encountered in notification; c) the laboratory shall have an escalation procedure for laboratory personnel when a responsible person cannot be contacted.

6. CONTD. Persons responsible for informing alert/critical values – Doctors & Technicians on duty. All critical values to be informed within 30 mins. Record is to be maintained in ALERT VALUE INFORMATION SHEET (SP/TECH/FR/02).

7. HOW TO VERBAL TEST RESULTS NOTIFICATION In compliance with HIPAA, test results are communicated verbally only to a member of the healthcare team responsible for the patient and authorized to take patient results. For authentication, client contacts are asked for: Their full name (first and last) Their department Their position or title In addition to the critical test result(s), and any accompanying information, the following information is provided: Patient name, spelled out medical record number and client ID number Full test name Date and time of collection The client contact receiving the verbal information is asked to: Read back the test results Read any other information provided Correctly spell the patient’s full name

8. 5 STEPS CHECK CONFIRM CALL ASK FOR READ BACK MAINTAIN RECORD

9. ACTIVITIES RELATED TO CRITICAL ALERT REPORTING Defining and identifying critical care results. Define and Identify pre-analytical/analytical/post-analytical errors prior to communication. Informing concerned lab consultant. Confirming Critical result. Communicating to concerned personnel (verbal/report dispatch/electronic modes). Documentation (specific register and in case files) and Communication of critical results (for both in-house and outsourced). Performing Mock Drills.

10. LIST OF CRITICAL VALUES MICROBIOLOGY GRAM STAIN, CSF OR OTHER CNS SYSTEM SAMPLE POSITIVE GRAM STAIN GAS ANGRENE INDIA INK, CSF CRYPTOCOCCUS ZN STAIN POSITIVE FOR AFB STOOL CULTURE SALMONELLA/ SHIGELLA/ VIBRIO EYE/ OCULAR CULTURE POSITIVE ALBERT STAIN C. DIPHTHERIAE HANGING DROP PREPARATION DARTING MOTILITY SEEN (PRESUMPTIVE V. CHOLERAE) CULTURE OF STERILE BODY FLUIDS/ BLOOD POSITIVE SURGICAL WOUND GAS (S. PYOGENES) BRUCELLA, LEGIONELLA, VRSA & VRE CULTURES POSITIVE ANY MOULD (BAL,SPUTUM, TISSUE ETC.) POSITIVE C. AURIS POSITIVE NOCARDIA POSITIVE B. anthracis , B. mallei , B. pseudomallei , F. tularensis , Y. pestis POSITIVE

11. CONTD. INFECTIOUS SEROLOGY VIRAL HEPATITIS (HAV, HBV, HCV, HEV) POSITIVE ASO >600 IU/ mL CRP >320 mg/L RA Factor >120 IU/ mL

12. CONTD. MOLECULAR TESTING SARS CoV-2 POSITIVE SWINE FLU (H1N1 2009) POSITIVE MTB DETECTION RIFAMPICIN RESISTANT

13. THANK YOU