10.PENANGANAN NILAI KRITIS-MUNAS PATELKI OK.pptx

Dr. Joko Widodo, M.Kes

PELAPORAN HASIL DIAGNOSTIK LABORATORIUM YANG KRITIS

MUNAS PATELKI

Dr. JOKO WIDODO, M.Kes

SURABAYA, 18 MEI 2017

PELAPORAN HASIL DIAGNOSTIK LABORATORIUM YANG KRITIS

MUNAS PATELKI

Dr. JOKO WIDODO, M.Kes

SURABAYA, 18 MEI 2017

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Ringkasan

Definisi Nilai Kritis laboratorium yang menunjukkan keadaan patofisiologis yang berbeda dengan kondisi normal yang memiliki risiko terhadap kehidupan pasien kecuali  jika segera diambil tindakan.” “Hasil

Lundberg GD, Med Lab Obs,1972;4:47-54

NOTIFICATION OF CRITICAL LABORATORY RESULT

• An important aspect of patient safety. • Failure to report critical lab results in a timely and reliable way is a threat to patient safety and healthcare quality.

• For Accreditation purpose, all Labs must have a list of critical limits, formulate notification procedures, document critical results and notify clinicians immediately.

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Ringkasan

U.S Regulatory (Examples) • CLIA ’88 Written procedure or critical value result reporting

• The Joint Commission National Patient Safety Goals Documention and Read Back Define Critical Value

• CAP Checklist Procedure, Documentation, read back, turn around time

Indonesia Regulatory

Tidak

ada daftar standar nilai kritis dalam literatur medis, institusi lab wajib menyusun daftar nilai kritis pemeriksaan masing-masing.

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Ringkasan

Prosedur Pelaporan Nilai Kritis

• Menetapkan daftar nilai kritis yang harus dilaporkan

• Mekanisme komunikasi nilai kritis • Penetapan waktu pelaporan (TAT) nilai kritis

• Dokumentasi

Howanitz PJ, Steindel SJ, Heard NV. Laboratory critical values policies and pro cedures: a College of 

Proses Penetapan Kebijakan Nilai Kritis

• Bagaimana seharusnya laboratorium menetapkan tes mana yang harus dimasukkan dalam daftar nilai kritis? • Bagaimana menentukan batasan nilai kritis yang harus ditetapkan?

Tanggung

jawab pimpinan laboratorium, harus

dilakukan komunikasi dan koordinasi dengan dokter pengguna layanan laboratorium, dan dewan peninjau medis dari institusi tersebut

Proses Penetapan Kebijakan Nilai Kritis

https://www.aruplab.com/testing/critical-values

Contoh Penentuan Batasan Nilai Kritis

Of the 111,545 sodium results occurring during the study, 615 (0.6%) were critical. By using criteria of 120 mEq/L (120 mmol/L) or less and 155 mEq/L (155 mmol/L) or more, we found 166 critically low results and 447 critically high results.

Critical values in Hematology

Critical values in Microbiology

LABORATORY PROCEDURE FOR NOTIFICATION and COMMUNICATION OF CRITICAL RESULTS MLT Results entered into LIS  ANY CRITICAL LIMIT?

VALIDATE CRITICAL RESULT CHECK RESULT CHECK SAMPLE CHECK QC VERIFY CRITICAL RESULT

LAB TEST ORDERS REFER CRITICAL VALUE LIST MLT atttempt to contact doctor 

VERIFY THE RESULT

REPEAT OR NO?

WHAT TO INFORM?

CHECK FOR PRE-ANALYTICAL,  ANALYTICAL & POST  ANALYTICAL FACTORS CHECK RECORD FROM RECORD BOOK/LIS

DOCUMENTATION THE NOTIFICATION  AND RELEVANT INFORMATION INTO RECORD BOOK OR LIS

 PHONE  ELECTRONIC  SMS  MANUAL

 INFORMER

DISPATCH

NAME

 DESIGNATION  PATIENT

ID &LOCATION NAME&RESULT  SAMPLE DATE &TIME  TEST

INFORM RESULT AND  ASK FOR READ BACK

RECORD:  INFORMER NAME & DESIGNATION  PATIENT ID & NAME TEST NAME &  RESULT  SAMPLE DATE & TIME RECIPIENT  NAME

Turn Around Time of Critical Value

Intervals between development and correction of a critical abnormality.

Median Time ?

48 7

1.8h

12h

Valenstein et al , Notification of Critical Results, Arch Pathol Lab Med,2008

The Process of Reporting a Critical Value

DOCUMENTATION NOTIFICATION VIA TELEPHONE • Informer name and designation • Confirm patient location • Patient ID : name, MRN • Sample date & time • Test name & result • Result read back by recipient • Document recipient name & designation • Document date & time of notification

FAIL SAFE PLAN NOTIFICATION

FORM REPORT CLR (Critical Laboratory Result) Identitas Pasien

Nama : No. Id : No. Lab : Tgl Periksa : Jenis Pemeriksaan :

PROSES LABORATORIUM Tgl/jam terima spesimen : Tgl/jam selesai pemeriksaan : Validasi hasil  jam : petugas : Jam Informasi Nilai Kritis :

HASIL LABORATORIUM 1. Pemeriksaan : Hasil : 2. Pemeriksaan : Hasil : 3. Pemeriksaan : Hasil : PENERIMA INFORMASI DAN HASIL NILAI KRITIS 1. Petugas penerima informasi via telephon : 2. Petugas penerima salinan hardcopy hasil nilai kritis : 3. Tanggal dan jam penerimaan informasi : Tandatangan TLM yang bertugas :

(………………………………)

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Ringkasan

REPEAT CRITICAL VALUE • Another common problem in critical value reporting is how a laboratory should handle repeat critical values

• Approximately 70% of surveyed laboratories have a policy on repeat critical values. •

For those that do not, one is strongly recommended because it will clarify laboratory technologist responsibility and establish consistency in performance.

REASONS FOR REPETATIONS : OVER THE RANGE QC not within acceptable limit Critical Values (CV) Early Notification (EN)

•

The results showed 97.6% agreement between initial and repeat values

•

Only 14 values out of 580 fell outside recommended limit.

Conclusion •

It was clear that modern analyzers are precise and repeating critical values did not yield better accuracy

•

This change has improved our laboratory’s efficiency and TAT in critical cases and improved our patient care

ORIGINAL ARTICLES

Does Routine Repeat Testing of Critical Values Offer Any Advantage Over Single Testing?  Adam D. Toll, MD; Jennifer M. Liu, MD; Gene Gulati, PhD; Eric M. Behling, MD; William D. Kocher, MD

: Routine repeated testing of critical values does not offer better accuracy and, hence,is unnecessary.

Conclusion

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Kesimpulan

REPORTING ASSESSMENT CRITICAL VALUE • Laboratories are responsible for reporting CLR to healthcare providers, as well as monitoring and improving the time of reporting and receiving critical values.

• Quality indicator in the critical value policy is the response time, defined as the time elapsed from when the laboratory first knew the critical result to the time when caregiver accepted the result .

Quality Indicator of Critical Value

Greatest Obstacle Faced by Laboratory

Bagaimana dengan notifikasi otomatis? CRITICAL TEST RESULTS MANAGEMENT (CTRM)

physician orders lab tests

THE CHALLENGE: TIME TO DELIVER CRITICAL LAB RESULTS

Results entered into LIS

physician accepted lab tests

physician orders lab tests REFER CRITICAL VALUE LIST

START

MLT attempt to contact Dr.

TIME TO COMPLETE THE PROCESS:

20 MINUTES

THE CHALLENGE: SPEEDING CRITICAL LAB RESULTS WITH CTRM (CRITICAL TEST RESULTS MANAGEMENT) Results entered into LIS

• Results sent directly to physician's device • Alert message is transmitted securely

physician orders lab tests

(CTRM) REFER CRITICAL VALUE LIST

• Alert will escalate in 15, 30, 60 min if the loop is not closed • Escalation period can be configured by the hospital

Electronic Medical Record(EMR)

STAR T

• Results can be sent to multiple devices and multiple caregivers

TIME TO COMPLETE THE PROCESS:

3 MINUTES

Outlines • Pendahuluan • Dasar Penetapan Kebijakan Nilai Kritis • Prosedur Pelaporan Nilai Kritis • Pengulangan Pemeriksaan Pada Nilai Kritis

• Penilaian Pelaporan Nilai Kritis • Ringkasan

QUICK GUIDE LABORATORIUM TLM IDENTIFIKASI HASIL NILAI KRITIS

  

VALIDASI HASIL NILAI KRITIS

SEGERA LAPORKAN NILAI KRITIS

DOKUMENTASIKAN PELAPORAN NILAI KRITIS

KESIMPULAN • Penetapan kebijakan pelaporan nilai kritis yang efektif menjadi dasar untuk perawatan dan keselamatan pasien.

• Perlunya komunikasi yang efektif mulai tingkat laboratorium sampai klinisi yang bertanggungjawab menangani pasien.

• Indikator keberhasilan adalah jumlah dan waktu respon mulai teridentifikasinya nilai kritis sampai informasi kepada dokter yang merawat atau tim yang bertanggung jawab untuk mengambil tindakan untuk pasien.

• Berkembangnya metode pelaporan berbasis komputerisasi, prosedur komunikasi baru akan muncul dan waktu pelaporan nilai kritis akan menjadi lebih cepat dan akurat.

TERIMA KASIH SEMOGA BERMANFAAT