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Results Review / Release, Interfaced Instruments

I. PRINCIPLE:

The Interfaced Instrument Results Review/Release (IIRRR) screen provides access for reviewing, modifying and releasing laboratory test results uploaded automatically into the LIS via an instrument interface with the LIS.

II. PROCEDURE:

  1. Open Instrument Review/Release:
    Click on the Instrument Review/Release button located on the Lab Palette or choose “Instrument Review/Release” from the Screens menu on the menu bar.
      
  2. Select an Instrument:
    1. Using the mouse, position the pointer arrow directly over the down arrow box to the right of the Instrument ID field, and click the left mouse button once to activate the drop down menu.
    2. Using the mouse, position the pointer arrow directly over the desired instrument and click the left mouse button once. The selected instrument name will display in the Instrument ID field.
      Note: The colored boxes to the right of the Refresh button provide information regarding the number of test results for each priority category (stat-red, expedite-yellow and routine-green; timed tests are included with routine) currently in the queue to be reviewed and released. The total of all three categories is displayed in the box labeled “Total”.

  3. Open the list of patients with results uploaded from the selected instrument ID:
    Using the mouse, position the pointer arrow directly over the Refresh box and click the left mouse button once or use the short cut keys Alt+r to display the patient list.
    Note: A patient list for the selected instrument will appear including the following information: patient ID number, patient name, upload time and test configuration ordered. The list is sorted according to priority of test order (from stat to routine) and the time results were uploaded from the instrument to the LIS. The patient names of stat orders are highlighted in red; expedite orders in yellow; routine and timed orders in green.

  4. Error Resolution: An error button will display in the upper right screen only if an instrument upload error has occurred.
     
    1. Open the Error Resolution screen:
      Using the mouse, position the pointer arrow directly over the Error button and click the left mouse button once to display the error list.
       
    2. Move the pointer arrow directly over the desired listing and click the left mouse button once to display the entire Error Resolution screen for the selected error.
       
      1. The "Error Description:" field will indicate the nature of the error.
      2. The "Resolution:" field is a text field in which the resolution to the displayed error is documented. Move the pointer arrow directly over the field and click the left mouse button once to insert the cursor. Type a description of action taken to resolve the error.
      3. Open the File menu on the Menu Bar and select “Save” to save the entered text and close the screen. The "Time:" and "Resolved By:" fields will auto-fill with the current time and User ID.
    3. Press the Ctrl+F4 keys to return to the Interface Review screen.
  5. Interface Result Review/Release:
    1. Select the desired patient with interfaced results from the list:
      Note: If the desired patient name is not displayed on the screen use the scroll bar to the right of the "Configuration" column to scroll the screen and locate the desired patient. If the name still does not appear, click the “Refresh” button and check again. If it is still not listed check for an upload error.

      Locate the desired patient; check the patient name and ID number against the test requisition. Using the mouse, position the pointer arrow directly over the desired patient name and click the left mouse button once, the selected patient information with uploaded results will display.
    2. The blinking cursor will default to the "Collection Time" field. To modify the collection date move the cursor backward to the date field by either using the mouse or press the Shift+TAB keys. Type in the appropriate date/time. The numbers are entered as a continuous string of numeric characters using the MMDDYYYY and HHMM format with no embedded dashes or colon (i.e.: January 6, 1996 = 01061996).
      Note: Future collection dates are not allowed. If a future date was entered on an interfaced order the date field will be blanked out and the cursor will default to the “Collection Date” field rather than the “Collection Time” field. In addition, if the collection date/time entered exceeds the resulted date/time in the database by more than 12 hours, a warning message will appear when releasing results. This message is a cautionary alert and will not prevent the user from releasing results.
    3. Type in the initials of the person responsible for specimen collection as recorded on the test requisition/report and press TAB to advance to the first test result field.
      Note: If the phlebotomist is unknown, type in "unk" for the initials. This is a required field and must be filled.
    4. Review each analyte result making necessary modifications. Use the TAB key to advance from field to field.
      1. Laboratory Alerts are displayed in a box to the right of the test result highlighting “Legend”, these alerts may be pertinent to specimen handling and/or testing. Laboratory Alerts may be added or removed via the Patient Registration screen. (Refer to the “Patient Registration” procedure for further instructions.)
      2. Test analyte result field background color-coding:
         
        1. The background color of any numeric result that falls outside its expected range, critical, unlikely limits or is designated as an ICR will be as follows after exiting the result field:
          • Yellow indicates the numeric value is “Abnormal”,
          • Red indicates the result is “Critical”, or
          • Magenta indicates the result is “Unlikely”; unlikely values need to be checked for transcription or other errors.
          • Orange indicates the result is an “Important Called Result”, these results are to be phoned to nursing service or the physician office to let them know that while it is not a “Critical Value” that needs to be called to the ordering caregiver/physician it is an important called result, document the call.
        2. The background color of any textual (non-numeric) result that falls outside its expected range, critical, or is designated as an ICR will be as follows after exiting the result field:
          • Yellow indicates the numeric value is “Abnormal”,
          • Red indicates the result is “Critical”, or
          • Orange indicates the result is an “Important Called Result”, these results are to be phoned to nursing service or the physician office to let them know that while it is not a “Critical Value” that needs to be called to the ordering caregiver/physician it is an important called result, document the call.
      3. Test analyte result delta check:
        Delta check is an analytical filter that automatically checks a currently entered result against the last “released” result of the same test analyte, when the last released result is within a predetermined delta time limit. Refer to the established
        protocol and “Delta Check Reaction Flow Diagram” for managing “Breached-Review” delta checks that fall outside the predefined delta limit.
      4. Delta check function indicators color-coding:
         
        1. The delta indicators are color coded as follows:
          •    Gray indicates “Passed”:
            The current result is within the predefined limit.
          •    Blue indicates “Breached-Review”:
            The current result is outside the predefined limit; result status is “on hold”, as indicated by the blue [Hold] status indicator button to the left of the result field.
            Note: Results left on hold will not be reported and will remain on the pending list.
          •    Green indicates “Breached-Reviewed”:
            The current result is outside the predefined limit but it has been determined the result is valid; result status has been changed to “release” as indicated by the green [Release] status indicator button to the left of the result field. These results will be reported.
        1. Delta check function:
          • If no delta button appears to the right of the result field, either there is no delta parameters established for this test analyte or no previously reported test falls within the predefined delta check dwell time. No delta check was performed; no action required, proceed with review as usual.
          • If a gray (same color as the screen background color) delta button appears to the right of the result field, the result has passed the predefined delta parameters; no action is required, proceed with established review and release protocol.
            Note: See “
            Display Range” instructions to display range and delta check parameter information for a selected analyte.
          • If a blue delta symbol appears to the right of the result field, the result has breached the delta parameters set for this test analyte and the result is placed “on hold”. Follow the protocol established for review of results that breach the delta parameters.
            Note: See “
            Display Range” instructions to display range and delta check parameter information for a selected result.
             
          • If it is determined that the result is valid and can be released, click on the blue delta button to change the analyte status from “on hold” to “release”, the delta symbol will turn green indicating that the test can now be released; the blue [Hold] status indicator button to the left of the result field will change to the green [Release] status indicator button. Proceed with test release.
          • A message will appear that indicates that the results being released have breached the posted delta limits. Click [OK] to authorize releasing the result or click [Cancel] to return to the review screen.
            Note: The delta breach warning message may be preceded by the following collection date/time warning message, if appropriate: “You have entered a Collection Time of (collection date/time) with results that were entered on (date/time of entry). Please check for accuracy”, if appropriate.

             
        2. Reportable Limit and Path Review Filters:
            
            
          •    Reportable Limits flag displays to the right of the result field if the result has breached the reportable limits set in the database. This flag serves as an alert to the instrument operator reviewing the results for release. If the result is flagged with this symbol STOP and refer to the relevant analytical procedure for specific instructions.
            Note: See “
            Display Range” instructions to display range, delta check parameter and reportable limits information for a selected analyte.
          •    Limits to designate pathologist review are set in the database for certain analytes within the Hematology Analyzer workarea. The Path Review flag will display to the right of any hematology analyte that breaches the set limits.
            Note: See the “
            Peripheral Blood Smear (PBS) Review; Technologist/Pathologist” document for further instruction on handling flagged PBS analytes.
      5. If no change in the uploaded result displayed is necessary TAB to the next analyte field.
      6. Change a result:
        Backspace over the uploaded value and type in the correction.
        Result field:
        1. If the result is numeric, type in numeric characters including the decimal point if the number is expressed as a decimal.
        2. If the result has a predefined text value (non-numeric result):
          Note: A “text value” is defined as any result that contains one or more non-numeric character (e.g.: “<1.0” or “Not detected”).
          • A yellow field will overlay the right side of the screen listing all registered text values for the selected analyte.
          • A scroll bar will appear to the right of the yellow field if the number of pre-defined text values exceeds the space provided. Move the pointer arrow directly over the up/down arrow boxes located at the top/bottom of the scroll bar, respectively, and click the left mouse button to scroll the field in the direction the selected arrow is pointing.
            Note: If it is necessary to scroll the text value field to find the appropriate text value, focus will no longer be on the result field and the cursor must be re-inserted into the appropriate result field before attempting to enter a result.
          • A short cut key (alpha or numeric) precedes each text value. Type in the short cut key and TAB, the associated text value will be inserted into the result field.
          • TAB to advance the cursor to either Lab Comment or Report Comment fields; or by moving the pointer arrow directly over the yellow field and double clicking the left mouse button.
      7. Hold a single analyte result:
        Click on the green [Release] status indicator button to the left of the result field and the button will change to the blue [Hold] status indicator button.
        Individual results can also be placed “on hold” as follows:
        1. TAB to the result field of interest and press the Ctrl+h keys
          or
        2. Position the pointer arrow over the result field and click the right mouse button once, a pop-up window will display with options to Display Ranges, Hold Analyte or Release Analyte. Position the pointer arrow directly over Hold Analyte and click the left mouse button once. The analyte status indicator button to the left of the analyte name will change from Release (green) to Hold (blue).
          Note: Short cut keys: Hold = Ctrl+h, Release = Ctrl+r, Show Ranges = Ctrl+a
      8. Hold all analyte results:
        Press and hold the Ctrl+Shift+h keys or using the mouse, position the pointer arrow directly over "Function" on the menu bar and click the left mouse button once, again position the pointer arrow directly over "Hold All" and click the left mouse button once. All of the analyte status indicators to the left of the analyte names will change from Release (green) to Hold (blue).
      9. Display analyte ranges/limits and delta check criteria:
        Either TAB to the result field of interest and press the Ctrl+a keys or position the pointer arrow over the result field and click the right mouse button once, a pop-up window will display with options to Display Ranges, Hold Analyte or Release Analyte. Position the pointer arrow directly over Display Ranges and click the left mouse button once. The ranges and delta check criteria for the selected analyte will display. Close the range/delta screen by pressing the Alt+F4 keys or click on the [Close] button.
         
      10. Release a single analyte result that have been placed on hold:
        Either TAB to the result field of interest and press the Ctrl+r keys or position the pointer arrow over the result field and click the right mouse button once, a pop-up window will display with options to Display Ranges, Hold Analyte or Release Analyte. Position the pointer arrow directly over Release Analyte and click the left mouse button once. The analyte status indicator buttons to the left of the analyte name will change from [Hold] (blue) to [Release] (green).
      11. Release all analyte results that have been placed on hold:
        Press and hold the Ctrl+Shift+r keys or using the mouse, position the pointer arrow directly over "Function" on the menu bar and click the left mouse button once; position the pointer arrow directly over "Release All" and click the left mouse button once. All of the analyte status indicator buttons to the left of the analyte names will change from [Hold] (blue) to [Release] (green).
      12. Return to the patient list:
        Using the mouse, position the pointer arrow directly over any area on the displayed patient result screen and click the left mouse button twice. A message will display asking: "You have neither Released nor Held the results. Skip this Patient for now?"
        1. [Skip]: If “Skip” is selected, the currently displayed patient will close and RESULTS WILL NOT BE RELEASED and the screen will re-display the Patient List.
        2. [Release]: If “Release” is selected, the currently displayed patient RESULTS WILL BE RELEASED and the screen will re-display the Patient List.
        3. [Cancel]: If “Cancel” is selected, the message will disappear and the previously displayed patient will remain displayed. No action will take place.
    5. After all analytes have been reviewed and appropriate modifications made, TAB to the Lab Comment field.
      1. Lab Comments: Internal non-reportable comments that are printed on the requisition regarding the testing, test result, the specimen collection or the sample integrity that are not to be reported, are typed into this field. Press TAB to advance to Reported Comments field. If the operator wants a particular Lab Comment viewable in Web Inquiry, then an asterisk (*) must be placed in front of and a the end of the text [example: *ImmNEU, plt: plt est: 4/oif*]. Web Inquiry will then pick up this text and display it as a Lab Comment.
        Note: Comments that are entered at the time of Order Registration in the LIS or HIS will appear in this field. Any comment that is not pertinent can be removed (e.g.: “none”, “patient going to x-ray”, “specimen already drawn”, “patient coming from admitting”). Comments that are pertinent to the results that are entered at time of order can be transferred to the "Reported Comments" field using the copy/paste functions (i.e.: select the desired text and copy the text (Ctrl+c), insert the cursor into the field where the text is to be placed and paste the text (Ctrl+v)). These comments will then be on the printed report.

        If a Canned Comment is to be inserted, insert the cursor in the Lab Comment field and right click on the mouse to access the Canned Comment selections.
      2. Manual Peripheral Blood Smear (mPBS) result entry in CLICS: for CBC with Differential and WBC with Differential. Currently this screen is not available for Hemogram, Hemoglobin & Hematocrit or Platelet Count.
        Click on the mPBS button.

        Refer to “
        Peripheral Blood Smear (PBS) Review, Technologist/Pathologist” procedure.
      3. Reported Comments: Comments regarding the testing, test result, the specimen collection or the sample integrity that are to be reported with the test results, are typed into this field. A number of frequently used comments are available under the Canned Comment function.
        1. Choose “Canned Comments” from the “Function” drop-down menu on the menu bar to display the list of Canned Comments or right click on the mouse to access the Canned Comment selections.
        2. Scroll to the desired comment or press the first letter of the comment short name to automatically scroll to the list of canned comments beginning with that letter (e.g., press c and the list will scroll to the comments with a short name beginning with the letter c, such as, Critical: critical value).
        3. Using the mouse double-click on the desired comment to insert it in the comment field where the cursor is located.
        4. If the comment is to be entered in both fields, either place the cursor in the other comment field and repeat this process or use the copy/paste function (i.e.: select the desired text and copy the text (Ctrl+c), insert the cursor into the comment field and paste the text (Ctrl+v)).
    6. FAX/Call Results Documentation:
      The IIRRR screen incorporates a function to document Phoned/FAXed results at time of release. . Click the box preceding the “Do you wish to document saved result? question to check it and the Phone/FAX Documentation screen will display.

      Note: This box will automatically be checked if the result being released falls into one of the following categories: Stat, Important Called Result, Critical Value or marked at order time to be phoned. Any result FAXed from the CLICS application (either through autoFAX or FAX on demand in Inquiry) will automatically be documented by CLICS, there is no further need to document these FAXes. Any FAX sent manually, i.e. from a FAX machine, will require separate documentation and these can be documented via the Inquiry screen of the CLICS application.

      Refer to the “
      Phoned/FAXed Result Documentation; CLICS” procedure.
    7. Click on the [Release] button to save the results. All test results not placed “on hold” will release and the screen will refresh.

      In the example below, the patient test result is critical and the documentation question is automatically checked so the documentation screen will display. This may be “unchecked” or checked at will by clicking on the box; the documentation screen will only display if the box is checked.
       
      1. If the documentation question was checked the Phone/FAX Documentation screen will appear; note that the results also display so the call can be made to the nurse/caregiver and the call documented at the same time.
      2. The green highlighted fields are required. Complete these fields to document the call. Observe below that the background reverts to white as the required fields are completed.
      3. Click “Save” to complete the documentation. Clicking “Cancel” will close the documentation screen without documenting the call and return the operator to the IIRRR screen.
    8. Another patient can be selected by pressing the up or down arrow keys. If this is done without saving the results already displayed, a warning will appear stating: "Currently Displayed Information is ready for release. Do you wish to release these results before continuing? [Yes] [No] [Cancel]". Using the mouse, position the pointer arrow directly over the appropriate response and click the left mouse button once to select the desired response. The next patient selected will then display.
      Note: If a patient's result(s) is displayed in IIRRR and the result(s) has changed in the database due to a second upload, without a subsequent screen refresh, a warning message will display when an attempt is made to save these results. The warning message will state: “Row changed between retrieve and update. No changes made to database”. When [OK] is clicked the result screen will display. The operator MUST refresh the screen before the results can be released.
    9. Continue reviewing interfaced results following step 5.A-E.
  6. Press and hold the Ctrl+F4 function key to close the screen when finished.

Manual PBS Named Formed Element Reporting

Named Formed Element

Acceptable Values

Auer Rods

Present

Basophilic Stippling

1+, 2+

Clefted Lymphs

Present

Giant Platelets

1+, 2+

Hairy Cell Lymphs

Present

Howell-Jolly Bodies

1+, 2+

Hypogranular PMN

Present

Megakaryocytes

Present

Microorganisms

Present

NRBC

#/100 WBC

Pelger-Huet

Present

Plasma Cells

%

Platelet Clumps

Present

Platelet Estimate

#/OIF

Reactive Lymps

%

Rouleaux

Marked

Schistocytes

1+, 2+

Sezary Cell Lymphs

Present

Sickle Cells

Present

Spherocytes

1+, 2+

    1. July 2008 M. English (Revised: II.5.D.a. lab alerts added)
    2. November 2008 M. English (Revised: II.5.F. FAX alert/documentation)
    3. September 2009 L. McGovern, M. English (Revised: II.5.E.b. for addition of manual pbs screen)
    4. September 2011 M. English (Revised: for new phone/fax documentation)
    5. March 2012 M. English (Revised: for reportable limit flag)

Comprehensive Review:

Interim Review:

November 2009 S. Hosch (Revised: II.7.G.)

February 2010 K. Wernimont (no changes)
July 2010 M. English (Revised: II.5.E.clarify how lab comments entry can be viewable in webinq)
February 2011 L. Cooksley (no changes)
February 2012 M. English (Revised: for reportable limits/flagging)

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