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Result Review/Release, Transcription

I. PRINCIPLE:

The Transcription Review/Release screen provides access for reviewing, modifying and releasing of manually entered laboratory test results and comments in the LIS.

II. PROCEDURE:

  1. Open Transcription Review/Release:
    Click on the Transcription Rev/Rel button located on the Lab Palette or choose “Transcription Review/Release” from the Screens drop-down menu on the menu bar.
      
  2. Type in the test accession number and press TAB to advance to the next field.
  3. Type in the test configuration code and press ENTER to initiate the search.
    Note: If the test configuration code is not known press the Alt+t keys. The "Search by Test Name" window will appear:
    1. Type in a few letters of the test name and press ENTER, a list of test names will fill the scroll window.
    2. Using the up/down arrow keys, select the desired test name and press ENTER or using the mouse, position the pointer arrow directly over the desired test name and click the left mouse button once. The selected name will fill the Test Description field.
  4. The patient name, test name, collection date and time (mm/dd/yyyy), phlebotomist initials, results and comments entered will display.
    Note: Future collection dates are not allowed. If a future date was entered on an interfaced order the “Collection Date” and “Collection Time” fields will be blanked out and the cursor will default to the “Collection Date” field. In addition, if the collection date/time entered is more than 12 hours before the resulted date/time in the database, a warning message will appear when releasing results. This message is a cautionary alert and will not prevent the user from releasing results.
    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 the “Delta Check Reaction Flow Diagram” for managing “Breached-Review” delta checks that fall outside the predefined delta limit.
      1. Delta check function indicators color-coding:
         
      2. 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.
      3. Delta check function:
        1. If no delta button appears to the right of the result field, either there are 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; proceed with established review and release protocol.
        2. If a gray delta button appears to the right of the result field, the result has passed the predefined delta parameters; proceed with established review and release protocol.
          Note: See “
          Display Range” instructions to display range and delta check parameter information for a selected analyte.
        3. 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 analyte.
           
        4. 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 and the [ ] “Hold” box will be cleared. Proceed with test release.
        5. 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.

           
    4. Reportable Limit and Path Review Filters:
        
        
      1.  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.
      2.  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. Display range and delta check criteria for a specific result:
    1. Move the pointer arrow over the desired result field and click the left mouse button once to select the field.
    2. Click the right mouse button once to display the range information window.
       
    3. Close the window by pressing the Alt+F4 keys or click on the [Close] button.
  6. Review all information entered against the appropriate document, e.g. requisition, instrument printout, etc. Proceed to step 11 if no corrections are required.
  7. If corrections are required, use the TAB key or mouse to select any result field in which the information entered requires correction.
  8. Type the correct information in the result field.
    1. If the result is numeric type in numeric characters and decimal point if the number is expressed as a decimal.
    2. If the result has predefined text values:
      1. A yellow text value field will overlay the right side of the screen listing all pre-defined text values for that analyte.
      2. A scroll bar will appear on the right side 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, the cursor must be re-inserted into the appropriate result field before attempting to enter a result.
      3. A keyboard 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.
      4. The yellow text value field displayed will disappear by tabbing out of the result field or by moving the pointer arrow directly over the field and double clicking the left mouse button.
  9. Continue to make necessary corrections as described in steps 6 through 8.
  10. After all analytes have been reviewed and appropriate modifications made, TAB to the Lab Comment field.
    1. Lab Comments:
      Lab Comments are entered by either inserting the cursor into the Lab Comment field and typing in the desired comment or, in the case of peripheral blood smear results, clicking on the [Manual PBS] button, which will display a standardized screen for PBS result entry into Lab Comments. These comment entries are not reported. If the operator wants a particular Lab Comment viewable in Web Inquiry, then an asterisk (*) must be placed in front of and 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.
      1. 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.
        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 comment field and paste the text (Ctrl+v)).

        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.
    2. 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.
      1. 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 m and the list will scroll to the comments with a short name beginning with the letter m, such as, Mayo: Refer to separate Mayo Medical Laboratory report).
        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)).
      2. When reviewing a result that has been changed (after it was previously released) the Canned Comment “Test results have been amended.” along with a date/time stamp will be displayed in the Report Comment field. Type the name of the analyte(s), in which the result(s) has been changed, in front of the comment indicating results have been changed.
        Note: Refer to the “
        Reported Erroneous Result” protocol (step 5.b.) in the Quality Assurance Manual. The comment auto-inserted by the CLICS application is in addition to the comment referred to in this section of the Reported Erroneous Result protocol and DOES NOT replace it.
  11. FAX/Call Results Documentation:
    The Transcription Review Release 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.
  12. 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 result is highlighted as an ICR and the documentation question is automatically checked. This may be “unchecked” or checked at will by clicking on the box; the documentation screen will only display if the box is checked.

    The following note also displays on the screen.
     
    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. Click on the Call Type located on the right side of the documentation screen. Once the call type is designated, note that the background coloration of the call documentation screen will change to the color of the chosen call type.

      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.

      Click “Save” to complete the documentation. Clicking “Cancel” will close the documentation screen without documenting the call and return the operator to the Transcription Review Release screen.
  13. Press the Ctrl +F4 keys or choose “Close” from the “File” menu on the menu bar to close the screen.

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 Lymphs

%

Rouleaux

Marked

Schistocytes

1+, 2+

Sezary Cell Lymphs

Present

Sickle Cells

Present

Spherocytes

1+, 2+

    1. November 2008 M. English (Revised: II.11. FAX alert/documentation)
    2. September 2009 L. McGovern, M. English (Revised: II.10.A.b. for addition of manual pbs screen)
    3. September 2010 M. English (Revised: II.11. ICR implementation)
    4. August 2011 M. English (Revised: Phone/Fax Documentation)
    5. March 2012 M. English (Revised: for reportable limit flag)

Comprehensive Review:

Interim Review:

November 2009 S. Hosch (Revised: II.11.)

February 2010 K. Wernimont (Revised: link repair)
July 2010 M. English (Revised: II.10.A. clarify how lab comments entry can be viewable in Web Inq)

February 2012 M. English (Revised: for reportable limits/flagging)

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