Patient Safety System (PSS) - Correctional Managed Health Care
Contents
1. 1 Fax Order Notice to UCHC Lab Central Processing 860 679 1401 YES Order Session Print or 2 Call UCHC Lab Central Processing dee 860 679 2498 aper Char Sending facility contacts receiving facility to schedule procedure Will procedure be performed at a different CDOC location Siemens PSS generates Internal Custody CMHC lab tech work flow process Worklist list Note PSS ad hoc reporting generates Lab tech updates order collection Worklist time indicates specimen amp source Inmate arrives in facility adds comments stick lab CMHC lab tech Note Order is sent over Performs order in the interface to Siemens PSS Order laboratory at this point status displays as Collection fields PERFORMED populate in LIS Labels print at stick lab printer Zebra TLP 3844 Z Result document is routed to pre defined Note Daily Lab facility network printer Specimen is collected Manifest is a page listing medical unit central of patient specimens nurse station Y 1 submitted by facility to Split lab label amp tube types JDH lab for the day indicated on Lab Manifest Y Order status in PSS Rd Specimen with label is updated to 4 y affixed is delivered to Department Complet2. All critical laboratory test results shall be reported to the facilities by the UCHC Laboratory staff as stated in their Department of Laboratory Medicine Policy Reporting of Critical Values Once the result has been authenticated the Laboratory staff will immediately place a telephone call to the location of the patient as stated on the requisition form The Laboratory staff will ask to speak to the requesting physician as stated on the requisition form or to a nurse working in the CMHC facility The critical results shall be reported to a licensed care provider A licensed CMHC care provider shall immediately notify a prescriber of the critical value and document the notification in the inmate health record See attached Form HCH 812 Laboratory Medicine Requisition See attached UCHC Laboratory Medicine Policy Reporting of Critical Results Effective Date 11 24 08 Revision Date 06 30 10 NUMBER P 1 05 Page 3 of 4 LABORATORY TEST ORDERING AND RESULTS REPORTING University of Connecticut Health Center Correctional Managed Health Care Patient Safety System Lab Electronic Order Processing Workflow Quick Admit Orders entered in PSS Patient Factors gt Current Orders Write Process Flow Orders Note Orders entered into PSS display as ORDERED Add On Orders Note E x print on Order over the interface to Notice lt VES Add On Order laboratory LIS system at this time
3. Li LITHIUM R PHENO PHENOBARBITAL R CARB TEGRETOL CARBAMAZEPINE R ADDITIONAL TESTS PLEASE PRINT TEST NAME TECHNICAL NOTES VALP VALPROIC ACID DEPAKOTE R URINE FECAL ANALYSIS CDAG C DIFFICILE TOXIN OVA PARASITES FECC STOOL CULTURE URC URINE CULTURE UMACR URINALYSIS MACRO B Blue Top 4 5 ml on G Green 3 mi on Ice R Plain Red 5 ml W White PPT 5 ml PLEASE FILL QUT PREMARITAL FORM 4 hours separate amp freeze LsLavender 3 mi S Gold SST Tube 3 5 ml PERFORMED PURSUANT OF PUBLIC ACT 068 120 DEPARTMENT OF LABORATORY MEDICINE REPORTING OF CRITICAL VALUES PRINCIPLE A critical value is a laboratory result which is at such variance with the established reference interval as to represent a pathophysiologic state that is life threatening to the patient unless immediate action is taken It is the responsibility of the laboratory to promptly communicate these results to a responsible individual with appropriate clinical skills who is in close proximity to the patient The results of all critical values obtained from patients in John Dempsey Hospital are to be called by telephone to the patient care area as listed by the ADT Admission Discharge Transfer system Critical value results obtained from outpatients must be called to the location identified on the test requisition The laboratory s obligation to speak to a responsible individual is the same for outpatients as it is for
4. E ROUTINE DOCHP CHRONIC HEP SCREEN ALT SGPT 5 HBSAG HEP B SURFACE AG SITE B Core Ab Hep B Surf Ab Hep B Suf Ag AST SGOT 8 HCVAB HEP C AB 5 CANDIDA SCREEN Hep B Surf Ab Quant Hep C Ab BILTD BILIRUBIN T amp D 8 HIVSC AB SCREEN 8 FDERM DERMATOPHYTE CULTURE CONSENT FORM REQUIRED DOCPR PRENATAL PROFILE 35 LR BUN BLOOD UREA NITROGEN 8 FuNGC FUNGAL CULTURE GFR GFR Estimate CBCSC CBC W AUTO DIFF L HIVP HIV VIRAL LOAD wW Adm Profile Chronic Hep Screen Rubella Ab CHOL CHOLESTEROL 8 X BOX IF CHANGE THERAPY DOCTN THYROID PROFILE 5 CREAT CREATININE 3 Free Thyrox Index T Uptake T3 T4 TSH GFR GFR Estimatey PSAN1 PROSTATIC SPEC AG GENC GENITAL CULTURE DOCDP TOXICOLOGY PROFILE CK CREATINE KINASE 5 HCGTN PREGNANCY 5 SOURCE E Cocaine Marijuana THC Opiates incl Codeine amp Morphine LvrE ELECTROLYTES 8 PTN2 PTW NR HERPES CULTURE DOCTP T CELL PROFILE 2L Sodium Potassium COZ PTT PTT B SOURCE Total T Cell Count CDA CDB Panel GLU GLUCOSE 8 RPR RPR 5 RESPC SPUT CULT amp GRAM STAIN GLUSO GLUCOSE 50 GM CHAL 5 SEDRT SEDIMENTATION RATE L VIRG VIRAL CULTURE THERAPEUTIC DRUGS GLYCH GLYCOHEMOGLOBINAIC L SICKLE CELL SCREEN L SOURCE SEE eee LE LDH LOH TOXOG TOXOPLASMOSIS IgG wc GRAM STAIN amp CULT DIGXN DIGOXIN R UPA 5 SOURCE _ DILANTIN PHENYTOIN R TRIG TRIGLYCERIDES 8
5. UNIVERSITY OF CONNECTICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER P 1 01 e POLICY PROCEDURE DEFINITION REFERENCES Page 1 of 1 PATIENT SAFETY SYSTEM PSS DOWNTIME PROCEDURE Effective Date 05 12 08 In the event of interruption of service of the Patient Safety System PSS CMHC staff shall ensure continuity of care by using a paper based process If unable to process orders using the Patient Safety System PSS staff shall revert back to manual paper requisitions UCHC Radiology Requisition HCH 576 Laboratory Medicine Requisition HCH 812 Patient Safety System Downtime is the interruption of service in the Patient Safety System PSS CMHC Patient Safety System PSS User s Manual Rev 3 2008 Approved UCHC CMHC Title CMHC Executive Director Robert Trestman MD PhD Title CMHC Director of Medical Services Mark Buchanan MD Title CDOC Director Health Services Daniel Bannish PsyD UNIVERSITY OF CONNECTICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER P 1 02 Page 1 of 1 e PATIENT SAFETY SYSTEM PSS INMATE ADMISSION QUICK ADMIT Effective Date 05 12 08 POLICY CMHC staff shall ensure that an established inmate health record HR exists in the Patient Safety System PSS All inmates admitted from the community to an in
6. a Halfway House or from a DOC facility to an acute care facility A transfer is the manual process of changing an inmate location in the Patient safety System PSS CMHC staff shall follow the instructions in the Patient Safety System PSS User Manual to update an inmate location CMHC Patient Safety System PSS User s Manual Rev 3 2008 Approved UCHC CMHC Title CMHC Executive Director Robert Trestman MD PhD Title CMHC Director of Medical Services Mark Buchanan MD Title CDOC Director Health Services Daniel Bannish PsyD UNIVERSITY OF CONNECTICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER P 1 04 Page 1 of 1 e PATIENT SAFETY SYSTEM PSS PHYSICIAN PRESCRIBER CO SIGNATURES Effective Date 05 12 08 POLICY The University of Connecticut Health Center UCHC Correctional Managed Health Care requires all telephone orders placed in the Patient oafety System PSS to have co signatures documented Physician Prescriber electronic co signature for telephone orders is required within 72 hours or when a physician is not on site during the next physician visit The electronic co signature will carry a date and time PROCEDURE The Physician Prescriber co signature function of the Patient Safety System PSS can be completed by following the procedure outlined in the CMHC Patient Safety System User Manual REFERENCES U
7. e Work Flow JDH laboratory Effective Date 11 24 08 Revision Date 06 30 10 NUMBER P 1 05 Page 4 of 4 LABORATORY TEST ORDERING AND RESULTS REPORTING Approved UCHC CMHC Title CMHC Executive Director Robert Trestman MD PhD Title CMHC Director of Medical Services Mark Buchanan MD Title CDOC Director Health Services Daniel Bannish PsyD Effective Date 11 24 08 Revision Date 06 30 10 PATIENT LAST FIRST M I UNIVERSITY OF CONNECTICUT HEALTH CENTER DATE OF BIRTH RACE W B H 263 FARMINGTON AVE FARMINGTON CT 06030 A i ET F DATE DRAWN TIME DRAWN LABORATORY MEDICINE REQUISITION HCH 812 gt FASTING LICENSES CT WHP 0213 M TD0002518 REV 6 08 PLEASE PLACE HIV INFORMED CONSENT LABEL BELOW CORRECTIONAL FACILITY TEL NO ers MD PR Under currant Federal and Site reguistans Reg 5 Subpart Mags 1316 6 all fee laboratory procedures ee in cem and ianed by thus pry AUTHORIZING PHYSICIAN NAME SIGNATURE PLEASE X DESIRED PROFILES INDIVIDUAL TESTS MICROBIOLOGY DOCAP ADMISSION PROFILE 251 ALBAU ALBUMIN 8 HAVTO HEP A AB IgG amp IgM 8 STRSN STREP SCREEN GFR GFR Estimate ALP ALK PHOSPHATASE 8 HBCAB HEP B CORE AB 5 BLOOD CULT AFB ISOLATOR CBCSC Hepalic Func Panel wireflex tery AMY AMYLASE 8 HBSUT HEP B SURFACE AR BLDCU BLOOD CULTUR
8. er the initial call was placed Y The call was attempted but not completed i e the phone was busy doctor paged but did not return call nurse or physician not available results faxed instead This disposition is used when you need to add additional information For example if you page a doctor and he or she calls 10 minutes later record the call back by first putting the Y sign in the Called field This will clear the message that was there and allow you to add additional information After you have done that Press F12 to indicate that the call was completed Person Message Enter the name of individual who received the critical value result as well as the telephone number to which the call was placed if different from the number displayed in the call list window Verification information must also be included The LIS will automatically log the date and time of the comments The technologist s password will automatically document the individual placing the call 5 To see how many times the call was attempted press the equal 7 key 6 After entering the appropriate information press F12 and Y to confirm entries CRITICAL VALUES FOR CLINICAL LABORATORY TESTS Clinical Chemistry Units Low High Serum calcium adult mg dL lt 6 6 212 9 newborn Serum ionized calcium mmol L lt 1 00 21 55 Serum glucose mg dL lt 50 2500 Serum phosphorus inorganic mg dL lt 1 0 27 5 Serum sodium mEq L lt 122 2160 Serum potassiu
9. heet right hand side Once the laboratory results have been received reviewed and filed the hard copy of the Order Session Print shall be removed from the inmate s record and shredded All CMHC Health Service Units without the ability to place Laboratory orders through the Patient Safety System and those with the ability but are experiencing a Downtime or interruption of service with the PSS should place orders by the manual process of using a paper requisition Form HCH 812 Laboratory Medicine Requisition see attachment All information requested on the requisition shall be completed The inmate s identification number shall be used and shall have the prefix 100 capital 1 to identify the referral source as CDOC The identification number should contain nine 9 digits For example l00123456 Effective Date 11 24 08 Revision Date 06 30 10 NUMBER P 1 05 Page 2 of 4 LABORATORY TEST ORDERING AND RESULTS REPORTING Each requisition shall have the following information CMHC Information Inmate Name Inmate Identification Number Requesting Physician Inmate Date of Birth Sex of Inmate Name of Inmate s facility Health Service Unit Phone Number Date Drawn Time Drawn TECH ID RESULTS Laboratory test results shall be available electronically in the Patient Safety oystem PSS Lifetime Clinical Record LCR Results shall be printed reviewed dated and signed by a prescriber and filed in the inmate health record
10. inpatients Appropriate documentation must be entered into the LIS laboratory information system The test menu for which critical values have been assigned by the laboratory directors is attached to the end of this procedure Any critical values reported by reference labs to the Department of Laboratory Medicine will be communicated to appropriate personnel by the procedure that follows PROCEDURE Inpatients 1 All critical value results must be repeated or confirmed by another method if possible i e platelet estimate to confirm low platelet count The time for repeat analysis or confirmation should not exceed 30 minutes Since critical value results are indicative of a life threatening situation where immediate medical action should be taken every effort should be made to verify confirm the result as soon as possible 2 After the critical value is authenticated immediately place a telephone call to the location of the patient as stated on the laboratory test requisition form i e ICU ED Surg 7 etc Ask to speak to the requesting physician or to the primary care nurse assigned to the patient or any other licensed provider 3 If both the physician or nurse on the unit are not available page the ordering physician or whoever is covering for that provider If no one calls back notify the supervisor or Lab Med faculty on call 4 Relay the results to the recipient and have the recipient read back the results to assure accuracy 5 Reco
11. m mEq L lt 2 8 25 9 Serum potassium newborn mEq L lt 2 4 2T 1 Serum potassium hemolyzed mEq L lt 2 8 28 0 Serum bicarbonate mEq L lt 12 240 Serum bilirubin total newborn mg dL 215 Serum blood urea nitrogen mg dL 2120 CSF glucose mg dL 40 2200 CSF protein mg dL gt 70 Acetaminophen mg L 2200 Amikacin peak ug mL 236 Amikacin trough ug mL 211 Carbamazepine mg L 215 Digoxin ng mL 24 Ethanol mg dL 2300 Gentamicin peak ug mL 211 Gentamicin trough ug mL 22 1 Lithium mmol L 22 0 Phenobarbital mg L 260 Phenytoin mg L 221 Salicylate mg dL 231 Theophylline mg L 221 Tobramycin peak ug mL 211 Tobramycin trough ug mL 22 1 Valproic acid mg L 2101 Vancomycin peak ug mL 241 Vancomycin trough ug mL 221 Hematology Units Low High Blood hematocrit lt 21 260 Blood hemoglobin g dL lt 7 220 Blood total leukocyte count WBC WBC uL 2100 000 Blood platelet count Cells uL lt 20 000 21 000 000 Plasma prothrombin time seconds 24 Plasma partial thromboplastin time seconds 2110 Fibrinogen mg dL 100 gt 1000 Microbiology 08 Any positive culture of normally sterile body fluid CSF Gram stain result antigen result or positive culture
12. niversity of Connecticut Health Center Correctional Managed Health Care Policy and Procedure Manual E 14 01 Prescriber Orders CMHC Patient Safety System PSS User Manual Rev 3 2008 Approved UCHC CMHC Title CMHC Executive Director Robert Trestman MD PhD Title CMHC Director of Medical Services Mark Buchanan MD Title CDOC Director Health Services Daniel Bannish PsyD UNIVERSITY OF CONNECTICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE LABORATORY MANUAL FOR USE IN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER P 1 05 Page 1 of 4 LABORATORY TEST ORDERING AND RESULTS REPORTING Effective Date 11 24 08 POLICY University of Connecticut Health Center UCHC Correctional Managed Health Care shall ensure for Connecticut Department of Correction CDOC inmates the required laboratory tests are ordered and the results from laboratory testing are available for review and filed in the inmates health record PROCEDURE LABORATORY ORDERS All CMHC Health Service Units with the ability to place laboratory orders electronically using the Patient Safety System PSS shall submit laboratory orders to the Department of Laboratory Medicine using the PSS When ordered in the PSS a hard copy of the laboratory order Order Session Print will print on site at the facility The PSS generated laboratory order hard copy Ordered Session Print shall be filed in the inmate s health record on top of the physician order s
13. overing the service Inform the physician of the verified critical value result 3 Document the name of the recipient of the call and the telephone number called if different from the number in the pop up screen in the LIS see section on entering call comments below 4 If the name and telephone number of the physician covering the service cannot be obtained from the page operator notify the laboratory medicine faculty on call If the physician identified by the page operator as covering the service refuses to accept responsibility for the result record his her name in the appropriate section of the LIS and notify the laboratory medicine faculty on call Entering Call Comments into the Laboratory Information System As the call is being placed open the call list window in the result entry portion of the LIS see below Record the name of the individual to whom the result was given The LIS will capture the date time technologist initials From bottom of Results Screen 2 Press C call comments 3 Enter Y or press F2 to open the call list window 4 With the call list window displayed call the number of the ward as indicated which is defaulted or the number page of the doctor entered in the order comment Enter the following data in each applicable field Called use this field to indicate the status of the call Y The results are called in N The results have been requested but are not yet called in Y Information was added aft
14. rd the name of the recipient of the call the telephone number called if different from the telephone number in the pop up screen a brief description of the nature of the call e g critical K to RN Jean read back into the LIS see section entering call comments below Outpatients 8 30 AM to 5 00 PM clinic hours 1 Repeat the analysis to confirm the abnormal result within 30 minutes Again every effort should be made to provide the verified result as expeditiously as possible 2 Once the result has been authenticated immediately place a telephone call to the location of the patient as stated on the requisition form i e medical specialties etc Ask to speak to the requesting physician as stated on the requisition form or to a nurse working in the clinic If you get an answering service or voice mail page the physician If the physician does not respond to the page record his her name in the appropriate section of the LIS and notify a the laboratory medicine faculty on call for evening night coverage 3 Record the name of the recipient of the call and the telephone number called if different from the telephone number in the pop up screen into the LIS see section entering call comments below 5 00 PM to 8 30 AM non clinic hours 1 Repeat the analysis or confirm the result using an appropriate confirmation test within 30 minutes 2 Immediately place a telephone call to the page operator 679 2626 and ask for the physician c
15. take facility and who will require orders for laboratory radiology or pharmacy services prior to the next routine OBIS feed around 2 00 am require the initiation of or reactivation of a Patient Safety System PSS HR DEFINITIONS An Inmate Admission is the creation of a new PSS HH for the initial incarceration of an individual to CDOC or the new admission of a former inmate who has no established PSS HR discharged prior to June 14 2004 A Quick Admit is the reactivation of a previously established PSS HR PROCEDURE CMHC staff shall enter the inmate current incarceration date facility and housing location following the instructions in the PSS User Manual REFERENCES CMHC Patient Safety System PSS Net User s Manual Rev 3 2008 Approved UCHC CMHC Title CMHC Executive Director Robert Trestman MD PhD Title CMHC Director of Medical Services Mark Buchanan MD Title CDOC Director Health Services Daniel Bannish PsyD UNIVERSITY OF CONNECTICUT HEALTH CENTER CORRECTIONAL MANAGED HEALTH CARE POLICY AND PROCEDURES FOR USE WITHIN THE CONNECTICUT DEPARTMENT OF CORRECTION NUMBER P 1 03 e POLICY DEFINITION PROCEDURE REFERENCES Page 1 of 1 PATIENT SAFETY SYSTEM PSS TRANSFER OF INMATES Effective Date 05 12 08 CMHC staff at the sending facility shall update the Patient Safety System PSS location information of any inmate who is transferred from one DOC facility to another or from a DOC facility to
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