JCAHO in relation to NICU care

[HurleyRN]

:confused:Hey everyone, I would love some input! At the end of last year, our unit was told that we were going to start putting comment codes into our glucometers if they were outside parameters. This change in policy was immediate and anyone failing to comply would be disciplined. Unfortunately, at that time I admitted my new primary, a 23 weeker. She was very unstable and had a lot of abnormal labs. Needless to say, I missed entering the code. As a background, our one touch shuts off after 10 minutes and you CANNOT go back in later and enter a code once it has been off. They made arrangements with lab that we can send a slip with a patient label, the time and value and they will reconcile it. This can be so difficult to remember, especially when I am managing so many other, important issues with the baby! I ALWAYS report the sugars, follow orders AND chart it all in my nursing notes. I dont understand why lab needs to be aware of what interventions I am doing for my patient? Are they supposed to call the floor if they feel it is inappropriate? I am concerned that in an effort to reconcile the gluc, that other care will be de-prioritzed! Are other facilities being so strict with discipline? Is this part of the JCAHO requirement or is it hospital/unit discretion?

[nicu4me]

We have that comment thing available but I don't think i have ever used it. I push accept. Then I call the NNP or neo with it, document (long hand charting) and also in the medical chart itself under orders if orders were received. Sugars are all over the place with some kids. We have critical stickers we put on our medical charts so if your glucose was low you would write it in there. They are pushing for 100% compliance on the stickers whether it be a gas, a K or a Na, even if no intervention was ordered and it must be initialed by the next shift. So critical babies, get your stickers out. Lab doesn't call with glucoses on a CMP, can u imagine all the ones you would get called on if you drew out of a UA/UVC with fluids? No you take the heel but they look back and see that the glucose was out of wack. They do not call criticals from out BMP/CMP for glucose. I will find out about the comment code thing, sometimes it's a bit before you can type it in.

[umcRN, BSN, RN]

We have that comment thing available but I don't think i have ever used it. I push accept. Then I call the NNP or neo with it, document (long hand charting) and also in the medical chart itself under orders if orders were received. Sugars are all over the place with some kids. We have critical stickers we put on our medical charts so if your glucose was low you would write it in there. They are pushing for 100% compliance on the stickers whether it be a gas, a K or a Na, even if no intervention was ordered and it must be initialed by the next shift. So critical babies, get your stickers out. Lab doesn't call with glucoses on a CMP, can u imagine all the ones you would get called on if you drew out of a UA/UVC with fluids? No you take the heel but they look back and see that the glucose was out of wack. They do not call criticals from out BMP/CMP for glucose. I will find out about the comment code thing, sometimes it's a bit before you can type it in.

We dont have any sort of sticker system where I work, lab will call for critical results and we are to notify the doc for any critical result we get and then chart that they were notified and if we recieved an order. We also do not typically draw labs of UVC's and our A-lines are always sterile h20 w/ acetate or 1/2 NS. There was an incident once where someone was drawing glucoses off a second lumen of a UVC w/o realizing it had dextrose in it and had the kid on VERY high amounts of insulin Next shift caught it with a critically low heel stick glucose, don't remember what happened with the baby

[Love_2_Learn]

We have those comment codes on our glucometers too. If we don't put in the comment right away we have never been called on it. Like you said, once it turns off you are toast. Fortunately we have an intervention in our computer charting called "critical report" where we can put things like the labs, blood gases, x-rays, and "other" items that are considered critical and then in that screen we can say what the test was, the result, who was notified, any new order, if we followed a protocol for the critical lab, etc. and there is a comment box where we can write more information. We can also change the date and time of when the Dr. was notified up to about 24 hours in the past. I think it is about the same as doing the glucometer comment code thing. The Joint Commission visited us within the past year and said nothing about our glucometers lacking comment codes; so maybe the critical report area was enough to make them feel we did what was needed based on the blood glucose result. Good luck!

[prmenrs, RN]

I think JACHO is putting pressure on the LAB to make sure critical values are reported and taken care of--that's where they're coming from. So they're putting pressure on you to help them comply.

The nurse manager needs to sit down w/the lab manager and figure out a way to deal w/critical values when the baby is too critical for the nurse to play w/the glucometer. One way would be to hand it off to someone else in the room?

jmho

[BittyBabyGrower, MSN, RN]

We always have to enter comments...honestly,it doesn't take that long. You have to look at it to get the number and right then you just hit comments and what you did. Covers your butt. When we dock the glucometer, it automatically downloads into our EMR so that what we did is right there. Critical values are a big bugaboo...we have a whole new protocol about reporting them, etc. Sometimes, it is what it is.

[LittleWonders]

Yes, ours is just as strict. If you forget to enter your action code, you're put into the disciplinary process.

We have to comment, but there are only two choices that ever apply - notified the MD/NNP or no intervention needed. Even in the midst of drawing other labs or providing other care, if you look at the displayed glucose you have time to enter the code. If something happens and I can't enter the code, I'll give a shout to another RN who will handle that part. If both of those things fail and the machine shuts off, we also have to alert the lab - only because they handle all of the lab related equipment and will manually enter the action code needed with their management software. Our electronic chart also allows for a comment to be entered by the RN later, but that's not the "preferred method."

I loathe to forget the first time, though. It's a pain in the rear, but much less so than the paper trail if you forget.

[Bortaz, MSN, RN]

We dont have any sort of sticker system where I work, lab will call for critical results and we are to notify the doc for any critical result we get and then chart that they were notified and if we recieved an order.

This is what we do, as well.