Pathology Troubleshooting Guide. June 2016 V0.1

Transcription

1 Pathlgy Trubleshting Guide June 2016 V0.1

2 Dcument histry The versin histry table is useful while the dcument is in draft. Once the dcument has been apprved, delete all rws except the rw with the latest versin number (usually 1.00). If an apprved dcument is later updated, update the versin histry table. Versin Date Status Key changes made Authr/s /06/2016 Draft Initial draft Damian Smith 02 10/06/2016 Draft Review draft Mel Niclsn /06/2016 Final Final Rbyn Cpley Cntact fr enquiries and prpsed changes If yu have any questins regarding this dcument r if yu have a suggestin fr imprvements, please cntact: Cntact Officer Title Rbyn Cpley Phne iemr Digital Release Clinical Engagement Lead rbyn.cpley@health.qld.gv.au Pathlgy Trubleshting V1.0 i

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4 Cntents 1 Ordering Clinicians D place my rders individually r all at nce? I can't find the test I need Hw d I cmmunicate t the labratry that these results are urgent and I require a phne-call fr results? I used t be able t just write my test n the request and the lab knew what I meant Are any rders remaining n Paper? Hw d t rder an ADDON Pathlgy test in iemr? My patient has been discharged, hw d I cancel the rders? I have rdered incrrectly, hw d I fix it? When d I need t print a Requisitin frm? D I need t physically sign the requisitin frm? Hw d I print a requisitin? There are sme rders that require a Cnsultant signature, hw is this nw managed? Surgery I rder the same specimens set f tests fr the majrity f my patients I need t place an AdHc histpathlgy rder during surgery I need t add M/C/S n the same HISTO specimens Requisitin Frms D I need t send the iemr requisitin frm t the Lab when cllected in Outpatient Clinics? Phlebtmists Why can't I see any cllectins fr a patient? The patient has a request frm, but n rders are available fr cllectin I have filtered fr 'Bth' (Lab/Nurse cllect) and checked 'Shw Nurse Cllect Indicatr'. Can I just cllect everything? Hw d I determine if my patients are required t be fasting? The Dctr has requested fasting blds, but the patient has nt fasted; hw is this nw cmmunicated t the lab? I marked a specimen as 'Cllected' when I didn't cllect it, what d I d? The patient was a difficult bleed, and I did nt cllect all f the required cntainers. Hw is this dne? I cllect specimens befre creating the rder. Hw will this wrk with iemr? Spare Tubes It is current practice t cllect a number f different types f tubes, but nly rder a basic suite f tests. Based n the results f the first tests, the Lab may be cntacted later t add further tests. Hw is this managed in iemr? Outpatients Clinics Hw will I give my patients a Pathlgy/Radilgy Requisitin frm? Specimen Cllectin I need t reprint a specimen cntainer label Pathlgy Trubleshting V1.0 iii

5 8 Requisitin Reprinting I need t prvide my patient with a requisitin frm Specimen Management I need t cllect mre tubes than iemr is suggesting I need t cllect LESS tubes than iemr is suggesting There is an identical rder fr the previus day. Can I cancel this duplicate rder? Appendix 1 Pathlgy Requisitins Pathlgy Trubleshting V1.0 iv

6 1 Ordering Clinicians 1.1 D place my rders individually r all at nce? Placing all f the required rders in a single rdering instance allws the system t calculate the apprpriate number f tubes/cntainers required. If placing rders individually, the system will calculate the tubes required fr the single rders resulting in a larger number than is required. 1.2 I can't find the test I need Try searching using the AUSLAB mnemnic. E.g. FBC, INR, CRP etc Try mving frm 'Starts with' t 'Cntains' t imprve the search criteria. If these bth fail, use PMISC. If multiple rders are required using PMISC, enter them all in the single rderable free-text field, separated by a cmma. It is a requirement t enter Clinical Infrmatin int the Reasn fr rder/details field r if further detail is required add this infrmatin t the Order Cmments tab. 1.3 Hw d I cmmunicate t the labratry that these results are urgent and I require a phne-call fr results? Select the cllectin pririty f Urgent and include in the Reasn fr Order/Details field Please call with results. Labratry staff will cntinue t call with critical results, and will call with results regardless f criticality if these steps are fllwed. 1.4 I used t be able t just write my test n the request and the lab knew what I meant This respnsibility has nw transferred t the rdering clinician. The Labratry will be able t prvide mre guidance n screening AUSLAB cdes fr rutine rders vs cnfirmatry tests. Ordering guides are attached t this FAQ fr Micrbilgy, Serlgy, Mlecular Bilgy, Human Genetics, Tissue Typing. Pathlgy Trubleshting V1.0 1

7 1.5 Are any rders remaining n Paper? Yes. Orders that g t the transfusin department (Crssmatch & Bld Prducts) are remaining n paper this is due t the mre stringent requirements f the transfusin department. NOTE****Grup & Hld Orders can still be place electrnically prvided the sample and the rder maintain current requirements. 3 pints f ID Name, DOB, UR Electrnic signature f MO r delegate 2 Pints f ID n Specimen Sign, Date and Time n Specimen Label by Cllectr at the time f cllectin Marked as Cllected and Signed in iemr Grup and Hld ADDON s can als be dne n stred samples <72hrs by: Cnfirming with the Transfusin team that an ADDON is pssible Maintaining Pathlgy requirements as utlined abve MET calls and ED Resuscitatin will remain n paper until the rdering prcesses are bedded in with the rdering Clinicians. Deceased Pathlgy Orders and Clinical Trials will als remain n paper, business as usual. 1.6 Hw d t rder an ADDON Pathlgy test in iemr? Cnfirm with the Labratry (phne call) that the specimen is viable. Search fr and select Pathlgy rder. Change the 'Pririty' OEF t 'ADDON' and the 'Cllected' checkbx t 'Yes'. Once signed, this will send the rder t the lab. NB. There is n need t print a label r fllw a cllectin prcess. 1.7 My patient has been discharged, hw d I cancel the rders? Find the rders by pening the rders tab (they will be the rders with the status f either rder (dispatched), select all rders by clicking (left muse buttn) and dragging dwn (Or clicking n the first rder, hlding SHIFT and selecting the last rder). Right click and select 'Cancel/Discntinue'. Enter a discntinuatin reasn, and sign. This has nw cancelled these rders. Discharge rders that are entered under the inpatient encunter will have the cllectin task remved (expired) 15 days after the Requested cllectin date/time set at the time f rdering. The rder status will remain Dispatched, hwever there will nt be a cllectin task that can be cmpleted. This means that rders 15 days pst requested cllectin date/time cllectin will nt be able t be cllected in iemr. Pathlgy Trubleshting V1.0 2

8 If the requested cllectin date/time is set t exceed the likely gap between rdering and review appintment, cllectin tasks will remain active. 1.8 I have rdered incrrectly, hw d I fix it? This depends n the circumstances. Ordered Clinician Cllect - N This designates the rder fr Phlebtmist cllectin, and if the lcatin is an area where phlebtmy cllectin ccurs, the rder will nt be available fr cllectin until the next cnfigured rund (0600, 0700, 0800, 0830 &1200. Please check time f ward rund). If cllecting immediately, select the relevant rders, right-click, and select Cancel/Rerder. Select a relevant cancellatin reasn, and select Cllectin Cllect-Yes when cmpleting the rders, the secnd time. Ordered Cllected Yes. Cerner functinality prevents cancellatin f these rders in Pwerchart this is the equivalent f the request and sample already being received in the Labratry. Please ring the Twnsville Labratry n ext. #32400 and they will rectify. Then select all f the relevant rders and Cpy Order t place the rders with Cllected-N. 1.9 When d I need t print a Requisitin frm? Requisitin frms will need t be printed under the fllwing scenaris: Inpatient Discharge Pathlgy rders. Outpatient Clinics. Orders t be cllected by external prviders D I need t physically sign the requisitin frm? As a general rule, if the requisitin is being cmpleted within a system that is integrated with iemr (Pathlgy Queensland), there is n legislative requirement fr the Dctr t physically sign the requisitin. If the requisitin will be given t an external prvider (S&N, QML etc) the rdering clinician is nt required t sign the frm hwever t ensure that the rders will be cmpleted by the external prvider, the Ordering Physician s prvider number is required. This will ensure that any Medicare billable items are billed apprpriately, rather than t THHS Hw d I print a requisitin? Find the rder(s) fr printing thugh the Order Page Select rders(s) (can multi-select if necessary) Right click Print, Reprint Requisitin. A printer selectin will appear. The last printer used will be selected. If anther printer is required: - Scan the barcde n printer (QRG available) t select the required printer. Click OK, and the requisitin will print t the selected printer. Pathlgy Trubleshting V1.0 3

9 1.12 There are sme rders that require a Cnsultant signature, hw is this nw managed? When placing the rder that requires cnsultant apprval: Right click n the rder and select Ordering Physician Change the Ordering Physician t the Cnsultants in the Physician Name sectin Select C-Sign Required. This will send a message t the Cnsultants Message Centre and a c-sign icn will be visible n the Order Summary Page. In the Order Cmments tab, This has been discussed with Cnsultant Dr XXX Nte: - If an rder is nt within a Clinician s scpe f practice, it will require a csign. Pathlgy Trubleshting V1.0 4

10 2 Surgery 2.1 I rder the same specimens set f tests fr the majrity f my patients This can be managed by cnfiguring a Persnal Plan fr these rders. Click +ADD rder, select the yellw star, and click Persnal Plans. Right click and chse Create Plan. Descriptin: Enter a descriptive name fr the Persnal Plan. Type: Select Medical & Check the Initiate n Sign bx. Click Next. Click the Clipbard icn t add rders. Search the rders catalgue as standard prcedure. Select the rder(s) required. Click dne when all required rders are selected. Duble click n the 1st rder t mdify OEFs. Nte: if multiple f the same rderable are required, select the Offset Details tab and add 1min t each subsequent rderable. This will allw the rders t be placed with n duplicate checking limitatins. Click Save. Search fr this descriptin when adding rders. All specimens will have the apprpriate labels with specific details n each label. Clinical details / Clinician Cllect etc are required t be set individually (free text fields can be cut/cpied). This is nly required t be cmpleted nce. All details n all rders within the Persnal Plan need t be the same, therwise the rders will print n multiple pages. 2.2 I need t place an AdHc histpathlgy rder during surgery **During** surgery, rders will be cmpleted as per current prcess. i.e. BAU labels placed n specimen cntainer(s) during the prcedure. Pst-surgery, the Surgen will place the rder electrnically and enter all relevant details int the Order Cmments tab in 1 cnsecutive line DO NOT hit enter. Cmplete all relevant OEF s Sign. NB: Details entered int the Order cmments tab will nt print n the requisitin if printed. They are sent t AUSLAB fr Labratry staff and Histpathlgist s infrmatin. Click Specimen Cllect buttn Click Print icn Select the HISTO Specimen Select Printer Print. One label will print, place this label n the first specimen cntainer and dcument all required infrmatin (specimen 1 f X, return lcatin, cllectin date/time etc.) This allws tracking f the specimen(s) frm surgery t the Labratry. Mark specimen as cllected by scanning the barcde r manually by right clicking n the HISTO rder drp dwn menu Click Cllected. Pathlgy Trubleshting V1.0 5

11 2.3 I need t add M/C/S n the same HISTO specimens After the single HISTO rder has been placed and signed, if micrbilgy is required n any/all f the specimens, select the TIS rder mnemnic (Tissue M/C/S). Enter all relevant details int the OEFs paying particular attentin t clinical details. Enter the specimens (as per the HISTO rder s cllectin cmments) that require M/C/S. Print the specimen label as per HISTO specimen Mark the specimen as Cllected. Pathlgy Trubleshting V1.0 6

12 3 Requisitin Frms 3.1 D I need t send the iemr requisitin frm t the Lab when cllected in Outpatient Clinics? Yes: if a requisitin was printed. Fr rders that have been cmpleted in iemr, nthing is required t be written n the requisitin. Please just place the frm in the specimen bag and send with the samples. Fr rders that haven t been cmpleted in iemr (expired cllectin task etc ), please cmplete the requisitin frm with the infrmatin that is rdinarily include (Cllectr s Name, Date & Time etc ). Please als write N Cllectin Task n the requisitin frm t alert the Labratry that n task was able t be fund. Pathlgy Trubleshting V1.0 7

13 4 Phlebtmists 4.1 Why can't I see any cllectins fr a patient? The filters may be incrrect. Select 'Bth' fr lab cllect / nurse cllect. Select 'Bld' fr specimen type. The rders may have been placed under a different encunter, search using the FIN n the requisitin frm. The cllectin task may have expired. Check the requisitin fr the requested cllectin date/time. If this date is >15 days in the past, please refer t the scenari belw. 4.2 The patient has a request frm, but n rders are available fr cllectin Check the request frm. There are several reasns why this may ccur. The wrng encunter may have been selected t where the rders were placed under. Search fr the patient by scanning the FIN barcde int the search windw. The requisitin may have been printed multiple times with ne already being used fr cllectin. Check the Order Summary Page t ensure cllectin has nt already ccurred. The rders were placed with a Requested Cllectin Date/Time greater than 15 days prir t cllectin. The cllectin task will expire >15 days after the determined cllectin date/time the rdering Dctr sets at the pint f placing the rder. E.g. 15 th June The cllectin task will expire 15 days after this requested cllectin date. E.g. 30 th June When this ccurs, reprint the required labels (click Label Reprint, and scan the accessin number n the requisitin frm this will select all required rders n this requisitin frm. If multiple requisitins are presented, repeat this prcess with each subsequent frm. Cllect the specimen as nrmal, and place these labels n the tubes. N cllectin task is able t be cmpleted, s t alert the Labratry that the cllectin task was unable t be cmpleted, please write N Cllectin Task n the requisitin. 4.3 I have filtered fr 'Bth' (Lab/Nurse cllect) and checked 'Shw Nurse Cllect Indicatr'. Can I just cllect everything? Prbably, hwever the Dctr may have a plan fr the Nurse Cllect rders, e.g. Timed studies/cllectin a certain perid after meals/medicatins. It is best t query with the clinical staff regarding these rders. 4.4 Hw d I determine if my patients are required t be fasting? This can be seen by accessing the patient's cllectins (after the psitive Patient ID screen), and hvering the muse pinter ver the rder name. Pathlgy Trubleshting V1.0 8

14 Check with the patient, and if the patient is fasting, please place a fasting sticker n the tube. This will allw the Labratry staff t update this field in AUSLAB at the pint f registratin. 4.5 The Dctr has requested fasting blds, but the patient has nt fasted; hw is this nw cmmunicated t the lab? With n lnger being able t write n the request frm, the absence f the Fasting sticker indicates t the Labratry staff that the patient is nt fasting. 4.6 I marked a specimen as 'Cllected' when I didn't cllect it, what d I d? If the cllectin instance hasn t been signed, right click n the cntainer (r left click n the three lines), and select 'Reset'. If the cllectin has been signed, ring the Lab t let them knw, as well as the rdering Dctr/Nurse s they can re-rder the test. If the rder needs t be placed again with different parameters, find the rder(s) in the rder details screen in the patient chart right-click n the rder(s) select Cpy Order Sign. The Lab needs t be cntacted t cancel the riginal rder as this cannt be dne in iemr. 4.7 The patient was a difficult bleed, and I did nt cllect all f the required cntainers. Hw is this dne? Simply dn t mark that particular cntainer as Cllected. This cllectin will remain fr the next cllectin rund. DO NOT click Nt Cllected This will permanently discntinue the rder. D NOT click re-schedule. This will make the rder unavailable until the next cllectin rund. 4.8 I cllect specimens befre creating the rder. Hw will this wrk with iemr? Place the rder and immediately fllw the specimen cllectin wrkflw in rder t print labels and Cllect the specimens in the iemr. This will send the request and rder status update t AUSLAB, where receipt and testing will cmmence. NB: Due t this wrkflw, the prcess f Signing the cllectin may be missed. The labratry will hld the specimen until this is cmpleted, and will ring t remind the treating clinicians. Pathlgy Trubleshting V1.0 9

15 5 Spare Tubes 5.1 It is current practice t cllect a number f different types f tubes, but nly rder a basic suite f tests. Based n the results f the first tests, the Lab may be cntacted later t add further tests. Hw is this managed in iemr? This wrkflw allws fr mre rapid diagnsis and treatment f the patient Cntinue t d this. Spare Tubes will still require an rder t be placed under PMISC. Select Clinician Cllect Yes Cllected N t allw labels t be printed In Order Cmments enter Spare Tube(s) Print label(s) thrugh Specimen Cllectin fr all rdered tests + PMISC rder (multiple labels can be printed fr the PMISC by selecting nly the PMISC rder and click Print. Cntinue t click print until enugh labels are generated fr the spare tubes. Cllect all rders either by scanning the barcde r manually and sign. Pathlgy Trubleshting V1.0 10

16 6 Outpatients Clinics 6.1 Hw will I give my patients a Pathlgy/Radilgy Requisitin frm? Select the relevant rders in the Order Details windw f the patient chart Right click select Print select Reprint Requisitin. Select the mst apprpriate printer. Selecting the printer may be dne by typing the asset number f the printer, r by scanning the barcde assciated with this printer. Pathlgy Trubleshting V1.0 11

17 7 Specimen Cllectin 7.1 I need t reprint a specimen cntainer label Reprinting labels frm the Specimen Cllectin windw can be dne until the cllectin is marked as cllected and signed. If the cllectin has been signed ff, the accessin number f the rder is required t reprint labels. If the requisitin frm has been printed, it is in the tp left f the frm and can be scanned. If n requisitin frm is available, right click n the rder, select Order Infrmatin, select Additinal Infrmatin. The accessin number may nt be cut and paste s will need t be written dwn. Select Label Reprint frm the banner bar f iemr and enter this number. Labels will print t the designated printer. Once the cllectin is cmpleted, sign, date and time each label and attach t the apprpriate cntainer. Nte: - Tests that have been rdered separately will result as 1 test per requisitin. Order all Pathlgy in ne instance and sign nce t bring the tests nt 1 frm. Pathlgy Trubleshting V1.0 12

18 8 Requisitin Reprinting 8.1 I need t prvide my patient with a requisitin frm Right-click n the rder in the Order Infrmatin tab and select Print then Reprint Requisitin. Select a printer; this search is dne via asset number. QRG have been created fr barcded selectin f lcal printers and descriptins. Nte: All rders that were accessined tgether will print when a single rder is printed. E.g. if FBC, INR, & ESR were rdered tgether, and the clinician selects FBC t reprint, all f these rders will print n the requisitin (even if the rest have been cancelled). Pathlgy Trubleshting V1.0 13

19 9 Specimen Management 9.1 I need t cllect mre tubes than iemr is suggesting If the system is making a suggestin which is different t yur current practice yu can reprint labels. In rder t d this, simply reprint anther label. If the cllectin instance is nt signed yet, just print anther. Please mark n the label that this is a reprinted label s the Labratry knws that this is a spare tube. If the cllectin instance has been signed, either hand-write the label, r click the Label Reprint buttn n the banner bar f the patient s chart. The accessin number f the rder that needs t be reprinted is required. This can be fund by right clicking n the required rder in the Order Infrmatin windw, then Order Infrmatin then Additinal Details. The accessin number cannt be cut and paste s will need t be written dwn. 9.2 I need t cllect LESS tubes than iemr is suggesting Because iemr specimen management is designed t add the Pathlgy Orders t a cntainer, simply NOT cllecting a cntainer will cause the Pathlgy Orders t remain uncllected and therefre incmplete within the Labratry. Cllect the required tubes, and print the labels fr all f the rders that are t be cllected. Attach labels t all cllected cntainers, and mark all as cllected (including the unattached label). Place the spare label in the Ziplc bag with the specimens. This will indicate t the labratry that rders have been incrprated int the cntainers cllected. Lab staff will be able t mve the rders n the uncllected specimen(s) t ther tubes and allw the cmplete digital jurney f the rder (results and messaging). 9.3 There is an identical rder fr the previus day. Can I cancel this duplicate rder? Ordering clinicians may place n rder errneusly (require an immediate cllectin, and select Clinician Cllect = N ). This may result in the generatin f a duplicate cllectin task (ne task will be scheduled), and ptentially lead t a duplicate cllectin. The Phlebtmists are authrised t cancel these duplicate rders in the fllwing circumstances: If an identical rder exists fr the previus day (e.g. FBC fr cllectin tday and FBC remains fr cllectin frm yesterday. T cancel these rders, firstly check with a member f the Treating Team and if apprpriate t cancel. T cancel: - Select the Did Nt Cllect icn Select the Order fr cancellatin Select first reasn Details n request frm incmplete Duplicate nt available fr selectin Sign the cllectin instance. Cllect the rest f the rders as usual. Pathlgy Trubleshting V1.0 14

20 FIN NO LAB NO iemr NO LAB NO Appendix 1 Pathlgy Requisitins URN Family name Given names Address Facility Patient lcatin Test Details Bld TTH Smith Damian 165 Eyre St. Nrth Ward QLD 4810 TTH TTH CARDIOLOGY (FBC) Full Bld Cunt (COAG) Cagulatin Prfile Phne n DOB Sex Requested cllectin time 20-MAR-1976 M Cnsultant Requesting clinician Prvider n Cpy dctr name Cpy dctr address 08:00 26-July b Mel Niclsn Paul Lane Paul Sullivan Cntact n Requisitin apprved and electrnically signed by r n behalf f <Paul <Requesting Lane> Clinician> Request date Twnsville Family Medical Centre Cllectin pririty 25-July-2016 Rutine AM P A T H O L O G Y Clinical Ntes Previus MI COLLECTION CODE Path Qld Cllect Inpatient Path Qld Cllect Outpatient Clinician Cllect Self Cllect Self Cllect Assist Other PEI REC D TIME Medicare Assignment Frm (Sectin 20A f the Health Insurance Act 1973) I ffer t assign my rights t benefits t the apprved pathlgy practitiner wh will render the requested pathlgy service(s), and any eligible pathlgist determinable service(s) established as necessary by the practitiner Patient signature PRACTITIONER USE ONLY (Reasn patient cannt sign) CONTAINERS COLLECTED (N f Tubes) EDTA EDTA BBANK URINE SST BL CULTURE SWAB CITRATE ABG HISTO PST FL OX SLIDE ESR OTHER Yur dctr has recmmended that yu use Pathlgy Queensland. Yu are free t chse yur wn prvider. Hwever, if yur dctr has specified a particular Pathlgist n clinical grunds a Medicare rebate will nly be payable if that Pathlgist perfrms the service. Yu shuld discuss this with yur dctr Fasting required Date INITIALS Self determine NO Fasting at cllectin I certify that I cllected the accmpanying sample frm the abve patient whse identity was cnfirmed by inquiry and/r examinatin f their nameband and that I labelled the sample immediately fllwing cllectin and befre leaving the patient. Cllectr name Signature Indigenus status Gestatin (Wks/40) Time cllected Date cllected / / Patient Status at the time f the service r when specimen cllected Private patient in a private hspital r apprved hspital facility Private patient in a recgnised hspital Public patient in a recgnised hspital Outpatient in a recgnised hspital Bulk Bill Rural & Remte COAG Medicare number Health fund Health fund n Veteran s affairs IRN Expiry Expiry Patient status Page n 1/1 Print time/date 07:55 25-July-2016 Q U E E N S L A N D Pathlgy Trubleshting V1.0