Critical Values
6-2012
TiftRegionalMedicalCenter
Policy for Reporting of Critical Values
A “Critical Value” is defined as a laboratory result which represents a pathophysiological state at such variance from normal as to be life-threatening unless some action is taken in a short time. Critical values are reported by MTs or MLTs only and should be reported within 30 minutes.
Critical Values for this laboratory are defined as:
Any positive CSF culture or CSF gram stain
Any positive blood culture
Any positive Cryptococcus antigen
Any positive reference lab testing for the detection of infectious agents including AFB, fungal, viral, or parasitic infections.
Any problems in Blood Bank that will cause any delay in crossmatching
Glucose≤40 or ≥400 mg/dl
Pediatric (0-17Y) ≤40 or ≥250 mg/dl
Sodium:≤120 or ≥160 mEq/L
Potassium:≤2.5 or ≥6.5 mEq/L
CO2:≤10 or ≥40 mEq/L
Calcium:≤6.0 or ≥13.0 mg/dl
Creatinine – Peds
0D-28D≥2.0 mg/dl
29D-12M≥0.5 mg/dl
13M-12Y≥0.8 mg/dl
Lithium>2.0 mmol/L
HCT:20%
Hgb:≤7 g/dl
WBC:≤2.0 or ≥50 x 103/mm3
Plts:<31 or >1,000 x 103
PT>45.2 secs
PTT>70.9 secs
Fibrinogen100 or 1000 mg/dl
Anti-Xa, LMW>1.10 U/ml
Acetaminophen:>30 ug/ml
Salicylate:>30 mg/dl
Digoxin:>2.5 ng/dl
Dilantin:20.0 ug/ml
Phenobarb:>44 ug/ml
Tegretol:>15.0 ug/ml
Valproic Acid:>100 ug/ml
Theophylline:>20.0 ug/ml
T. Bili:>14.9 mg/dl
CKMB:5.0 ng/ml
Trop I (Beckman)>0.49 ng/ml
Trop I (Biosite)>0.11 ng/ml
Magnesium:≥7.0 mg/dl
Lactic Acid2.2 mmol/l
Gentamicin:Trough>2.0 ug/ml
Peak>10.0 ug/ml
Random>4.0 ug/ml
Tobramicin:Trough2.0 ug/ml
Peak>10.0 ug/ml
Random>4.0 ug/ml
Procedure for Action on Critical Values:
1.Verify the results,if necessary, by repetition or re-draw.
2.Notify the patient’s physician or licensed caregiver and document.
3.For outpatient critical values, call the physician’s office and report the critical value to a licensed caregiver.
If on weekends or after hours, have the physician’s answering service page the doctor or whomever is on call.
Attempt to contact the physician at least three times waiting 20 minutes between each try. If, after one hour, you are unable to contact the physician, proceed as follows:
- Look in HPF Webstation or contact registration and get the patient’s contact phone number and address including county.
- Call the pathologist on call and give her/him this information along with the critical value and the phone number of the sheriff’s department for that county (see page 5).
- Document, as a reportable comment in HLAB, all the attempts including times and when the last call was made to the pathologist.
- Print a copy of this report and place it in the Medical Director’s box.
The pathologist will contact the patient and recommend they go to the ER of their choice.
The Medical Director will send a follow-up letter to the ordering physician regarding attempts to contact her/him regarding the patient’s critical result.
Documentation:
All critical values including Blood Bank must be reported in a timely manner and documented appropriately. Documentation must include the name of the physician or licensed caregiver you called the results to, RB&V procedure completed (Read, Back, & Verify), time reported, and your initials. Keep the physician and nursing units updated with any problems causing delays in crossmatching and document appropriately. Complete documentation of critical values is required, not optional.
Contact Numbers:
911 – Can be contacted for Sheriff Dept. and Police numbers if necessary.
PoliceSheriff County
Adel896-2224896-7471Cook
Alapaha686-7664686-2091Berrien
Ashburn567-2323567-2401Turner
Douglas384-2222384-7675Coffee
Enigma533-4185 (day)686-2091Berrien
686-7664 (night)
Fitzgerald426-5000426-5161Ben Hill
Lenox546-4251896-7471Cook
Moultrie985-3131616-7430Colquitt
Nashville686-7666686-2091Berrien
Ocilla468-5700468-7459Irwin
Omega528-4911388-6020Tift
Sparks549-8211896-7471Cook
Sylvester776-8501776-8211Worth
Tifton386-5299388-6020Tift
TyTyNone388-6020Tift
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