New Alert for C. diff by PCR Orders

In the next few weeks, there will be a new alert added that will aid in the prevention of ordering unnecessary C. diff by PCR testing.

As approved by the Use & Standards governance committee, the alert will impact inpatient ordering only.

There will be an alert that will prevent ordering C. diff by PCR if a previous C. diff has been ordered within 7 days.  

According to Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA), it is recommending to not repeat Clostridium difficile testing (within 7 days) during the same episode of diarrhea.  As a result, all Stool C difficile toxin by PCR orders placed within 7 days of the previous order will be rejected.

IDSA Clinical Practice Guidelines

Lipid Panel Changes

Updated Direct LDL Order Education: 7.2.18

As per education provided in June 2018, the UMC lab and financial departments identified that they were receiving no reimbursement for Direct LDLs with Triglycerides less than 400. Based on this, subject matter experts were consulted and a new set of Lipid Panel orders were developed.

You will now find Lipid Panel and Lipid with Cardiac Risk panel for your use.

Contents:

Lipid Panel:

Non-HDL Cholesterol

Triglycerides

VLDL

LDL Calculated

HDL

Cholesterol

Lipid with Cardiac Risk:

Non-HDL Cholesterol

Chol/HDL

Triglycerides

VLDL

LDL Calc/HDL

HDL

Cholesterol

BOTH panels will have a calculated LDL and reflex Direct LDL when Triglycerides are over 400.

If the triglycerides are over 400, LDL Direct will reflex

If the LDL cannot be calculated you will see this comment.

Diagnosis Requirement on All Outpatient lab orders

Announcement per UMC Clinical IT:

As of 8:00 AM Monday, February 19^th, 2018 all Outpatient Lab Orders (orders placed from a clinic encounter in a future state) will require a diagnoses associated with it.  As shown below, the diagnosis tab will show the blue ball/white “X” indicating the need for a diagnosis code to be added. This workflow is the same as the current radiology order process.  

This change will require all ordering clinicians to associate the appropriate diagnosis at the time the outpatient order is placed. 

NOTE: All EXISTING Future Lab Orders that are still active will require the diagnosis to be added to the order when activated in the lab. This means any orders placed from the clinics prior to Monday, awaiting your patient to get their labs drawn, will require the UMC laboratory registration staff to try and identify a patient’s diagnosis for that visit from the chart. If there is no diagnosis associated, then additional steps will be required to perform the order; including possibly calling the ordering provider/clinic, and ultimately canceling the order if no diagnosis can be found or ordering provider approval cannot be reached (UMC Laboratory is solidifying this workflow).

This change is being implemented to improve the amount of rejected lab charges declined due to the lack of diagnoses.

 

Duplicate Checking: Hemoglobin A1c

Hemoglobin A1C now has restricted duplicate checking of 7 days (it was a warning for less than 1 day). If the test needs to be performed within a 7-day period, the lab would need to override the restriction.

This restricted duplicate checking will not prevent future orders if the requested collection day(s) are separated by more than 7 days.