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					      SBH 3 G 05 12                                                 Crisis Recovery Unit
                                  Laboratory Procedure

Purpose: To provide uniform procedures for ordering, collecting, handling and reporting
laboratory specimens.
Procedure:
1. Behavioral Health Medical Practitioner (BHMP) determines what Clinical Laboratory
   Testing is indicate to support and safely treat the consumer.
            A. BHMP orders lab tests on physician order sheet.
            B. BHMP gives order to RN.
            C. All medication blood levels should be presumed as 12-hour post dose levels
               and should be drawn accordingly unless ordered otherwise by the BHMP.
            D. RN or staff completes label, lab request form.
            E. RN or trained staff identifies consumer and obtains specimen using Universal
               Precautions.
            F. If RN or trained staff person is unable to draw blood specimen after two
               attempts another RN or trained staff person will attempt no more than two
               times. If the specimen is still not obtained the BHMP is notified and the
               attempts to draw and the notification are documented in the chart.
            G. The BHMP may attempt to draw the specimen or order that the person be taken
               to the contracted laboratory’s location to be drawn if it is safe for them to leave
               the CRU site.
            H. RN or staff places specimen in lab specimen bag with the lab request form in
               nursing station, refrigerating if indicated after completing any on-site processing
               of the specimen required for a specific test.
            I. RN or staff arranges for transportation of the specimen by contacting the lab


1. Inpatient Lab Reports

              A. All new lab results received by fax are to immediately be given to the RN on
                  duty who reviews them. If the BHMP is on site the results will be given to them
                  to review and evaluate. If the BHMP is not present they will immediately be
                  notified by phone of any abnormal values. The RN will make a notation in the
                  progress notes of the call, the abnormal values reported to the BHMP and any
                  follow up action that is ordered.

SBH/CRU/Lab Procedures
Revised: 26 Aug 02; 5 Jul 11
              B. All calls from the lab reporting Critical values are to be given immediately to
                  the RN on duty who immediately informs the BHMP whether on site or on-call.
                  The RN will then meet with the consumer to determine if any symptoms are
                  present related to the Critical value and will check vital signs. The RN makes a
                  notation in the progress notes of the telephonic notification from the lab
                  including the reported value, that the BHMP was notified, the time of the
                  notification, the findings from the RNs examination of the consumer and any
                  follow up action that was ordered by the BHMP. The printed/faxed report from
                  the lab after the phone call will be handed to the BHMP who, if on site will initial
                  and date it and then it is filed in the chart. If the BHMP is not present at the
                  time, the results will be made available to them when they arrive, to be initialed
                  and signed by them before filing.
              C. The BHMP is responsible for making sure that they have received the results of
                  all lab tests that they have ordered and initiating follow up if they have not. The
                  BHMP must acknowledging they have reviewed all results received by initialing
                  and dating the results and documenting the significance of results outside the
                  normal ranges and any planned follow up.

2. Inpatient responsibility for SBH Outpatient Programs Critical Lab Values After
   Regular Business Hours, Weekend Days and Holidays (CRUs will not receive
   critical lab information for Apache Junction and Payson programs)

            A. Lab will contact CRU RN after hours (5 pm – 8 am), weekend days and
               holidays to report a critical lab value.
            B. Lab will fax critical lab results to CRU RN. Typically this is related to
               electrolytes, glucose and/or toxic medication levels (i.e., Lithium).
            C. CRU RN contact crisis line to call client at home (i.e., 3-way conference call
               facilitated by crisis). This is a “transferring or relaying of information” to the
               client. I.E., “there is a potential problem with your lab results; we are
               recommending that you go to the ER to get redrawn”. For NARBHA programs,
               RN communicates information to the SBH crisis staff person on call who will
               relay information to the individual in service.

                                      Crisis Phone Numbers

                Bullhead          Flagstaff            Maricopa             Prescott
                  City           (NARBHA)               County             (NARBHA)
               (NARBHA)                               (Magellan)

               928-542-8924     928-600-8389          602-222-9444        928-710-1708



SBH/CRU/Lab Procedures
Revised: 26 Aug 02; 5 Jul 11
            D. Report above information to Guardian / parents for minors.
            E. If client doesn’t answer the phone then you request crisis to do a home visit /
               wellness check.
            F. If client address and phone number are not documented on the lab slip then
               O/N staff to assist RN to secure client information so that appropriate follow up
               care can be coordinated.
            G. RN documents 2 progress notes (one for t/c taken from the lab and one for the
               t/c made to report the information) that includes: time of service, service
               duration, billing code, service description, brief description of service, staff
               signature and date. When applicable (see chart) one SAL is completed and
               both billable services are documented on the same SAL.
            H. Email sent to the VP of Outpatient Services, the VP of SBH in northern Arizona,
               the VP of CRS and the Medical Director; CC the Director of Nursing reporting
               incident. Attach to the email a scanned copy of the lab slip, progress note and
               SAL (if applicable) and add to the email any pertinent information that you
               secured from ECR, CMHC, HMS (i.e., if there was inaccurate information on the
               lab slip, client wasn’t able to be reached, etc…).

                                           Documentation
                               Hand Written
                                                SAL       Billing Code / Service
                               Progress Note
                                                                Description

                      ECR        BHP(RN)        Yes    5234 RN services out of
                                                       office

                      HMS        BHP(RN)        No     No code




                   Retrieval of Client Address and/or Phone Number:

ECR: Client intake / summary page or in the scanned documents (client cover sheet).

HMS: Look at the client contact information. It is the responsibility of Sue Ann, Doctor
Kilgore and Doug Barshter to follow up with the designated OP site to: 1) ensure that all case
management billing for these clients gets entered into ECR, HMS or paper charts and 2)
is completed by the designated OP Program staff person, assigned to the client.




SBH/CRU/Lab Procedures
Revised: 26 Aug 02; 5 Jul 11

				
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