This document provides guidelines for improving the notification of critical laboratory results at Changkat Melintang Hospital. It defines critical values as those outside normal limits that could cause imminent danger to patients and require immediate medical attention. It establishes critical limits for various chemical pathology and hematology tests for adults and pediatrics. The document outlines procedures for laboratories and wards on verifying, notifying, documenting, and acting on critical results to ensure timely medical intervention.

1. IMPROVING
NOTIFICATION OF
CRITICAL LABORATORY
RESULT
PATHOLOGY AND TRANSFUSION UNIT
CHANGKAT MELINTANG HOSPITAL

2. DEFINATION
CRITICAL VALUE/RESULT
Value that falls outside the critical limits
Presence of any unexpected abnormal findings,
cells or organism
May cause imminent danger to patient
Require immediate medical attention

3. DEFINATION
CRITICAL LIMITS
Boundaries of low and high laboratory test
values
May cause imminent danger to patient
Require immediate medical attention

4. LOWER LIMIT
(CLINICAL IMPLICATION)
NORMAL REFERANCE
RANGE
UPPER LIMIT
(CLINICAL IMPLICATION)
Value <135 mmol/L
(hyponatraemia)
SODIUM
Value >145 mmol/L
(hypernatremia)
LOWER CRITICAL VALUE/RESULT
135-145 mmol/L
UPPER CRITICAL VALUE/RESULT
Value = 120mmol/L
(potential harm likely to
occur:cerebral oedema)
Value ≥ 158-160mmol?l
(potential harm likely to
occur: anorexia,muscle
weakness,nausea,vomitting,
lethargy and coma)
Value ≤ 115mmol/L or rapid
reduction in sodium level (may
lead to coma or death)
ACCEPTABLE
LOWER
CRITICAL
LIMIT:
120mmol/L
125
mmol/L
Value ≥ 160mmol/L
(ass.with 75% mortality in
adult
155
mmol/L
ACCEPTABLE
UPPER
CRITICAL
LIMIT:
158mmol/L

5. LABORATORY PROCEDURE FOR NOTIFICATION OF CHEMICAL PATHOLOGY AND HAEMATOLOGY
CRITICAL RESULTS
LABORATORY
PERFORM
TEST(ROUTINE /
URGENT/STAT)
ANY
CRITICAL
LIMIT?
WHO SHOULD BE
RESPONSIBLE?
MLT/JTMP
SCIENCE OFFICER
MEDICAL OFFICER
PATHOLOGIST
RECORD:
INFORMER
NAME &
DESIGNATION
PATIENT ID
& WARD NAME
TEST NAME &
RESULT
SAMPLE
DATE & TIME
RECIPIENT
NAME
REFER
CRITICAL
VALUE
LIST
DOCUMEN THE
NOTIFICATION
AND RELEVANT
INFORMATION
INTO RECORD
BOOK,LIS OR
STANDARD
NOTIFICATION
DISPATCH A
COPY OF
RESULT TO
WARD/A&E
VERIFY THE
RESULT
CHECK
RECORD
CHECK FOR
COMMON
ANALYTICAL
INTERFERENCE
FROM
RECORD
BOOK OR
LIS
CHECK FOR PREANALYTICAL,
ANALYTICAL &POST
ANALYTICAL FACTOR
INFORM
RESULT AND
ASK FOR READ
BACK
PHONE
ELECTRONIC
SMS
MANUAL
DISPATCH
STAFF NURSE
SPECIALIST
MO
JM
MA
SAME
TREND
CHECK FOR
TREND
COMPARE
WITH
PREVIOUS
RESULT
HOW?
WHAT
TO
INFORM?
TO
WHOM?
INFORMER NAME
DESIGNATION
PATIENT ID
&LOCATION
TEST NAME&RESULT
SAMPLE DATE
&TIME
DIFFERENT
TREND
REPEAT
TEST

6. WARD/CLINIC/A&E PROCEDURE FOR NOTIFICATION OF LABORATORY CRITICAL RESULT
WARD STAFF
RECEIVES CRITICAL
RESULT
NOTIFICATION
FROM LAB
VIA:
VERBALLY(PHONE)
ELECTRONIC ALERT
(THIS)
MANUAL DISPATCH
OF RESULT
SMS
E-MAIL
RESPONSIBLE STAFF:
STAFF NURSE IN
CHARGE
MEDICAL ASSISTANT
HO
MO
SPECIALIST
RECORD
INFORMATION
RECEIVED
IN:
STANDARD FORM
PATIENT CASE NOTE
(IMMEDIATELY DONE)
BHT FOR IN-BHT
OTHERS: i.e: STAMP
WHAT TO RECORD?
PATIENT NAME
PATIENT RN,ID
TEST NAME AND
RESULT
SAMPLE TIME
AND DATE
DATE AND TIME
OF NOTIFICATION
NAME OF
INFORMER
READ BACK
INFORMATION
RECEIVED
TO READ BACK:
PATIENT NAME
& ID
TEST NAME &
RESULT
IF PATIENT
TRANSFERRED
OUT TO ANOTHER
HOSPITAL/WARD
RECEIPIENT OR
SN IN CHARGE
INFORM/FORWARD
TO STAFF IN
ANOTHER WARD
IF PATIENT HAS
BEEN
DISCHARGED
INFORM
DOCTOR
IMMEDIATELY
CONTACT THE
DOCTOR IN
CHARGE
IMMEDIATELY
RECORD IN
NURSING
NOTES/NURSING
CARE
PLAN/BHT
MEDICAL
ATTENTION
BY DOCTOR
IN-CHARGE
THE DOCTOR
HAS TO SIGN
ON THE RESULT
SLIP
WRITE THE
PLAN
MANAGEMENT
IN PATIENT’S
BHT
ATTACH
RESULT IN BHT
MO/SPECIALIST IN CHARGE
WILL DECIDE:
CALL BACK PATIENT TO
WARD/CLINIC
BRING FORWARD
APPOINTMENT DATE
CALL PATIENT FOR EARLY
APPOINTMENT

7. CRITICAL LIMIT FOR HAEMATOLOGY
VALUES FOR ADULT
LOWER CRITICAL
LIMIT
ANALYTE
UPPER CRITICAL
LIMIT
6.0g/dL
HAEMOGLOBIN
0.2
HAEMATOCRIT
20x10³/µL
PLATELET
100x10³/µL
100mg/dL
FIBRINOGEN
-
-
INR(RATIO)
>5
-
PT(SEC)
>2.5 UPPER LIMIT
-
APTT(SEC)
80 SEC OR >2x UPPER
REFERENCE RANGE

8. VALUES FOR PAEDIATRIC
LOWER CRITICAL
LIMIT
ANALYTE
UPPER CRITICAL
LIMIT
7.0g/dL
HAEMOGLOBIN
(PAEDS)
20.0g/dL
8.0g/dL
HAEMOGLOBIN
(NEONATES)
22.0g/dL
0.20
HAEMATOCRIT
(PAEDS)
0.40
0.25
HAEMATOCRIT
(NEONATES)
0.70
50x10³/µL
PLATELET
1000x10³/µL
70mg/Dl
FIBRINOGEN
-
-
INR(RATIO)
>5
2.0X10³µ
WBC
50x10³/µL

9. CRITICAL LIMIT FOR CHEMICAL PATHOLOGY
VALUES FOR ADULTS
LOWER CRITICAL
LIMIT
ANALYTE
2.8mmol/L
POTASSIUM
6.0mmol/L
125mmol/L
SODIUM
155mmol/L
2.8mmol/L
GLOCOSE
20mmol/L
1.5mmol/L
CALCIUM
3.0mmol/L
0.41mmol/L
MAGNESIUM
2.0mmol/L
0.32mmol/L
PHOSPHATE
2.87mmol/L
-
LACTATE
5.0mmol/L
7.2
pH
7.55
7.8kPa
pO2
-
-
pCO2
9.3kPa
250mmol/Kg
SR OSMOLARITY
UPPER CRITICAL
LIMIT
350mmol/Kg
-
CREATINE KINASE
5000U/L
-
LITHIUM
1.5mmol/L

10. VALUES FOR PAEDIATRIC
LOWER CRITICAL
LIMIT
ANALYTE
UPPER CRITICAL
LIMIT
2.8mmol/L
POTASSIUM
6.0mmol/L
125mmol/L
SODIUM
155mmol/L
1.6mmol/L
CSF-GLUCOSE
-
1.7mmol/L
CALCIUM
3.1mmol/L
0.5mmol/L
MAGNESIUM
1.8mmol/L
0.4mmol/L
PHOSPHATE
2.8mmol/L
-
LACTATE
3.0mmol/L
-
pH
7.60
5.85kPa
pO2
16.2kPa
2.6kPa
pCO2
9.1kPa
250mmol/Kg
SR OSMOLARITY
310mmol/Kg
-
CREATININE
330µmol/L
-
AMMONIA
100µmol/L
-
BILIRUBIN
-
CSF-PROTEIN
1.87g/L
-
UREA
19.0mmol/L
-
URIC ACID
500µmol/L
NEONATE 513µmol/L
CHILDREN 428µmol/L

11. QUICK GUIDE
LABORATORY
1) IDENTIFY ANY
CRITICAL RESULT
9) ATTACH
RESULTS IN BHT
2) CONFIRM CRITICAL RESULT
CHECK RESULT
CHECK SAMPLE
CHECK QC
VERIFY CRITICAL RESULT
8) GET HARD COPY OF
RESULT FROM LAB
7) INFORM MO
IMMEDIATELY
3) CALL WARD
IMMEDIATELY
4) INFORM RESULT
ASK FOR READ BACK
5) RECORD THE
NOTIFICATION
6) RECEIVE,RECORD AND
READ BACK THE CLR
WARD

12. REFERENCE

13. THANK YOU