Results Called on these Critical Therapeutic Drug Levels: | |
Test Name | Greater Than |
Acetaminophen | 40 μg/mL |
Amikacin | 35 μg/mL |
Carbamazepine | 12 μg/mL |
Digoxin | 2.0 ng/mL for adults |
Gentamicin | 15 μg/mL |
Lidocaine | 5 μg/mL |
Lithium | 1.4 mEq/L |
Phenobarbital | 60 μg/mL |
Phenytoin | 40 μg/mL |
Procainamide | 16 μg/mL |
Salicylate | 40 mg/dL |
Theophylline | 20.0 μg/mL |
Tobramycin | 10 μg/mL |
Valproic Acid | 150 μg/mL |
Vancomycin | 30 μg/mL |
Microbiology
Critical or Significant values: patient results are called to the physician or service area as soon as results are available.
1. Critical value patient results include:
a. Positive direct examination from sterile body fluid/site
1) Cerebrospinal fluid
2) Joint fluid
3) Pericardial fluid
4) Pleural fluid
5) Peritoneal fluid
b. Positive blood culture (initial gram stain report)
c. Positive Legionella pneumophila antigen (also page on-call epidemiologist)
d. Positive Cryptococcus neoformans antigen
e. Positive malaria smears
2. Significant patient results include:
a. Positive STAT gram stain results
b. Negative STAT gram stain results from the Operating Room. If patient is out of the Operating Room when
results become available, results will not be called.
c. Positive direct examination from intraoperative specimens
d. Positive direct gram stain with hyphal forms seen, both sterile and non-sterile sites.
e. Positive culture of sterile body fluid (Do not call identical result within 5 days)
1) Cerebrospinal fluid
2) Joint fluid
3) Pleural fluid
4) Pericardial fluid
5) Peritoneal fluid
6) Intraoperative body fluids
f. Positive direct antigen tests
1) Pneumocystis carinii
2) Malaria
g. Epidemiology considerations (call to floor)
1) Methicillin-resistant Staphylococcus aureus (8JC; NICU; 4JPE; 7RC only)
2) Vancomycin-resistant enterococci (8JC; NICU; 4JPE; 7RC only)
3) ESBL (inpatient's)
h. Epidemiology considerations (call floor and on-call epidemiologist pager)
1) Acid-fast bacilli smear
2) M. tuberculosis (culture or PCR)
3) Legionella pneumophila (urine antigen or growth from environmental culture)
4) Neisseria meningitidis (CSF gram stains with gram negative diplococci or growth from normally sterile site)
5) Category A bioterrorism agents (Bacillus anthracis, Yersinia pestis, Francisella tularensis,
Clostridium botulinum toxin, Smallpox, Viral hemorrhagic fever)
6) Extended spectrum B-lactamases - call floor inpatient's only
7) Multi-drug resistant gram negative rods - inpatient's only
i. Culture or molecular detection of following organisms from any source:
(If patient is from OB/GYN do not call results unless the organism is isolated from blood or normally sterile body fluids.)
1) Streptococcus pyogenes
2) Virus Detection
3) Herpes Simplex (HSV), or Enterovirus PCR
4) Dimorphic fungi
5) Clostridium difficle - Inpatient's only
6) Cryptococcus neoformans
j. Positive ocular cultures (other than conjunctiva)
k. Molecular detection or culture of stool pathogens
1) Salmonella spp.
2) Shigella spp.
3) Campylobacter spp.
4) Yersinia spp.
5) Escherichia coli H7;O157
l. Culture of potential bioterrorism agents
1) Francisella tularensis
2) Bacillus anthracis
3) Brucella spp.
4) Yersinia pestis
5) Coccidiodes immitis
6) Burkholderia mallei or pseudomallei
3. Calling Algorithm:
Follow Department of Pathology guidelines (500.020) entitled "Reporting Critical Tests and Critical Values." This policy defines authorized staff that may accept critical values and provides a detailed calling algorithm. The results must be "read back" by the authorized staff and the call documented in Comm log.
For OB/GYN patients only smear or culture results from blood cultures and normally sterile body fluid specimens are phoned on a STAT basis.