Microbiology User’s Guide Sunquest Laboratory™ Sunquest Information Systems 250 S. Williams Boulevard Tucson, AZ 85711 Copyright © 2005–2012 Sunquest Information Systems, Inc. All Rights Reserved. Microbiology User’s Guide for Sunquest Laboratory UD-1527/00-11-MC Released 03/12 Software Version 7.1 Sunquest and Sunquest Information Systems are registered trademarks, and Sunquest Laboratory, among other marks, is a trademark of Sunquest Information Systems, Inc. All other brands, names, and marks are the property of their respective owners. Features and specifications described herein are subject to change without notice. Screen and report examples presented in this guide may be based on the implementation of all the Sunquest Laboratory modules: general laboratory, microbiology, and blood bank. The screens and reports at the user’s facility may differ from those presented in this guide based on the Sunquest Laboratory modules installed and any site-specific modifications. Designed and supported blood transfusion or blood donor functionality can only be achieved through the utilization of the Sunquest Laboratory – Blood Bank Transfusion or Sunquest Laboratory – Blood Bank Donor modules. Sunquest Information Systems does not support the use of any other blood transfusion or blood donor software applications with Sunquest Laboratory. Contents Chapter 1 Introduction ...................................................................................................................................13 Overview................................................................................................................................13 Getting Help...........................................................................................................................13 Using Help .............................................................................................................................14 Printing Help ..........................................................................................................................14 Using Microsoft Windows .....................................................................................................15 Using Common Keyboard Commands............................................................................16 Displaying Keyboard Navigation Indicators ...................................................................16 Chapter 2 Conventions for Microbiology Applications ...................................................................19 Overview................................................................................................................................19 About Data Protection and Locking.......................................................................................19 Getting to Know Customized Keyboards ..............................................................................20 About Customized Keyboards.........................................................................................20 About Default Keyboards for Unassigned Batteries .......................................................23 About Susceptibility Keyboards......................................................................................23 About the Tech Final Key................................................................................................23 About the Final Key ........................................................................................................23 About the No Growth Key ..............................................................................................24 About Colony Count Keys ..............................................................................................24 Selecting a Customized Keyboard...................................................................................25 Entering Codes Using a Customized Keyboard ..............................................................27 Entering Free Text and Codes Not Defined on a Customized Keyboard........................27 Modifying Shift, Tech Code, and Lab Location ....................................................................28 Printing Workcards and Worklabels.......................................................................................30 Printing at Order or Receive Time ..................................................................................31 Printing at Setup Time.....................................................................................................31 Using Two Printers ..........................................................................................................31 Using Reprinting Options................................................................................................31 Chapter 3 Entering a Setup Time...............................................................................................................33 Overview................................................................................................................................33 Getting to Know Microbiology Setup Entry..........................................................................33 About the Reasons for Using Microbiology Setup Entry................................................34 About Alternatives for Entering the Setup Date and Time .............................................35 About Settings That Affect Access and Use ...................................................................36 About Printing in Microbiology Setup Entry ..................................................................36 iv Contents Deciding Between Quick Mode and Single Specimen Mode ............................................... 37 Starting Microbiology Setup Entry........................................................................................ 37 Entering the Setup Date and Time......................................................................................... 38 Entering the Setup Date and Time in Quick Mode ......................................................... 38 Entering the Setup Date and Time in Single Specimen Mode........................................ 40 Modifying an Existing Setup Date and Time.................................................................. 43 Reprinting in Microbiology Setup Entry ............................................................................... 44 Chapter 4 Entering Direct Exam and Culture Results ...................................................................... 47 Overview ............................................................................................................................... 47 Getting to Know Microbiology Result Entry ........................................................................ 48 About Direct Exam and Culture Result Entry ................................................................ 48 About Microbiology Result Entry................................................................................... 50 About the Patient and Specimen Headers ....................................................................... 51 About Microbiology Batteries ........................................................................................ 52 About Other Applications Affecting Microbiology Result Entry................................... 52 About Paperless and Nonpaperless Microbiology .......................................................... 53 About the Paperless Microbiology Audit Trail Report ................................................... 53 About Entering Workload ............................................................................................... 54 About Rules for Direct Exam and Culture Entry............................................................ 55 Starting Microbiology Result Entry ...................................................................................... 55 Searching for a Microbiology Order ..................................................................................... 55 About Selecting a Search Mode...................................................................................... 56 Searching for an Order by Specimen .............................................................................. 56 Searching for an Order by Batch..................................................................................... 58 Looking Up a Batch Number in Batch Mode ................................................................. 58 Searching for an Order by Direct Exam or Culture Worksheet ...................................... 59 Searching for an Order by Sequence Worksheet............................................................. 60 Looking Up a Sequence Worksheet Batch Number........................................................ 61 About Online Workcards and Searching for an Order .................................................... 62 Using Worksheets in Microbiology Result Entry.................................................................. 63 About Worksheets in Result Entry.................................................................................. 63 Entering Results Using a Worksheet............................................................................... 64 Recording Direct Exam and Culture Observations ............................................................... 66 About Direct Exam Entry ............................................................................................... 66 About Culture Entry........................................................................................................ 67 About Flagging Significant Findings.............................................................................. 67 Entering Direct Exam and Culture Observations............................................................ 67 Entering Colony Count ................................................................................................... 70 Viewing Recorded Information About a Culture Specimen.................................................. 72 Viewing Direct Exam Observations................................................................................ 72 Viewing Susceptibility, Hold, Online, or Biotype Data .................................................. 72 Setting a Print Order for Observations .................................................................................. 73 About the Print Order of Observations ........................................................................... 74 Changing the Print Order of Observations...................................................................... 74 Entering Comments Using Composed Text .......................................................................... 75 About Composed Text .................................................................................................... 76 Entering and Modifying Composed Text........................................................................ 76 Placing Results on Hold ........................................................................................................ 77 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Contents v Releasing Direct Exam or Culture Results from Hold...........................................................78 Hiding Direct Exam or Culture Results on Patient Reports...................................................80 Recording Online Workup Data.............................................................................................82 About Paperless Microbiology and Workup Data...........................................................82 About Workup Data Entry...............................................................................................83 Entering Workup Data .....................................................................................................83 Viewing Workup Results .................................................................................................86 Modifying Workup Results .............................................................................................87 Entering Extra Workload for Nonpaperless Orders ...............................................................88 Recording Biotype Data.........................................................................................................89 Entering and Modifying Biotype Data ............................................................................90 Viewing Biotype Data .....................................................................................................91 Deleting Biotype Data .....................................................................................................92 Clearing Data in Microbiology Result Entry .........................................................................92 Selecting Another Microbiology Order .................................................................................93 Viewing a Summary of Results..............................................................................................94 Saving Microbiology Result Data..........................................................................................97 Modifying the Setup Time .....................................................................................................97 Modifying Specimen Description and Special Request.........................................................99 Entering Bill Only Data .........................................................................................................100 Modifying Direct Exam and Culture Observations ...............................................................101 Changing a Result............................................................................................................101 Applying Correction Statements .....................................................................................103 Deleting an Observation ..................................................................................................104 Deleting an Observation with Associated Online Results...............................................105 Viewing Laboratory and Microbiology Results in Inquiry....................................................105 Printing a Patient Cumulative Report ....................................................................................106 Working with Results Requiring Clinical Validation.............................................................108 Manually Assigning Results to a Validation Queue ........................................................109 Resolving Rule Conflicts for Validation Queues.............................................................110 Viewing and Entering Internal Notes ..............................................................................111 Using Accession Result Comments .......................................................................................112 About Accession Result Comments ................................................................................112 Opening Accession Result Comments in Microbiology Result Entry ............................112 Entering Accession Result Comments ............................................................................113 Editing or Deleting Accession Result Comments ...........................................................114 Responding to QA Failures for Direct Exams and Cultures..................................................115 Chapter 5 Accepting Results from Online Instruments ...................................................................117 Overview................................................................................................................................117 Getting to Know Online Results ............................................................................................117 About Online Organism Identifications and Susceptibility Results................................118 About Online Instrument Data ........................................................................................119 About Quality Assurance Checking for Online Results..................................................120 About Previously Filed Codes and Online Results................................................................120 Replacing Organism IDs and Enumeration Codes with Online Results .........................121 Replacing Organism IDs on Hold with Online Results...................................................122 Replacing Biotype Data with Online Results..................................................................122 Replacing Susceptibility Data with Online Results.........................................................122 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems vi Contents Replacing Susceptibility Data on Hold with Online Results .......................................... 122 Replacing Other Testing Results on Hold with Online Results ...................................... 122 Combining and Overlaying Drug Results ............................................................................. 123 About the Combine Data Message.................................................................................. 123 Choosing Not to Combine Susceptibilities ..................................................................... 123 Combining Susceptibilities with No Drugs in Common ................................................ 123 Combining Susceptibilities with Drugs in Common ...................................................... 124 Autofiling Results from Online Instruments ......................................................................... 124 About Autofiling of Organism Identification Results..................................................... 124 About Autofiling of Susceptibility Results..................................................................... 125 About Applying Correction Statements When Autofiling.............................................. 126 Viewing Results Sent from Online Instruments .................................................................... 126 Accepting Online Results ...................................................................................................... 127 Accepting All Online Results for an Order..................................................................... 128 Displaying and Selecting Individual Online Results ...................................................... 129 Accepting Individual Online Results for an Observation ............................................... 130 Modifications Resulting from Accepted Results ............................................................ 132 Selecting an Organism ID for Susceptibility Interpretation............................................ 132 Actions Resulting from Accepting Online Results ......................................................... 133 Locating Autofiled or Accepted Online Data........................................................................ 134 Saving Online Results to a Patient Record............................................................................ 135 Deleting Online Data ............................................................................................................. 135 Chapter 6 Entering Susceptibility Results ............................................................................................ 137 Overview ............................................................................................................................... 137 Getting to Know Microbiology Susceptibility Entry ............................................................ 137 About Entering Susceptibilities ...................................................................................... 138 About Susceptibility Entry.............................................................................................. 139 About Rules for Susceptibility Entry .............................................................................. 139 Selecting a Keyboard and an Organism ................................................................................ 140 Entering Susceptibility Results.............................................................................................. 141 About Keyboard Methods............................................................................................... 141 About Applying Tech Final or Final Status to a Battery................................................. 141 Entering Drug Results..................................................................................................... 142 Entering Drug Codes....................................................................................................... 144 Entering Additional Drug Results................................................................................... 144 Using Alternate Susceptibility Interpretive Codes.......................................................... 146 Using the Kirby Bauer Result Method............................................................................ 147 Using MIC or MBC Result Format................................................................................. 147 Entering Composed Text for Susceptibility Results.............................................................. 148 Placing Drug Results on Hold ............................................................................................... 149 Releasing Susceptibility Results from Hold.......................................................................... 151 Hiding Drug Results on Patient Reports................................................................................ 153 Applying Drug Classification................................................................................................ 154 Viewing Susceptibility, Hold, Online, or Biotype Data ........................................................ 154 Viewing a Summary of Susceptibility Results ...................................................................... 155 Filing and Saving a Drug Result............................................................................................ 156 Responding to QA Failures for Susceptibilities .................................................................... 156 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Contents vii Modifying a Susceptibility.....................................................................................................157 About Correction Statements and Modified Drug Results..............................................158 About the Not Done Code ...............................................................................................158 About Crediting a Microbiology Battery ........................................................................158 About Automatic Susceptibility Updates ........................................................................158 Modifying a Drug Result.................................................................................................160 Chapter 7 Entering Results for Other Testing .....................................................................................163 Overview................................................................................................................................163 Getting to Know Other Testing Result Entry.........................................................................163 Entering Other Testing Results ..............................................................................................166 Responding to QA Failures for Other Testing Results ..........................................................168 Placing Other Testing Results on Hold ..................................................................................169 Releasing Other Testing Results from Hold .........................................................................170 Hiding Other Testing Results on Patient Reports ..................................................................171 Saving Microbiology Result Data..........................................................................................172 Chapter 8 Assigning Tech Final and Final Results ...........................................................................173 Overview................................................................................................................................173 About Tech Final Status and Final Status ..............................................................................173 Assigning a Tech Final Status to a Battery ............................................................................174 About Quality Assurance Checking for Tech Final Status..............................................174 Assigning a Tech Final Status .........................................................................................175 Deleting a Tech Final Status............................................................................................176 Assigning a Final Status to a Battery .....................................................................................176 About Quality Assurance Checking for Final Status ......................................................176 About Final Status and Deleting Online Data .................................................................177 Assigning a Final Status to a Battery ..............................................................................177 Assigning a Final Status to a Battery with Tech Final Status..........................................178 Deleting a Final Status.....................................................................................................179 Chapter 9 Releasing Microbiology Results ...........................................................................................181 Overview................................................................................................................................181 Getting to Know Microbiology Tech Final Release ..............................................................181 About Releasing Batteries and Tech Final Status............................................................181 About the Microbiology Tech Final Release Window ....................................................182 Starting Microbiology Tech Final Release.............................................................................184 Releasing a Batch of Microbiology Batteries ........................................................................184 About Locked Accession Numbers and Releasing Batteries ..........................................184 About Crediting Accession Numbers and Releasing Results..........................................184 Looking Up a Batch Number ..........................................................................................185 Releasing Batteries in a Culture Review Batch...............................................................186 Releasing Batteries in a Sequence Worksheet Batch.......................................................187 Modifying a Batch .................................................................................................................189 Adding and Removing Accession Numbers....................................................................190 Confirming Changes to a Culture Review Batch ............................................................190 Confirming Changes to a Sequence Worksheet Batch ....................................................191 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems viii Contents Chapter 10 Automatically Updating No-Growth Cultures ................................................................. 193 Overview ............................................................................................................................... 193 Getting to Know Automatic No-Growth Result Entry.......................................................... 193 About the Uses of Automatic No-Growth Result Entry ................................................. 194 About the Scheduling of No-Growth Updates and Final Results ................................... 195 About Basing the No-Growth Update on the Receive or Setup Time ............................ 195 About Filtering the Cultures on a Worksheet.................................................................. 196 About the Automatic No-Growth Result Entry Workflow.................................................... 197 Starting Microbiology Automatic No-Growth Result Entry ................................................. 198 Performing the No-Growth Update ....................................................................................... 198 About Using No-Growth Worksheets ............................................................................. 198 Step 1: Entering One or More Worksheets ..................................................................... 199 Step 2: Adding a Comment............................................................................................. 200 Step 3: Filtering the Cultures on the Worksheets............................................................ 201 Step 4: Performing the No-Growth Update .................................................................... 202 Troubleshooting Microbiology Automatic No-Growth Result Entry ................................... 203 Chapter 11 Inquiring on Microbiology Results ...................................................................................... 207 Overview ............................................................................................................................... 207 Getting to Know Microbiology Inquiry................................................................................. 207 About Security Levels..................................................................................................... 208 About Report Blocking ................................................................................................... 208 Starting Microbiology Inquiry............................................................................................... 209 About the Microbiology Inquiry Workflow .......................................................................... 209 Step 1: Searching for Results .......................................................................................... 210 Step 2: Filtering Results.................................................................................................. 210 Step 3: Selecting Results to View ................................................................................... 212 Step 4: Viewing Results .................................................................................................. 213 Searching for Results............................................................................................................. 214 Filtering Results..................................................................................................................... 216 About Query Filters ........................................................................................................ 216 Filtering by Episodes or Events ...................................................................................... 217 Filtering by Specimen Groups ........................................................................................ 218 Specifying Restrictions on Time..................................................................................... 219 Filtering Out Suppressed Results.................................................................................... 220 Filtering for a Selected Requisition Number .................................................................. 221 Filtering by Container or Accession Number ................................................................. 222 Selecting Results to View ...................................................................................................... 223 About the Accession/Battery List Window..................................................................... 223 Selecting Items from the Accession/Battery List to View Detailed Results................... 225 Canceling a Search.......................................................................................................... 226 Viewing Detailed Results of a Query .................................................................................... 226 Viewing Results in Interim Format................................................................................. 226 Switching Between Interim and Table Formats.............................................................. 227 Viewing Results in Table Format.................................................................................... 228 Viewing Internal Notes in Microbiology Inquiry .......................................................... 229 Modifying a Query ................................................................................................................ 230 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Contents ix Viewing the History of a Microbiology Battery ....................................................................230 Printing Detailed Results .......................................................................................................232 Chapter 12 Using Microbiology Maintenance Inquiry (MMIQ) .........................................................233 Overview................................................................................................................................233 Getting to Know Microbiology Maintenance Inquiry ...........................................................233 Starting Microbiology Maintenance Inquiry (MMIQ)...........................................................234 Inquiring on Microbiology Maintenance ...............................................................................235 Looking Up Sensitivity Codes (MMIQ 1).......................................................................236 Looking Up Sensitivity Batteries (MMIQ 2) ..................................................................236 Looking Up Sensitivity Interpretations (MMIQ 3) .........................................................237 Looking Up MIC Exam Interpretive Values (MMIQ 4) .................................................238 Looking Up MIC Exam Usual/Dosage Values (MMIQ 5)..............................................238 Looking Up Workcards (MMIQ 6) .................................................................................239 Looking Up Culture Keyboards (MMIQ 7) ....................................................................239 Looking Up Direct Exam Keyboards (MMIQ 8) ............................................................240 Looking Up Sensitivity Keyboards (MMIQ 9) ...............................................................241 Looking Up Quality Assurance Definitions (MMIQ 10) ................................................241 Looking Up No-Growth Worksheets (MMIQ 11)...........................................................242 Looking Up Online Filing Parameters for Organism IDs (MMIQ 12) ...........................242 Looking Up Online Filing Parameters for Sensitivities (MMIQ 13) ..............................243 Looking Up Specimen Description Groups (MMIQ 14) ................................................244 Looking Up Drug Reporting Classifications (MMIQ 15)...............................................244 Looking Up Online Workcard Definitions (MMIQ 16) ..................................................245 Looking Up Bill-Only Tests (MMIQ 17) ........................................................................246 Looking Up Inquiry Specimen Groups (MMIQ 18) .......................................................247 Looking Up the Security Settings for Organism Codes (MMIQ 19) ..............................247 Looking Up Logical Progressions (MMIQ 20) ...............................................................248 Looking Up Label Print/Setup Time Options (MMIQ 21)..............................................249 Looking Up Other Testing Keyboards (MMIQ 22) ........................................................249 Chapter 13 Reviewing and Validating Clinical Results ......................................................................251 Overview................................................................................................................................251 Getting to Know Clinical Validation......................................................................................251 About Clinical Validation Reviewers ..............................................................................251 About Validation Queues.................................................................................................252 About the Clinical Validation Workflow .........................................................................253 About Rules for Clinical Validation ................................................................................253 About Internal Notes, Result Comments, and Accession Result Comments ..................254 Starting Clinical Validation ....................................................................................................254 Selecting Accessions from a Validation Queue .....................................................................255 About Accessions and Batteries in a Review Queue.......................................................256 Selecting Accessions to Review......................................................................................257 Selecting a Date Range....................................................................................................259 Selecting a Filter..............................................................................................................260 Creating and Editing Filters.............................................................................................260 Deleting a Filter...............................................................................................................264 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems x Contents Reviewing Results ................................................................................................................. 265 Understanding the Clinical Validation Review Window ................................................ 266 Moving from One Accession to Another........................................................................ 268 About Clinical Validation Review Statuses .................................................................... 268 Changing the Review Status ........................................................................................... 270 Redirecting an Accession to a Different Validation Queue ............................................ 271 Suppressing or Unsuppressing a Result .......................................................................... 273 Reviewing Susceptibility Histories................................................................................. 274 Opening Other Sunquest Laboratory Applications......................................................... 276 Adding New Tests to an Accession................................................................................. 277 Entering Result Comments ............................................................................................. 278 Clearing All Changes to an Accession............................................................................ 281 Printing Clinical Validation Details ................................................................................ 282 Printing or Faxing Interim Reports ................................................................................. 283 Exiting the Review Window ........................................................................................... 286 Exchanging Notes about Clinical Results ............................................................................. 286 About Internal Notes....................................................................................................... 287 Viewing Internal Notes ................................................................................................... 288 Creating and Editing Internal Notes................................................................................ 291 Using Accession Result Comments in Clinical Validation ................................................... 293 About Accession Result Comments................................................................................ 293 Opening Accession Result Comments in Clinical Validation......................................... 293 Viewing Clinical Validation Reports ..................................................................................... 294 Opening Clinical Validation Reports .............................................................................. 294 Viewing the Clinical Validation Log............................................................................... 295 Viewing the Internal Notes Report.................................................................................. 297 Appendix A Settings for Microbiology Applications ............................................................................ 301 Overview ............................................................................................................................... 301 Setting Security for Microbiology Applications ................................................................... 301 About Security for Microbiology Applications .............................................................. 302 Setting Security for Microbiology Setup Entry .............................................................. 302 Setting Security for Microbiology Result Entry ............................................................. 302 Setting Security for Microbiology Tech Final Release ................................................... 303 Setting Security for Microbiology Automatic No-Growth Result Entry........................ 304 Setting Security for Microbiology Inquiry...................................................................... 304 Setting Security for Clinical Validation .......................................................................... 305 Microbiology Setup Entry Settings ....................................................................................... 305 Microbiology Setup Entry Maintenance Settings ........................................................... 306 Microbiology Setup Entry Site Parameters..................................................................... 306 Microbiology Result Entry Settings ...................................................................................... 308 Bill-Only Tests Maintenance Settings............................................................................. 309 Biotype Data Maintenance Settings................................................................................ 309 Colony Count Site Parameter.......................................................................................... 309 Composed Text Site Parameters ..................................................................................... 310 Correction Statement Site Parameters............................................................................. 310 Specimen Resulting Site Parameter ................................................................................ 311 Future Setup Time Site Parameter .................................................................................. 311 Accession Result Comment Site Parameters .................................................................. 311 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Contents xi Keyboard Maintenance Settings for Cultures..................................................................312 Keyboard Maintenance Settings for Direct Exams .........................................................312 Keyboard Maintenance Settings for Susceptibilities.......................................................312 Other Testing Settings .....................................................................................................314 Online Instrument Result Settings...................................................................................315 Paperless Microbiology Settings .....................................................................................316 Paperless Microbiology Audit Trail Report Settings ......................................................319 Performing Lab Maintenance ..........................................................................................320 Print Order Site Parameter...............................................................................................320 Searching for a Record Site Parameter............................................................................321 Suppressing Results Settings...........................................................................................321 Susceptibility Update Site Parameter ..............................................................................322 Viewing Results Site Parameter ......................................................................................322 Workload Code Maintenance Settings ............................................................................322 Worksheet Settings ..........................................................................................................322 Microbiology Tech Final Release Settings ............................................................................323 Assigning Multiple Batteries to an Accession Number Site Parameter ..........................324 Worksheet Selection Site Parameter................................................................................324 Microbiology Automatic No-Growth Result Entry Settings .................................................324 Automatic No-Growth Result Entry Maintenance ..........................................................325 Automatic No-Growth Result Entry Site Parameters......................................................326 Microbiology Inquiry Settings ...............................................................................................327 Microbiology Inquiry Maintenance.................................................................................327 Microbiology Inquiry Site Parameters ............................................................................327 Clinical Validation Settings....................................................................................................328 Clinical Validation Maintenance .....................................................................................329 Clinical Validation Site Parameters .................................................................................329 Appendix B Message Reference ....................................................................................................................331 Overview................................................................................................................................331 Messages for Microbiology Result Entry ..............................................................................332 Messages for Microbiology Automatic No-Growth Result Entry .........................................339 Messages for Microbiology Setup Entry ...............................................................................341 Messages for Microbiology Susceptibility Entry...................................................................342 Messages for Microbiology Tech Final Release ....................................................................343 Messages for Microbiology Inquiry.......................................................................................345 Messages for Clinical Validation ...........................................................................................345 Glossary ..........................................................................................................................................349 Index .................................................................................................................................................357 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems xii Contents UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Chapter 1 Introduction Overview The Microbiology module of Sunquest Laboratory™ enables you to efficiently enter microbiology and epidemiological results. Customized keyboards, online workcards, and automated no-growth updates help you reduce the time it takes to process a specimen in your laboratory. This section provides information that will help you use Microbiology effectively. This section includes the following topics Getting Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Using Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Printing Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Using Microsoft Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Getting Help Use the following techniques for gaining access to Help in Windows®-based Sunquest Laboratory. To … In the application, in the active window, do this … See a list of tasks you can perform from the active window. Click See Help about an element in a window. Related Topics Using Help on page 14 Printing Help on page 14 . Use the TAB key to select an element, and then press F1. 14 Chapter 1: Introduction Using Help Help includes several navigational aids to help you browse and find information. Make sure that Help is showing. For more information, see Getting Help on page 13. Click to view the previous page. Click to show or hide the tabs in the left pane. In the left pane, do any of the following to find information: • To view the table of contents, click Contents. • To find information in the index, click Index. • To search for specific information by entering a keyword, click Search. Related Topics Printing Help on page 14 Printing Help Description Use this procedure to print individual topics or all topics within a section directly from Microbiology Help. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Microsoft Windows 15 You Need to Know The Microbiology Help included with the software is created directly from the latest update of the Microbiology User’s Guide. However, the contents of the user’s guide your site last received from Sunquest Information Systems may be different from the Help included with the latest software build installed at your site. Sunquest therefore recommends that you print product documentation by printing the Microbiology User’s Guide and any applicable Update Pages (UPs). Before You Begin Make sure that the left pane of the Help is showing the table of contents. For more information, see Getting Help on page 13 and Using Help on page 14. Steps to Take With the table of contents showing in the left pane of the Help, To print an individual Help topic 1 Display the page you want to print. 2 On the toolbar, click Print. The Print Topics window opens. 3 Click Print the selected topic, and then click OK. The Print window opens. 4 Make your selections, and then click Print. To print all Help topics in a section 1 In the table of contents, click the section (book icon) you want to print. 2 On the toolbar, click Print. The Print Topics window opens. 3 Click Print the selected heading and all subtopics, and then click OK. The Print window opens. 4 Make your selections, and then click Print. Using Microsoft Windows If you are not familiar with Microsoft Windows, refer to your Windows documentation for information about Windows functions, such as: • • • • Performing mouse operations. Opening and closing windows. Using keyboard shortcuts (shortcut keys, underlined letter). Using shortcut menus. For more information, see … Using Common Keyboard Commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Displaying Keyboard Navigation Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 16 Chapter 1: Introduction Using Common Keyboard Commands For your convenience, see the following commonly used keyboard commands. These keyboard commands work in most Windows-based Sunquest Laboratory applications. To … Press … Move forward through tabs. CTRL+TAB Move backward through tabs. CTRL+SHIFT+TAB Move forward through options. TAB Move backward through options. SHIFT+TAB Carry out a command or select an option. ALT + the underlined character in the label for the command or option Note By default, underlining does not appear until you press the ALT key. To permanently display the underlining, see Displaying Keyboard Navigation Indicators on page 16. Carry out a command for an active option or button. ENTER An option or button is active when it appears surrounded by a dotted line. Select or clear an active check box. SPACEBAR Select an active button if the active option is a group of option buttons. Arrow keys Show the items in an active list. F4 Move through a list of options. Arrow keys Open a code lookup or patient filter window. F3 or F2 Move through a matrix, such as the result entry area in Microbiology Result Entry. TAB (for single line entries) TAB+TAB (for multiple line entries) Arrow keys Close the current window. ALT+F4 Displaying Keyboard Navigation Indicators Description You can carry out a command or select an option using ALT plus the underlined character in the label for the command or option. However, by default the underlining does not appear until you press the ALT key with the window open. Use this procedure to ensure that navigation keys are underlined at all times. Steps to Take From your Windows desktop, 1 From the Start menu, click Settings, then Control Panel. The Control Panel window opens. 2 Double-click Display. The Display Properties window opens. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Microsoft Windows 17 3 On the Appearance tab, click Effects. The Effects window opens. Clear this check box to display underlined navigation indicators. 4 Clear the check box labeled Hide keyboard navigation indicators until I use the Alt key, then click OK. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 18 Chapter 1: Introduction UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview Some features, such as data protection and customized keyboards, are common to several microbiology applications and are documented as conventions. This section includes the following topics About Data Protection and Locking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Getting to Know Customized Keyboards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Modifying Shift, Tech Code, and Lab Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Printing Workcards and Worklabels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 About Data Protection and Locking To protect data from being modified inadvertently, the system locks patient and accession data when a technologist accesses a record in an application in which order data can be updated. Here is what occurs: • When a technologist accesses an accession record, the system locks the data for ten minutes or until the technologist exits the record, whichever occurs first. • If another technologist attempts to access a record that is in use before ten minutes have elapsed, the system displays a message indicating that the accession record is locked. Because this message includes the number of seconds remaining on the lock, the second technologist can determine when the record will become accessible. • If another technologist attempts to access a record that is in use after ten minutes have elapsed, the system opens the record and allows the second technologist to enter and save data. If the first technologist tries to save the record while the second technologist has it opened, the system displays a message indicating that the save has been canceled. Chapter 2 Conventions for Microbiology Applications 20 Chapter 2: Conventions for Microbiology Applications Getting to Know Customized Keyboards You can use a customized keyboard to record direct exam, culture, and susceptibility observations, and results for other testing. You can also view a visual map of the keys assigned to a customized keyboard. For more information, see … About Customized Keyboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 About Default Keyboards for Unassigned Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About Susceptibility Keyboards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About the Tech Final Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About the Final Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About the No Growth Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 About Colony Count Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Selecting a Customized Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Entering Codes Using a Customized Keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Entering Free Text and Codes Not Defined on a Customized Keyboard . . . . . . . . . . 27 About Customized Keyboards Using customized keyboards helps assure that specimens are processed and results entered in a consistent manner. Your system manager assigns any of the following types of codes to keys on a standard PC keyboard: organism, susceptibility, workup workload, and media codes, or codes for other testing results and tests. The customized keyboard is then associated with microbiology batteries in Microbiology Maintenance (MMA). For more information about defining microbiology keyboards, see the Microbiology Administrator’s Guide. The customized keyboards are defined specifically for direct exams, cultures, susceptibilities, and other testing, and contain predefined keys for resulting. Sunquest Laboratory checks maintenance definitions to determine which keyboards to use for the selected microbiology battery. The following table lists the keys on a standard PC keyboard that can be assigned codes: For the standard PC keyboard … Codes can be assigned to … First (top) row 13 symbol and number keys. Second row 10 letter keys and three symbol keys. The three symbol keys are: • Left curly bracket / Left square bracket • Right curly bracket / Right square bracket • Pipe / backslash UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Customized Keyboards For the standard PC keyboard … Third row Fourth row 21 Codes can be assigned to … Nine letter keys, two symbol keys, and the Enter key. The two symbol keys are: • Colon / Semicolon • Double quote / Single quote Seven letter keys and three symbol keys. The three symbol keys are: • Less than / comma • Greater than / period • Question/ pipe / forward-slash (? | /) During direct exam, culture, susceptibility, or other testing entry, you can view a visual map of a customized keyboard. The keyboard map shows the codes that are assigned to individual keys. The keyboard map display is determined by the keyboard maintenance settings for each hospital or laboratory facility. For example, angle brackets can appear on the same key on one keyboard and on separate keys on another keyboard. The following illustrates a keyboard map display. The name of the keyboard appears in the title bar. Press F8 to open or close the keyboard map, or click the X to close the map. Some keys are assigned shifted and unshifted values. A code assigned a shifted value appears at the top of the key. A code assigned an unshifted value appears at the bottom of the key. Your system manager assigns organism, susceptibility, workup workload, media codes, other tests, and results to letter, number, and symbols keys on the keyboard. Sunquest Laboratory displays as many characters as can fit on the key. Any additional characters are indicated by an ellipsis. Note Some symbol keys are not assigned codes because they are reserved for system use only. For susceptibility and other testing keyboards, codes are not assigned to the # sign. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 22 Chapter 2: Conventions for Microbiology Applications Some keys can be assigned two values: a top value that is activated by the Shift key and a bottom value that is an unshifted key value: • To activate the shifted value key, press the Shift key and the key. • To activate the unshifted value key, press the key. The following illustrates codes assigned to the number 2 key and the value that is activated by the Shift key. Top (@) and bottom (2) value for key. Press @ (Shift + the 2 key) to enter ng. Press only the 2 key to enter MVKC. The Caps Lock and Num Lock keys can also affect the values assigned to a key. If the Caps Lock key is on and you press the Shift key, you can activate the unshifted (bottom) value for a key. Special function keys assigned to the keyboard appear in bold lowercase letters to differentiate them from other key assignments. The Tech Final, Final, No Growth, Colony Count Indicator, and Other keys appear on the keyboard as tfnl, fnl, ng, cnt, and othr. The Count Terminator key appears as a text code, because the code translation (in most cases Col/ml) is applied after the numeric entry (for example, >100,000 Col/ml). Caps Lock Off indicates the Caps Lock key is inactive. Special function keys appear in bold lower case letters. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Customized Keyboards 23 About Default Keyboards for Unassigned Batteries It is possible that a battery may not be associated with a keyboard. Your system manager uses Microbiology Maintenance to create a default keyboard for such unassociated batteries. This default keyboard is loaded in Microbiology Result Entry so that you can record observations for an unassociated battery. If no default keyboard is defined, you must select a keyboard for the battery you are working with. About Susceptibility Keyboards Two types of susceptibility keyboard definitions are available: susceptibility result keyboards and susceptibility drug code keyboards. If key assignments have been made for MIC values, the system displays as many characters as can fit on the key, followed by an ellipsis. About the Tech Final Key You can use the Tech Final key to assign a Tech Final status to a battery if all tests within the battery have results. The Tech Final key is for internal laboratory use only and is used to notify the laboratory supervisor or pathologist that results are ready for internal review. All cultures, direct exams, and other testing results with a Tech Final status qualify for the Culture Review Report. The report allows the supervisor or the person with the appropriate security level to review all qualifying cultures before applying a Final status to them. When you press the Tech Final key, a message displays Tech Final, the date, and (tech code), and the report status is updated. The report status for the battery appears in Microbiology Inquiry as Preliminary and in Laboratory Inquiry and on patient reports as Pending until it is updated to Final. On any particular keyboard the Tech Final key, Final key, or both may be functional. The Tech Final and Final keys are controlled by keyboard definitions in Microbiology Maintenance. For more information, see the Microbiology Administrator’s Guide. If you have the proper security level, you can use two methods to apply a Final result to cultures if the Tech Final key is used. Do either of the following: • Use Microbiology Tech Final Release to release batches of cultures and update the Tech Final status to Final. • Use a key defined on the keyboard to apply a Final status to qualifying cultures individually. Related Topics Assigning a Tech Final Status to a Battery on page 174 About the Final Key You can use the Final key to apply a Final status to a battery if all tests within the battery have results. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 24 Chapter 2: Conventions for Microbiology Applications When you press the Final key, a message displays Final, mmddyy, and the tech code, and the report status is updated. The report status appears as Final in Inquiry, Microbiology Inquiry, and on patient reports. When you apply a Final status to a culture battery, the system compares the results of the direct exam (if ordered) to the culture results according to site-specified data in the Quality Assurance definition in Microbiology Maintenance. Sunquest Laboratory validates that organism groups within a specified quantification range have an organism of the same group identified in the culture result. Example If you specify that all 3+ and 4+ gram negative rods for a direct exam must have a corresponding gram negative organism in the culture result, the system checks for that group in the culture result and alerts you if none were reported. Any results that fail quality assurance checking appear in the QA Warnings Found window. Related Topics Assigning a Final Status to a Battery on page 176 About the No Growth Key Sunquest Laboratory automatically calculates the number of days or, for the first 24 hours, the number of hours of no growth and displays the result during culture entry. An entry of NG1 would display No Growth 1 Day, while NG02 would display No Growth after 2 Hours. The result is calculated based on the specimen receive date, unless the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] is set to Y. In that case, the setup date and time are used. For more information, see Automatic No-Growth Result Entry Site Parameters on page 326. About Colony Count Keys Special culture keyboard keys and a count factor are used to enter colony count results in Microbiology Result Entry. The count factor is a value of 1, 10, or a multiple of 10 by which the colony count entry is multiplied. The following special keys are defined on the culture keyboard for recording colony count observations: • Count Indicator - Indicates that the result that follows is to be applied to the test code CNT (colony count) and that the result entered is to be multiplied by the count factor. • Count Terminator - Indicates the termination of a colony count result and adds the value COL/ML to the numeric result. Example If the following keys are defined on the Culture keyboard: • M = Count Indicator • T = Count Terminator And the count factor is defined as 1,000. Enter the colony count result: M > 90 T to mean >90,000 COL/ML. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Customized Keyboards 25 Selecting a Customized Keyboard Description You can select a customized keyboard that includes result and modifier keys for entering observations on a direct exam, culture, or drug susceptibility. You can also select a customized keyboard to enter results and add tests for other testing. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take On the Direct Exam, Culture, Susceptibility, or Other Tests tab, 1 In the Keyboard box, do one of the following: If … Do this … You want to use the default keyboard. Go to step 2. A default keyboard name appears but you want to use a different keyboard. Type or select another keyboard name from the list. Note If you are already entering susceptibility results, you must file results or place results on hold before selecting a different keyboard. No default keyboard is associated with the battery, and a message appears prompting you to select a keyboard. Type or select a keyboard name from the list. Note You can select a keyboard by using the down arrow key or by typing the first letter of the keyboard name. 2 To activate the selected keyboard on the Direct Exam or Culture Entry tab: • The keyboard is usually active when the tab opens. If the keyboard icon does not show the word “On,” click any result entry cell to activate the keyboard. Shows On when keyboard is active. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 26 Chapter 2: Conventions for Microbiology Applications • To view the result and modifier keys for the selected keyboard, press F8. Use the keyboard map to view predefined keys. 3 To activate the selected keyboard on the Susceptibility tab: • In the Organism list, click an organism. The keyboard icon shows the word “On” indicating the keyboard is active and the cursor appears in an empty cell. • To view the result and modifier keys for the selected keyboard, press F8. 4 To activate the selected keyboard on the Other Tests tab: • If the keyboard icon does not show the word “On,” click a blank cell in the Test Code column or any cell in the Result column to activate the keyboard. • To view the result and test keys for the selected keyboard, press F8. 5 To close the keyboard map, press F8. The system returns to the previous window. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Customized Keyboards 27 Related Topics Recording Direct Exam and Culture Observations on page 66 Entering Other Testing Results on page 166 Entering Susceptibility Results on page 141 Entering Codes Using a Customized Keyboard Description Sunquest recommends that you use either the keyboard map or the PC keyboard to select codes defined to a customized keyboard. Alternating between the keyboard map and the PC keyboard when entering codes can cause confusion as to whether Caps Lock is activated. You Need to Know Caps Lock and Shift settings control whether the upper- or lower-case value of a key is recorded when the key is pressed. The Caps Lock setting on the PC keyboard works independently of the Caps Lock setting on the keyboard map. The Caps Lock indicator on your PC keyboard may indicate that Caps Lock is not on, while on the keyboard map, Caps Lock is activated. Steps to Take In Microbiology Result Entry, with Caps Lock off, To enter codes using the PC keyboard 1 Press F8 to display the keyboard map and see the codes assigned to the customized keyboard, if necessary. 2 To enter a lower-case code, press the key for the appropriate code. 3 To enter an upper-case code, do one of the following: • While pressing the Shift key, press the key for the appropriate code. • Press the Caps Lock key. Then, press the key for the appropriate code. Caps Lock remains activated. To enter codes using the keyboard map 1 On the PC keyboard, press F8 to display the keyboard map. On the keyboard map, Caps Lock is automatically activated. 2 To enter a lower-case code, do the following: a Click the Caps Lock key. The Caps Lock key indicates that Caps Lock is off. b Click the key for the appropriate code. After a code is selected, Caps Lock remains off. 3 To enter an upper-case code, click the key for the appropriate code. Entering Free Text and Codes Not Defined on a Customized Keyboard Description You can use a special function key called the Other key to temporarily make the customized keyboard inactive. This allows you to enter and look up codes not defined to keys on the keyboard and to enter free text. For susceptibility entry, you can use the Other key to enter a code defined as a drug code and then enter the susceptibility result. Similarly, you can add tests and results for other testing. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 28 Chapter 2: Conventions for Microbiology Applications Note When you type text comments, do not use any of the following symbols: !, #, -, |, or \. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take On the Direct Exam, Culture Entry, Susceptibility, or Other Tests tab, 1 Select a keyboard. For more information, see Selecting a Customized Keyboard on page 25. 2 On the keyboard, press the Other key. Notice the keyboard icon shows the word “Off” indicating that the customized keyboard is inactive. Shows Off when keyboard is inactive. 3 Do any of the following: To … Do this … Enter a text code. Do one of the following: • Type the code. • To look up a code, click or press F3. The description of the code appears. Type free text. Enter a semicolon followed by up to 140 characters of free text. Enter a combination of codes and free text. 1 Type a code and then press the TAB key. A new line appears for the second result. 2 Press the Other key. 3 Type a semicolon followed by free text. 4 To end entering additional codes, click on another cell or press the TAB key on a blank line. The multiple codes appear on a single line, separated by a hyphen. Modifying Shift, Tech Code, and Lab Location Description You can modify the tech code or work shift information of the technologist entering data in microbiology applications. In some applications, you can change the lab location, as well. This information is used to associate a work shift, lab technician, and lab location with data entered about a microbiology test. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying Shift, Tech Code, and Lab Location 29 The shift and tech code of the technologist appear in the User Profile area near the top of the window in all microbiology data-entry applications. The following example shows the User Profile area in Microbiology Tech Final Release. Click to modify the shift or add tech codes. In Microbiology Result Entry and Microbiology Automatic No-Growth Result Entry, you can view and modify the lab location, as well. In these applications, the lab location also appears under User Profile. You Need to Know Because Microbiology Inquiry does not enable you to change data, the lab and tech code information is not tracked or displayed. Steps to Take In any microbiology data-entry application, To modify shift information 1 Under User Profile, click Modify. The Modify Shift/Tech window or Modify Shift/ Tech/Lab Location window opens. 2 In the Shift box, enter 1, 2, or 3 for the shift. 3 Click OK. To add or modify tech codes 1 Under User Profile, click Modify. The Modify Shift/Tech window or Modify Shift/ Tech/Lab Location window opens. 2 In the Tech code box, do one of the following: • Type the tech code. • To look up a tech code, click or press F3. 3 Click Add. The selected code and its description appear in the list. Repeat steps 2 and 3 for every tech code you want to add. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 30 Chapter 2: Conventions for Microbiology Applications Note Sunquest Laboratory truncates the tech codes if the number exceeds 14 tech code characters. To view all the tech codes, use terminal-based Accession Number Inquiry (ANIQ). 4 Click OK. To remove tech codes 1 Under User Profile, click Modify. The Modify Shift/Tech window or Modify Shift/ Tech/Lab Location window opens. 2 In the list of codes and descriptions, click the tech code. 3 Click Remove. Repeat steps 2 and 3 for every tech code you want to remove. Note You cannot remove the tech code of the technologist who logged on to Sunquest Laboratory. 4 Click OK. To modify the lab location 1 Under User Profile, click Modify. The Modify Shift/Tech/Lab Location window opens. 2 In the Lab location box, do one of the following: • Type the lab location code. • To look up a lab location code, click or press F3. 3 Click OK. Printing Workcards and Worklabels Depending on your system’s settings, workcards (defined in MMA 6) or worklabels (defined in MA 22:6) automatically print at the time that the order is entered, at the time that the specimen is received into the system, or at the time that the setup date and time are entered. In a multi-facility environment, different HIDs can have different automatic printing settings. For more information about Microbiology printing settings, see the Microbiology Administrator’s Guide. For more information, see... Printing at Order or Receive Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Printing at Setup Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Using Two Printers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Using Reprinting Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Printing Workcards and Worklabels 31 Printing at Order or Receive Time If your system is set up to print workcards or worklabels at order or receive time, automatic printing takes place when the Specimen Description (SDES) and/or Special Request (SREQ) result is manually or automatically entered in the following functions: • Windows-based Order Entry when processing routine orders, processing or updating rapid orders, processing standing orders, and modifying requisition entry account numbers • Requisition Entry (RE) and related functions • Order Entry Review (OER) • Collection Verification by Batch (CLV) and related functions • Order Receipt/Modification (ORM) for sites that use Specimen Management Routing and Tracking (SMART) • Rapid Receipt Mode (RRM) in ORM • Reference Lab Inbound Order Processing (RIB) Printing at Setup Time If your system is configured to print workcards or worklabels at the time that the culture’s setup time is entered, automatic printing occurs when you enter the setup date and time in Microbiology Setup Entry or when the system automatically saves the setup date and time to the database. For more information about automatically entering the setup time, see About Alternatives for Entering the Setup Date and Time on page 35. Using Two Printers The microbiology area of your laboratory can be set up to use two printers. These two printers—a microbiology workcard printer and a microbiology setup printer—are defined in Laboratory Location Codes (MA 6:6). They can be located in different parts of the laboratory. If your microbiology area is set up with two printers, another maintenance setting determines: • Which batteries by HID are defined to print at order or receive time on the microbiology workcard printer. • Which batteries by HID are defined to print at setup time on the microbiology setup printer. For more information, see About Printing in Microbiology Setup Entry on page 36. Using Reprinting Options When a workcard or worklabel has already printed, the system recognizes this and reprints it only if you modify the SDES or SREQ. However, you can reprint a workcard or worklabel without changing the SDES or SREQ by using the Reprint button that appears in the Order Entry window, the Microbiology Setup Entry Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 32 Chapter 2: Conventions for Microbiology Applications window, and the Rapid Orders window. In the terminal-based functions RE, REI, REM, CVIS, and CLVS, you can reprint a workcard or worklabel by entering the command L-[accession number]. Note that a workcard or worklabel cannot be reprinted for an accession number that has been credited in Microbiology. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview You use Microbiology Setup Entry to enter the date and time that a specimen is inoculated onto a growth medium. This section includes the following topics Getting to Know Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Deciding Between Quick Mode and Single Specimen Mode . . . . . . . . . . . . . . . . . . 37 Starting Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Entering the Setup Date and Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Reprinting in Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Getting to Know Microbiology Setup Entry Technologists use Microbiology Setup Entry to enter the setup date and time for a specimen. The setup date and time indicate the moment when the culture was or will be inoculated onto a plate or other growth medium and placed in an incubator. This may be hours or even days after the laboratory received it. Knowing exactly how long a culture has been growing can greatly increase the accuracy of results. After you enter the setup date and time, this information appears on: • • • • • Microbiology application windows Internal, cumulative, interim, autosend, and requisition-based reports The Setup Time report in Microbiology Reports (MCR) Printed workcards or worklabels (depending on the setup of your system) The Windows-based Inquiry results window Chapter 3 Entering a Setup Time 34 Chapter 3: Entering a Setup Time The following illustration shows the setup date and time as they appear on a Windows-based Inquiry results window. Setup date and time in the Inquiry results window For more information, see … About the Reasons for Using Microbiology Setup Entry. . . . . . . . . . . . . . . . . . . . . . . 34 About Alternatives for Entering the Setup Date and Time . . . . . . . . . . . . . . . . . . . . . 35 About Settings That Affect Access and Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 About Printing in Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 About the Reasons for Using Microbiology Setup Entry Here are some reasons to enter the setup date and time for a specimen: • No-growth results from Microbiology Automatic No-Growth Results Entry are more accurate when they are based on the setup date and time rather than on the receive date. • The no-growth results can appear in hours for the first 23 hours after setup date and time have been entered into the system. For more information, see About Basing the No-Growth Update on the Receive or Setup Time on page 195. • When performing the automatic no-growth update, you can filter the worksheets by restrictions based on the setup date and time. For more information, see About Filtering the Cultures on a Worksheet on page 196. • When you know the setup date and time, you can calculate how long incubation has been in process and anticipate the availability of results. • Cultures can be read with greater accuracy, because you can determine the actual length of time that the culture has been incubating or in progress. • Knowing the setup date and time helps managers identify and address problems with prolonged transports and processing delays after specimen receipt. Because of these reasons, Microbiology Setup Entry is especially valuable for: • Sites with multiple hospital and facility IDs (HIDs) that send specimens to a centralized laboratory, where a specimen may be delayed before it is processed or plated. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Setup Entry 35 • Sites that have multiple offsite outpatient clinics or satellite labs that collect specimens and enter the receive dates and times before sending them to the central lab. • Sites that have blood culture instruments that dynamically upload the setup date and time to Sunquest Laboratory. • Sites that need to comply with regulatory guidelines that mandate documentation of the date and time that a specimen was processed. About Alternatives for Entering the Setup Date and Time The availability of the following alternatives depends on your system settings. Using Microbiology Setup Entry for All Specimens A setup date and time can be entered for all specimens at sites where the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] is set to Y. You can do this in the Microbiology Setup Entry window or in one of the other ways listed in Entering the Setup Time in Other Functions and Applications on page 35. For more information about the site parameter [Enable Setup Date/Time (Y/ <N>)\MST Display Hang 1-999], see About Settings That Affect Access and Use on page 36. Using Microbiology Setup Entry for Only Selected Specimens Your system can be configured by HID and battery to automatically use the receive date and time as the setup date and time. This allows you to bypass the Microbiology Setup Entry window for any specimen that has a receive date and time that are acceptable for use as the setup date and time. The system does not accept a future receive date and time as the setup date and time. For specimens that require the actual setup date and time, you can enter that information in the Microbiology Setup Entry window or in one of the other ways listed in the next section. Entering the Setup Time in Other Functions and Applications In addition to being entered through the Microbiology Setup Entry window, the setup date and time for batch or single orders can be: • Entered or modified by a technologist during the resulting process in Microbiology Result Entry. • Uploaded as results from a blood culture instrument interface. This uploaded setup date and time do not override a setup date and time that already exist in the system. When a setup date and time have been uploaded from a blood culture instrument interface, and all of the following situations are true: • your site associates multiple batteries with an accession number, • an automated blood culture instrument uploads the setup date and time, and • there is no existing setup time in any of the batteries on this accession number, Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 36 Chapter 3: Entering a Setup Time then all batteries are given the same setup date and time as the first battery uploaded by the blood culture instrument interface. If necessary, you can change the setup date and time for each battery in either Microbiology Result Entry or Microbiology Setup Entry. For more information, see the Microbiology Instrument Interface Administrator’s Guide. About Settings That Affect Access and Use The Microbiology Setup Entry application appears in the Sunquest Gateway only if your password has access to Microbiology Setup Entry associated with it. After you have opened Microbiology Setup Entry, you can enter a setup date and time only for batteries at HIDs that have the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] set to Y. Note that this site parameter is set separately for each HID, so one site can choose to enter the setup date and time for microbiology batteries while another site chooses not to do so. After the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] is set to Y, a hang time must be entered. The hang time determines the number of seconds that must elapse before the system automatically saves the current date and time as the setup date and time when Microbiology Setup Entry is used in quick mode. The typical setting is five seconds. For more information, see Deciding Between Quick Mode and Single Specimen Mode on page 37. Microbiology Maintenance option MMA 21 determines if your system automatically uses the receive date and time for the setup time result for specified batteries. For more information, see Using Microbiology Setup Entry for Only Selected Specimens on page 35. The site parameter [Number of hours to allow for future setup time (<0>)] determines if you are able to enter a setup date and time in the future. For an overview of all Microbiology Setup Entry settings, see Appendix A, Settings for Microbiology Applications on page 301. About Printing in Microbiology Setup Entry If your system is set up to do so, in Microbiology Setup Entry, you can automatically print a workcard or worklabel on a microbiology setup printer after entry of the setup date and time. If your system uses such a printer, you should be aware that: • A setup printer must be defined in MA 6. • A battery must be defined to print at setup time in MMA 21. • If you want the setup date and time to appear on the printed worklabel, you must define this in MA 22. (This feature doesn’t apply to workcards created in MMA 6.) At any time, you can reprint one or more workcards or worklabels in Microbiology Setup Entry by clicking the Reprint button at the bottom of the window. For instructions, see Reprinting in Microbiology Setup Entry on page 44. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Deciding Between Quick Mode and Single Specimen Mode 37 Deciding Between Quick Mode and Single Specimen Mode In the Microbiology Setup Entry window, you can enter the setup date and time for a specimen in either quick mode or single specimen mode. The following table lists the differences between these two modes of data entry. Note In both quick mode and single specimen mode, you can enter the accession number or container ID of a specimen that already has a setup date and time in the system and then modify that existing information. Use this mode … When … Quick mode (default selection) • You have a specimen for which the current date and time are close enough to the setup date and time to be used in their place. • You do not want to modify the specimen description (SDES) or special request (SREQ) result. Note Using quick mode saves time. You simply type or scan an accession number or container ID. After a pre-set hang time (typically five seconds), the system automatically saves the current date and time as the setup date and time. Single specimen mode • You have a specimen for which processing may be delayed after receipt into the microbiology laboratory, and the current system date and time are not acceptable for use as the setup date and time. • You want to add a date and time in the future. • You want to change the default setup date or time (that is, the system-supplied current date and time). • You want to add or modify the specimen’s Specimen Description (SDES) and/or Special Request (SREQ) result. Note After making your changes, you must click Save when using single specimen mode. Starting Microbiology Setup Entry Description You can use this procedure to start Microbiology Setup Entry if you have the proper security level, along with access to at least one HID that has the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1999] set to Y. For more information, see Setting Security for Microbiology Setup Entry on page 302. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Logging On to Sunquest Laboratory on page 22 of the Laboratory for Windows User’s Guide. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 38 Chapter 3: Entering a Setup Time 2 In the Sunquest Gateway window, on the All tab or on the Microbiology tab, double-click Microbiology Setup Entry. The Microbiology Setup Entry window opens. Your tech code and shift appear in the User Profile header near the top. If you want to change these items, see Modifying Shift, Tech Code, and Lab Location on page 28. Note Microbiology Setup Entry does not appear in the Sunquest Gateway window if your password security does not include access to the application. Entering the Setup Date and Time Microbiology Setup Entry provides two data-entry modes—quick mode and single specimen mode. For a summary of the differences between these modes, see Deciding Between Quick Mode and Single Specimen Mode on page 37. For more information, see … Entering the Setup Date and Time in Quick Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Entering the Setup Date and Time in Single Specimen Mode . . . . . . . . . . . . . . . . . . 40 Modifying an Existing Setup Date and Time. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Entering the Setup Date and Time in Quick Mode Description The following illustration shows how to enter an accession number or container ID in the Microbiology Setup Entry window. If using SMART, click Container ID if it is not the default. Type or scan accession number or container ID. Search for the value you typed or scanned. Load the previous accession number or container ID. In quick mode, the system automatically saves the current date and time as the setup date and time after a pre-set hang time has elapsed. For more information, see About Settings That Affect Access and Use on page 36 and Deciding Between Quick Mode and Single Specimen Mode on page 37. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering the Setup Date and Time 39 The following illustration shows the Display tab, which appears after you enter an accession number or container ID. Note that the setup date and time, as well as the SDES and SREQ, appear in read-only format. You Need to Know If your site does not use Specimen Management Routing and Tracking (SMART), the only available Lookup value is Accession Number. If your site uses SMART, the Lookup list also includes container ID. Before You Begin Make sure that all the specimens you want to update already have a receive date and time entered in the system. Steps to Take In the Microbiology Setup Entry window, 1 Leave the data-entry selection at Quick mode. 2 In the Value box, type or scan the Microbiology battery accession number or container ID that you want to update with the setup date and time. 3 Click Search. • If multiple batteries are associated with your entry, all of them appear in the Order Code Selection list on the Search tab. Either double-click the battery you want, or single-click it and then click Select. The Display tab appears. • If your entry has only one battery, the Display tab appears immediately after you click Search. It contains the following information about the accession number or container ID: • In the upper section of the window: Read-only patient demographic data and specimen information, including the SDES and/or SREQ (if they exist in the system). Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 40 Chapter 3: Entering a Setup Time • In the Setup date and Setup time boxes: The read-only current date and time (indicated by asterisks, as shown below) or, if the battery already has a setup date and time, that setup date and time in editable format. 4 Wait for the system to automatically save the current date and time after a pre-set hang time (typically five seconds) has elapsed. The cleared Search tab appears with focus in the Value box. Note that automatic saving occurs only when a specimen has no previously entered setup date and time. For more information about the hang time, see About Settings That Affect Access and Use on page 36. 5 To modify a setup date and time that was previously entered in the system, see Modifying an Existing Setup Date and Time on page 43. 6 To continue your work session, either: • Type or scan another accession number or container ID. • Click Previous to re-enter the accession number or container ID that you just updated. If that accession number or container ID has multiple associated batteries, the setup date and time appear beside the battery that you just updated in the Order Code Select list. Related Topics Entering the Setup Date and Time in Single Specimen Mode on page 40 Modifying an Existing Setup Date and Time on page 43 Entering the Setup Date and Time in Single Specimen Mode Description The following illustration shows how to enter an accession number or container ID in the Microbiology Setup Entry window. If using SMART, click Container ID if it is not the default. Type or scan accession number or container ID. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Search for the value you typed or scanned. Load the previous accession number or container ID. Microbiology User’s Guide Sunquest Laboratory Entering the Setup Date and Time 41 In single specimen mode, you can modify the default setup date and time and change the SDES and/or SREQ definition. For more information, see Deciding Between Quick Mode and Single Specimen Mode on page 37. The following illustration shows the Display tab, which appears after you enter an accession number or container ID. Note that the setup date and setup time, as well as the SDES and SREQ, appear in editable format. You Need to Know If your site does not use Specimen Management Routing and Tracking (SMART), the only available Lookup value is Accession number. If your site uses SMART, the Lookup list also includes container ID. Before You Begin Make sure that all the specimens you want to update already have a receive time entered in the system. Steps to Take In the Microbiology Setup Entry window, 1 Click Single specimen mode. 2 In the Value box, type or scan the Microbiology battery accession number or container ID that you want to update with the setup date and time. 3 Click Search. • If multiple batteries are associated with your entry, all of them appear in the Order Code Selection list on the Search tab. Either double-click the battery you want, or single-click it and then click Select. The Display tab appears. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 42 Chapter 3: Entering a Setup Time • If your entry has only one battery, the Display tab appears immediately after you click Search. It contains the following information about the accession number or container ID: • In the upper section of the window: Patient demographic data and specimen information, including the editable SDES and/or SREQ (if they exist in the system). • In the Setup date and Setup time boxes: The current date and time (indicated by asterisks, as shown below) or, if the battery already has a setup date and time, that setup date and time in editable format. Note If the battery has a receive date and time in the future, no setup date or time appears, the Setup date and Setup time boxes are disabled, and a message appears, indicating the setup date or time is prior to the receive time. 4 Perform one or more of the following steps. To … Do this … Use the current time as the Click Save. The cleared Search tab appears with focus setup date and time and accept in the Value box. To continue your work session, go to the existing SDES and/or SREQ step 5. Change the setup date and time Type your changes or click to display a calendar that enables you to select a different date. Note that: • The setup date and time that you enter must be later than both the collect date and time and the receive date and time. • If your site permits the entry of a setup date or time in the future, the future time must be within the number of hours from the current system time specified by site parameter [Number of hours to allow for future setup time (<0>)]. For more information, see, Microbiology Setup Entry Site Parameters on page 306. • When making a deletion, you must delete both the setup date and time. • The setup date and time can be modified independently of each other. To change the SDES and/or SREQ, go to the next step in this table. To proceed without making more changes, click Save. The system displays the cleared Search tab with focus in the Value box. To continue your work session, go to step 5. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering the Setup Date and Time 43 To … Do this … Change the SDES and/or SREQ Do one or more of the following and then click Save: • Type your changes to the SDES or SREQ, or click to select from a list of available values. • To enter multiple text codes, click the SDES or SREQ, and press the TAB key. Type a code or • To enter free text alone or with a text code, type a semicolon followed by your text. • To make the system show multiple text codes on the same line on Inquiry displays and reports, select the Group check box to the left of the last code that you want to appear on the same line. For example, if you enter four codes and select the Group check box for the third one, the translations of the first three codes will appear on the same line on displays and reports, while the fourth code will appear on a separate line. click to select from a list of available values. To continue your work session, go to step 5. 5 To continue your work session, either: • Type or scan a new accession number or container ID and repeat steps 3 and 4. • Click Previous to re-enter the accession number or container ID that you just updated, and then repeat steps 3 and . If the accession number or container ID has multiple associated batteries, the setup date and time appear beside the battery that you just updated in the Order Code Select list. Related Topics Entering the Setup Date and Time in Quick Mode on page 38 Modifying an Existing Setup Date and Time on page 43 Modifying an Existing Setup Date and Time Description In both quick mode and single specimen mode, you can enter an accession number or container ID that already has a setup date and time in the system and make modifications to that setup date and time. Steps to Take In the Microbiology Setup Entry window, 1 In the Value box, type or scan the Microbiology battery accession number or container ID for which you want to modify the setup date and time: • If multiple batteries are associated with your entry, all of them appear in the Order Code Selection list. • To select a battery, either double-click it or single-click it and then click Select. 2 Click Search. The Display tab appears with detailed information about the accession number or container ID. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 44 Chapter 3: Entering a Setup Time 3 In the Setup date and/or Setup time box, type your changes or click to display a calendar that enables you to select a different date. Note that: • The setup date and time that you enter must be later than both the collect date and time and the receive date and time. • If your site permits the entry of a setup date or time in the future, the future time must be within the number of hours from the current system time specified by site parameter [Number of hours to allow for future setup time (<0>)]. For more information, see, Microbiology Setup Entry Site Parameters on page 306. • In order to save, both the setup date and time must be present. • When making a deletion, you must delete both the setup date and time. • You can modify the setup date and time independently of each other. 4 Click Save. Related Topics Entering the Setup Date and Time in Quick Mode on page 38 Entering the Setup Date and Time in Single Specimen Mode on page 40 Reprinting in Microbiology Setup Entry Description At any time, you can reprint one or more workcards or worklabels in Microbiology Setup Entry by clicking the Reprint button at the bottom of the window. Depending on the setup of your system, printing occurs on the microbiology setup printer or the microbiology workcard printer. For more information, see Printing Workcards and Worklabels on page 30. Steps to Take In the Microbiology Setup Entry window, 1 Click the Reprint button. • If the accession number that you are updating has only one battery, the workcards or worklabels print on either the microbiology setup printer or the microbiology workcard printer. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reprinting in Microbiology Setup Entry 45 • If the accession number that you are updating has multiple batteries, the following window appears. 2 If the Reprint Labels window appears, do one of the following: • Click one or more batteries in the Order codes list. • Click Select All to select all the batteries. • Click Deselect All to deselect all the batteries, then select one or more batteries by using one of the above procedures. 3 In the Micro Workcard Printer box, type the name or number of the printer to which you want to print. 4 Click Print. Depending on the setup of your system, the workcards or worklabels print on either the microbiology setup printer or the microbiology workcard printer, or the printer you selected in step 3. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 46 Chapter 3: Entering a Setup Time UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview In Microbiology Result Entry, you can record observations for direct exam and culture batteries. This section includes the following topics Getting to Know Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Starting Microbiology Result Entry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Searching for a Microbiology Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Using Worksheets in Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Recording Direct Exam and Culture Observations . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Viewing Recorded Information About a Culture Specimen . . . . . . . . . . . . . . . . . . . . 72 Setting a Print Order for Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Entering Comments Using Composed Text. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Placing Results on Hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Releasing Direct Exam or Culture Results from Hold . . . . . . . . . . . . . . . . . . . . . . . . 78 Hiding Direct Exam or Culture Results on Patient Reports . . . . . . . . . . . . . . . . . . . . 80 Recording Online Workup Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Entering Extra Workload for Nonpaperless Orders . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Recording Biotype Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Clearing Data in Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Selecting Another Microbiology Order. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Viewing a Summary of Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Saving Microbiology Result Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Modifying the Setup Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Modifying Specimen Description and Special Request . . . . . . . . . . . . . . . . . . . . . . . 99 Entering Bill Only Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Modifying Direct Exam and Culture Observations. . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Viewing Laboratory and Microbiology Results in Inquiry . . . . . . . . . . . . . . . . . . . . . . 105 Printing a Patient Cumulative Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Chapter 4 Entering Direct Exam and Culture Results 48 Chapter 4: Entering Direct Exam and Culture Results This section includes the following topics Working with Results Requiring Clinical Validation. . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Using Accession Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Responding to QA Failures for Direct Exams and Cultures . . . . . . . . . . . . . . . . . . . . 115 Getting to Know Microbiology Result Entry Microbiology Result Entry combines multiple result entry functions into one convenient application. You can complete several tasks during the same data entry session, such as record observations, enter workup data, review previous results, and access online and biotype data, and, when included, enter results to tests defined in Other Testing maintenance. For information about resulting other testing in Microbiology Result Entry, see Chapter 7, Entering Results for Other Testing. For more information, see … About Direct Exam and Culture Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 About Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 About the Patient and Specimen Headers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 About Microbiology Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 About Other Applications Affecting Microbiology Result Entry . . . . . . . . . . . . . . . . . . 52 About Paperless and Nonpaperless Microbiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 About the Paperless Microbiology Audit Trail Report . . . . . . . . . . . . . . . . . . . . . . . . . 53 About Entering Workload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 About Rules for Direct Exam and Culture Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 About Direct Exam and Culture Result Entry Laboratory or microbiology technologists use Microbiology Result Entry to record observations of direct exam and culture tests. To record observations efficiently, you use customized keyboards. The customized keyboards contain result and modifier keys for direct exam and culture observations. You can also type free text and composed text comments and save the text with the observation. Any previously filed microbiology data, such as results, results on hold, data from online instruments, or biotype data, is available for you to view. You can also view laboratory and microbiology results associated with the selected patient. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Result Entry 49 There are several ways to flag an observation for additional review. Observations that include results that require immediate investigation can be flagged as significant. Observations that require an internal review can be placed on hold. Microbiology batteries that require an internal review before the results are released can be flagged with a Tech Final status. If your site uses paperless microbiology, you can also record and save workup data, such as the media used to process the specimen and a description of the workup process. Direct exam and culture results appear on patient reports, managerial reports, and in Microbiology Inquiry. Workup results are retained until the patient data is purged from the system. After a culture battery is finalized, the direct exam and culture results are available for review in Microbiology Result Entry until the accession number is deactivated. After the accession number is deactivated, results, including workup data, can be reviewed only by reactivating the accession number in System Utilities. For more information, see Reactivate Old Accession Number (Option 8) on page 30 in the System Operations Administrator’s Guide. Results appear on reports in the same order that the data was entered during the result entry session. You must have the proper security level to enter observations and view patient data. For more information, see the Windows-Based Applications Installation Guide. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 50 Chapter 4: Entering Direct Exam and Culture Results About Microbiology Result Entry The Microbiology Result Entry windows are similar for all the result entry options. The following graphic illustrates the first Microbiology Result Entry window, which contains the lookup options for selecting a microbiology order by specimen, worksheet, or batch. Select specimen, worksheet, or batch mode. View active orders for the patient. Select an option to look up an existing microbiology order. View accession numbers associated with the patient. View patients that match the search criteria. + Indicates composed text, free text, or a non-MO/MG code exists. * Indicates susceptibilities have been filed. The following graphic illustrates the second Microbiology Result Entry window, which contains the patient header and the specimen header; tabs for entering direct exam, culture, and susceptibility results; a tab for viewing and accepting online instrument data, a tab for and viewing or entering biotype data; a tab for modifying UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Result Entry 51 the setup date and time, specimen description (SDES), and special request (SREQ) results; a tab for entering bill-only test codes, and a tab for entering results to nonmicrobiology (“other”) tests. Patient header. Tabs for entering and viewing microbiology results. Click to open PTCUM, Micro Inquiry, or Lab Inquiry. Specimen header. Enter observations into the matrix. About the Patient and Specimen Headers The patient and specimen headers provide a snapshot of demographic and microbiology order data associated with the patient. The patient header shows demographic data for the selected patient. The specimen header shows specimen data for the selected patient. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 52 Chapter 4: Entering Direct Exam and Culture Results In the patient header, you can quickly review patient demographic and event data. The specimen header contains order and specimen information and comments. Site parameters control which comment fields appear in the patient and specimen headers. About Microbiology Batteries Direct exam or culture tests are ordered as part of a battery. A microbiology battery is composed of several tests, such as specimen description (SDES), special request (SREQ), direct exam, culture, and report status. For more information, see Test and Battery Definitions (MA 1) in the Microbiology Administrator’s Guide. The following table describes the tests that are required in a microbiology battery. Test … Description … SDES A code or free text that describes a specimen. SREQ A code or free text that describes any special requests or information about a specimen. Direct exam test A code that describes the direct exam procedure to be used to identify an organism. A direct exam test is not required in a culture battery, but if defined is limited to a single direct exam. Culture test A code (CULT) that identifies the culture test used to identify an organism. A culture test is not required in a direct exam only battery. Report status A code (RPT) that describes the status of the direct exam only or culture battery. It is used to indicate whether the culture is final or preliminary. The status of a battery on a sequence worksheet batch may also indicate whether the battery is credited. Note Any batteries that require additional handling can incur special billing charges. If the microbiology battery includes non-microbiology (“other”) tests, their results appear in inquiry and on reports immediately after those to SREQ. An other testing only battery consists of SDES, SREQ, the other tests placeholder test, and RPT. For more information, see Chapter 5, Setting Up Non-Microbiology Tests for Microbiology Result Entry in the Laboratory for Windows Administrator’s Guide. About Other Applications Affecting Microbiology Result Entry Microbiology Result Entry interacts with other Sunquest Laboratory applications: • Callback manages the telephone calls that your laboratory makes to report test results and problem specimens. For more information about Callback, see the Callback User’s Guide. • Specimen Management, Routing, and Tracking (SMART) prompts users to enter tracking information for a specimen. For more information about SMART, see the Specimen Management, Routing, and Tracking Administrator’s Guide or the Specimen Management, Routing, and Tracking User’s Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Result Entry 53 • Some sites are defined as outreach laboratories and use applications such as Requisition-Based Reports (RBRs), client database, and courier routing. For more information about these outreach applications, see the Client Database and Courier Routing User’s Guide and the Requisition-Based Reports User’s Guide. • Syndrome Index tracks a patient’s test results that are related to a long-term disease. Results entered in Microbiology Result Entry can trigger creation of a syndrome index based on defined rules. For more information, see Chapter 15, Viewing Test Results for a Syndrome, in the Laboratory for Windows User’s Guide. • Rules may perform actions when you enter direct exam or culture results. For more information, see About Rules for Direct Exam and Culture Entry on page 55. About Paperless and Nonpaperless Microbiology A facility can choose to enter workup data either online or using paper workcards. Some facilities use a combination of both. Entering workup data online is referred to as paperless microbiology. Entering workup data on workcards is referred to as nonpaperless microbiology. Sites using paperless microbiology can access an online workcard to enter workup data. For more information, see Recording Online Workup Data on page 82. Two site parameters control paperless microbiology: • [Enable microbiology on-line workcard?] activates paperless microbiology. • [Display option for online workcard?] allows access to online workup and workcards. For information on defining workload methods and workload unit codes for paperless microbiology, see Paperless Microbiology Settings on page 316. Paperless workup results are retained in an internal file until patient data is purged from the system. After a culture battery is finaled, the results are available for review within the microbiology keyboard functions until the accession number is deactivated. After that time, microbiology results including workup can be reviewed only by reactivating the accession number in System Utilities if the accession number has not been reassigned. About the Paperless Microbiology Audit Trail Report If paperless microbiology is in use, you can print an Audit Trail report. The Audit Trail report can be printed on a dynamic or scheduled basis so that direct exam, culture, and workup information will be available if the system goes down. This report displays workup data used in the processing of a culture or direct exam battery. If the audit trail printer is defined as a scheduled autosend device, this frees the printer for other reports. A sequence number prints in the upper-right corner of each audit trail entry. It is highly recommended that the printer be a scheduled autosend device so that multiple entries filed for each culture or direct exam are cumulative. A different audit trail printer may be defined for each lab location. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 54 Chapter 4: Entering Direct Exam and Culture Results All microbiology keyboard results filed in Microbiology Result Entry qualify for the audit trail report, including susceptibility comments and composed text for direct exam and culture results. Automatic results filed through Microbiology Automatic No Growth Result Entry do not qualify for the report. If you use a scheduled autosend device to print the Audit Trail report, you can use the Special Report function (SRF) to generate a NOW batch if you anticipate downtime before the next scheduled print time. You can also use the SRF function to print the report after resolving a paper jam or if the printer has been out of paper for a few days. For more information about SRF, see the Laboratory Reports User’s Guide. For more information about the site parameters and maintenance definitions used to generate the Audit Trail report, see Paperless Microbiology Audit Trail Report Settings on page 319. Following is an example of an audit trail report containing culture results, susceptibility results, biotype data, and biochemical workup results. (Print Date: 07/03/2003 Print Time: 11:36) --------------------------------------------------------------------------------TC: 113 (RESP) EVANS, BARBARA *M2619* SDES: SPUT CDT: 07/01/2003 (0945) SREQ: NONE RDT: 07/01/2003 (1014) SDT 07/01/2003 (1035) GS : 1) HIDE CULT: ^1. STAPHYLOCOCCUS AUREUS BIO: *VTK, GPI, 77525064014, 99% API, API20S, 7144553, 98% 2. STAPHYLOCOCCUS EPIDERMIDIS BIO: *API, API20S,5001772, 98% 3. KLEBSIELLA PNEMONIAE BIO: *VTK, GNI, 6004724633, 99% -MIC(ZZ00) AM:64-R CARB: 64-R CEPH: SS GM: SS 4. PROTEUS MIRABILIS BIO: *API, API20E, 30036000, 92% VTK, GNI, 60204000400, 97% -MIC(ZZ01) AM:1-SS CEPH: 2-SS GM: 1-SS TET: 16-R WKP: CNA 2) EMB 1) RPT: PRELIMINARY <WHITE> GPC SMR:GPCC HEM:BETA CAT:POS COA:NEG <LF> GNR OXI:NEG MOT:POS IND:POS ORN:NEG BILLING: MBIL1 About Entering Workload Microbiology workload codes can be added to an order to track extra workload for procedures that are performed outside of the initial setup of the direct exam or culture, such as non-revenue producing tests and confirmatory tests. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Starting Microbiology Result Entry 55 Extra workload is added to a battery in one of two ways: • If your site uses paperless microbiology, you can enter workload data via an online worksheet. For more information, see Recording Online Workup Data on page 82. • If your site uses nonpaperless microbiology, you can specify a workload worksheet when you select an accession number and enter workload after you save your observation. For more information, see Entering Extra Workload for Nonpaperless Orders on page 88. Your system manager defines maintenance and site parameters for workload codes. For more information, see Keyboard Maintenance Settings for Cultures on page 312. About Rules for Direct Exam and Culture Entry Rules can perform the following actions: • • • • • Display informative messages (such as notices of special handling). Append a text code to a culture. Append significant findings flag to a direct exam or culture observation. Automatically apply a Tech Final or Final status to a culture. Generate a call request for a call to be documented in Microbiology Result Entry or Callback. • Create a syndrome index for a patient. If your site uses rules, your system manager assigns them to perform an action when you select an accession number, enter a direct exam or culture observation, apply a Final status to a result, or save a result. Consult your system manager with any questions about the rules in your application or see the Rules Administrator’s Guide. Starting Microbiology Result Entry Description You can use this procedure to start Microbiology Result Entry. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Navigating the Sunquest Gateway in the Laboratory for Windows User’s Guide. 2 In the Sunquest Gateway window, on the Microbiology tab, double-click Microbiology Result Entry. The Microbiology Result Entry window opens. Searching for a Microbiology Order You can search for a microbiology order by specimen, batch, or worksheet. For more information, see … About Selecting a Search Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Searching for an Order by Specimen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 56 Chapter 4: Entering Direct Exam and Culture Results For more information, see … Searching for an Order by Batch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Looking Up a Batch Number in Batch Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Searching for an Order by Direct Exam or Culture Worksheet. . . . . . . . . . . . . . . . . . 59 Searching for an Order by Sequence Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Looking Up a Sequence Worksheet Batch Number . . . . . . . . . . . . . . . . . . . . . . . . . . 61 About Online Workcards and Searching for an Order . . . . . . . . . . . . . . . . . . . . . . . . 62 When you perform a search and then select an accession number or battery, if the site parameter [Disallow entering microbiology results on un-received specimens] is set to Y for the HID of the resulting lab location you are logged on to, the system verifies that specimens have been received before results can be entered. For more information about this site parameter, see Specimen Resulting Site Parameter on page 311. About Selecting a Search Mode You can use any of several different search modes to search for an order. Options include specimen mode, worksheet direct exam mode, worksheet culture mode, sequence worksheet mode, and batch mode. In the Data entry mode section of the first Microbiology Result Entry window, you select the type of search you want to perform. Select the type of search you want to perform. Related Topics Searching for an Order by Specimen on page 56 Searching for an Order by Batch on page 58 Searching for an Order by Direct Exam or Culture Worksheet on page 59 Searching for an Order by Sequence Worksheet on page 60 Searching for an Order by Specimen Description You can use this procedure to search for a microbiology order by specimen. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Searching for a Microbiology Order 57 Steps to Take In the Microbiology Result Entry window, 1 Under Data entry mode, in the Select mode box, select Specimen Mode. The options for a specimen search appear. 2 Under Data search, in the Lookup by box, select a patient or specimen search parameter, such as Accession Number, Patient ID, or Patient Name. For more information, see Searching for Patient Data in Windows-Based Sunquest Laboratory on page 52, in the Laboratory Conventions User’s Guide. 3 In the Value box, do one of the following: • Type a search parameter, such as the first few letters of a patient name, and then click Search. • To apply a filter to the search, click . For more information, see Filtering the Patient Search on page 57 in the Laboratory Conventions User’s Guide. 4 If more than one patient appears in the list, click the patient you want to select. Orders associated with the selected patient appear in the Accession/Battery list. Note The data fields you can view in the patient list are determined by your security level. For example, you cannot view a patient’s date of birth unless your login security enables you to do so. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 58 Chapter 4: Entering Direct Exam and Culture Results 5 In the Accession/Battery list, click an accession number or battery, and then click Select. Data for the selected order appears in the Microbiology Result Entry window on either the Direct Exam or Culture Entry tab. Rules may be assigned to perform an action when an accession number is selected. For more information, see About Rules for Direct Exam and Culture Entry on page 55. Related Topics Recording Direct Exam and Culture Observations on page 66 Searching for an Order by Batch Description You can use this procedure to search for a microbiology order by batch number. Steps to Take In the Microbiology Result Entry window, 1 Under Data entry mode, in the Select mode box, select Batch Mode. The options for a batch search appear. 2 Under Batch selection and results, in the Batch number box, do one of the following: • Type the number of the batch you want to view. • To look up a batch number, click or press F3. For more information, see Looking Up a Batch Number in Batch Mode on page 58. 3 Click Search. All active orders assigned to the selected batch appear in the Batch selection and results list. 4 Either double-click the order that you want to enter observations for, or single click it and then click Select. Information about the selected order appears on either the Direct Exam or Culture Entry tab. Looking Up a Batch Number in Batch Mode Description You can view a list of batches created within the past seven days and select a batch number from the list. Steps to Take In Microbiology Result Entry, 1 Under Batch selection and results, click UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems . The Select Batch window opens. Microbiology User’s Guide Sunquest Laboratory Searching for a Microbiology Order 59 2 In the How many days? box, enter zero to seven to specify the number of days before today’s date from which to search, and then click Search. Lists the number of batteries already released. Enter zero to seven, and then click Search. In the list, click a batch, and then click Select. In the list you can view data, such as batch number, batch creation date and time, batch release start and finish date, and the number of batteries in the batch already released using Microbiology Tech Final Release. 3 To select a batch, click it, and then click Select. In the list you can view data, such as batch number, batch creation date and time, batch release start and finish date, and the number of batteries in the batch already released using Microbiology Tech Final Release. 4 To select a batch, click it, and then click Select. Searching for an Order by Direct Exam or Culture Worksheet Description You can use this procedure to search for a microbiology order by direct exam or culture worksheet. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 60 Chapter 4: Entering Direct Exam and Culture Results Steps to Take In the Microbiology Result Entry window, 1 Under Data entry mode, in the Select mode box, select Worksheet Direct Exam Mode or Worksheet Culture Mode. The Worksheet box and column headings for the result list appear. 2 In the Worksheet box, do one of the following: • Type the code that identifies the worksheet you want to view. • To look up a worksheet code, click or press F3. 3 Click Search. All active orders assigned to the selected worksheet appear in the worksheet list. 4 To enter observations for an order, either double-click the order, or single click it, and then click Select. Information about the selected order appears on either the Direct Exam or Culture Entry tab. Related Topics Recording Direct Exam and Culture Observations on page 66 Searching for an Order by Sequence Worksheet Description You can use this procedure to search for a microbiology order by sequence worksheet. You Need to Know If you do not have the proper security levels for an HID, then the accession numbers associated with that HID do not appear. For more information, see Setting Security for Microbiology Result Entry on page 302. Before You Begin Sequence worksheets must be manually or dynamically built in the MWS (Manual Worksheet) function. For more information, see Chapter 6, Sequence Worksheets in the Laboratory User’s Guide. Steps to Take In the Microbiology Result Entry window, 1 Under Data entry mode, in the Select mode box, select Sequence Worksheet Mode. The Worksheet and Batch boxes and column headings for worksheet results appear. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Searching for a Microbiology Order 61 2 In the Worksheet box, do one of the following: • Type the code that identifies the worksheet you want to view. • To look up a worksheet code, click or press F3. 3 In the Batch box, do one of the following: • Type the number of an active batch on the sequence worksheet you selected, and then click Search. If you enter the number of a batch that is no longer active or has been deleted, the system displays a message indicating that the batch number is not valid. • To look up a batch number, click or press F3. For more information about searching for a batch number, see Looking Up a Sequence Worksheet Batch Number on page 61. All active orders assigned to the batch on the sequence worksheet appear in the worksheet list. Note that if an accession has multiple batteries associated with it, only those assigned to the selected sequence worksheet appear. The first accession is automatically selected. 4 To enter observations for an order, either double-click the order, or single click it, and then click Select. Information about the selected order appears on either the Direct Exam or Culture Entry tab. Related Topics Recording Direct Exam and Culture Observations on page 66 Looking Up a Sequence Worksheet Batch Number Description You can view a list of batches created within the past 365 days for a sequence worksheet batch. You can then select a batch number from the list. Steps to Take In Microbiology Result Entry, 1 Under Worksheet selection and results, next to the Batch box, click . The Select Batch window opens. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 62 Chapter 4: Entering Direct Exam and Culture Results 2 In the How many days? box, enter 0 to 365 to specify the number of days before today’s date from which to search, and then click Search. Only active batch numbers are listed. Enter 0 to 365, and then click Search. In the list, click a batch, and then click Select. The first batch is selected by default. Indicates whether the batch is complete. In the list you can view the batch number, batch creation date and time, and whether the batch is complete. A batch is complete if all the batteries defined to it have been finaled, deleted, or credited. 3 To select a batch, click it, and then click Select. About Online Workcards and Searching for an Order If your site uses paperless microbiology, you can enter workup data for an order using an online workcard. When you select a patient or worksheet and search for an order, the Online workcard check box appears in the Microbiology Result Entry window. Site parameter settings determine whether paperless microbiology is activated and if the Online workcard check box appears. For more information, see Paperless Microbiology Settings on page 316. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Worksheets in Microbiology Result Entry 63 The Online workcard check box is automatically selected. When you select an order and it appears on the Direct Exam or Culture Entry tab, the Workups button is available for entering workup data. If the Online workcard check box does not appear or is not selected when you select an order, the Workups button is not available on the Direct Exam or Culture Entry tab. Select the Online workcard. If you want to enter online workup data for an order, make sure that the Online workcard check box is selected when you select the order. If you do not use online workups for a particular type of test, you can clear the Online workcard check box for the order you are selecting. The Workload worksheet box appears. For more information, see Entering Extra Workload for Nonpaperless Orders on page 88. Related Topics Recording Online Workup Data on page 82 Using Worksheets in Microbiology Result Entry You can use worksheets to select the orders for which you will enter direct exam and culture results. For more information, see … About Worksheets in Result Entry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Entering Results Using a Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 About Worksheets in Result Entry A worksheet is a list of specific tests or batteries ordered for patients. There are three types of worksheets you can use in Result Entry: Culture review, direct exam, and sequence worksheets. For culture review and direct exam worksheets, Sunquest Laboratory searches for orders that are associated with specific tests and automatically assigns the tests to the appropriate worksheet based on laboratory work areas. These worksheets are sorted by accession number, receive date and time, or setup date and time. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 64 Chapter 4: Entering Direct Exam and Culture Results You create sequence worksheets in function Manual Worksheets (MWS). This type of worksheet lists accessions corresponding to the position of specimens in your tray or rack. The system assigns a batch number when the sequence worksheet is created, and to search for an order by sequence worksheet, you enter both the worksheet code and the batch number. The position of accessions on the list can be changed as the worksheet is used. For more information about sequence worksheets, see Chapter 6, Sequence Worksheets, in the Laboratory User’s Guide. You select an order from the worksheet list and enter observations for all tests and batteries on the Direct Exam or Culture Entry tab. After you enter the observation, you can return to the worksheet to select another test. The observations/results appear on patient reports and in Inquiry applications. If the report status is assigned a Final status in worksheet mode, the status appears on the Culture Review report and the Microbiology Audit Trail report. A nightly background job removes accession numbers assigned a Final status from the worksheet. Site parameter settings determine if worksheet mode is available at your site. Your system manager defines maintenance and site parameters for worksheets. For more information, see Worksheet Settings on page 322. You need the proper security level to enter data onto worksheets. For more information, see the Windows-Based Applications Installation Guide. Related Topics Entering Results Using a Worksheet on page 64 Entering Results Using a Worksheet Description If your site uses worksheets for selecting orders, you can use this procedure to select the direct exam or culture order for which you want to enter results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Worksheets in Microbiology Result Entry 65 Steps to Take In the Microbiology Result Entry window, 1 Select an order from the worksheet. For more information, see Searching for an Order by Direct Exam or Culture Worksheet on page 59 or Searching for an Order by Sequence Worksheet on page 60. Select Worksheet Culture Mode, Worksheet Direct Exam Mode, or Sequence Worksheet Mode. Select the worksheet for which you want to enter results. Click Select to display the selected order on the Direct Exam or Culture Entry tab. Select an order from the worksheet list. 2 Enter observations for the order. For more information, see Entering Direct Exam and Culture Observations on page 67. 3 Click Save. The worksheet that included the saved order reappears. 4 Do one of the following: • To continue entering observations, select the next accession number, and then click Select. • To select a different worksheet in Culture or Direct Exam mode, in the Worksheet box, enter another worksheet code. • To select a different sequence worksheet, in the Worksheet box, enter another worksheet code, and then, in the Batch box, enter a batch number. You can also select a different batch on the same worksheet. Related Topics About Worksheets in Result Entry on page 63 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 66 Chapter 4: Entering Direct Exam and Culture Results Recording Direct Exam and Culture Observations You can record the physical characteristics of a microorganism for a direct exam test and organism identification for culture exams. For more information, see … About Direct Exam Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 About Culture Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 About Flagging Significant Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Entering Direct Exam and Culture Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Entering Colony Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 About Direct Exam Entry You use the Direct Exam tab of the Microbiology Result Entry window to enter direct exam observations. The following graphic illustrates the direct exam entry process. Select a keyboard. To view the key assignments on a keyboard map, press F8. Click to record observations or workup data, or add composed text or accession result comments. Indicate if direct exam results are significant, on hold, or suppressed, and enter results. Type a new print order for results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Direct Exam and Culture Observations 67 About Culture Entry You use the Culture Entry tab of the Microbiology Result Entry window to enter culture observations. The following graphic illustrates the culture entry process. See if susceptibility results, susceptibility results on-hold, online, or biotype data exist. Click to delete a selected observation. Select a keyboard. To view the key assignments on a keyboard map, press F8. Type a new print order for results. Enter observations and indicate if they are significant, on hold, or suppressed. Click to view a summary of the culture observations. Click to record workup or observation data, add composed text or accession result comments, or enter colony counts. View direct exam observations entered for the specimen. About Flagging Significant Findings You can specify important results for microbiology direct exams or cultures as significant. Results flagged as significant qualify for the Significant Findings report. This report lists patients sorted by name and the number or location of critical results that require immediate investigation, such as positive blood cultures. For more information about the Significant Findings report, see the Microbiology Reports User’s Guide. Because direct exams or cultures do not have to be finaled to have their results qualify for the report, the Significant Findings report can be used to provide critical result information important for patient care. Entering Direct Exam and Culture Observations Description You can examine a direct exam slide or a culture specimen and record one or more observations. Use this procedure to record both direct exam and culture results. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 68 Chapter 4: Entering Direct Exam and Culture Results The customized keyboards you use to enter observations include result and modifier keys specific to direct exam and culture tests. For more information, see Getting to Know Customized Keyboards on page 20. You can use common keyboard commands to navigate in the application rather than using a mouse. For more information, see Using Common Keyboard Commands on page 16. Note Your system manager can assign an autoanswer code, such as HIDE, to a direct exam or culture test. The translation for the autoanswer code automatically appears on the Direct Exam or Culture Entry tab, such as << Do Not Report >>. You can modify or delete the autoanswer. You Need to Know No-growth results require specific entries to ensure that the system can continue to evaluate the result for no-growth update. Example When manually entering a result for a seven-day-old culture on a fungus worksheet that has the no-growth code NF, you must enter NF7. The next time that accession number is evaluated for update by the Microbiology Automatic NoGrowth Result Entry application, the system recognizes this result as a valid nogrowth code. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. 2 Notice that the default keyboard appears in the Keyboard box. The word “On” indicates that the keyboard is active. Do any of the following: • To select a different keyboard, type or select a keyboard name. For more information, see Selecting a Customized Keyboard on page 25. • To view a map of predefined keys for the selected keyboard, press F8. 3 Under Observations, in the Result cell, the cursor appears in an empty cell. Do any of the following: To … Do this … Enter a code. • Press a key that represents the code you want to enter. For more information, see Getting to Know Customized Keyboards on page 20. Enter codes manually without using a customized keyboard. • Press the Other key and enter text codes. Enter free text comments. • Press the Other key, type a semicolon, and then type up to 140 characters of free text. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Direct Exam and Culture Observations To … Do this … Enter a callback code. • 69 In the same cell as a recorded result, press the Other key, and then enter a callback (CB) code or document callback (CD) code. Note When you append a callback code to a direct exam or culture result on hold, a Callback window opens after the result is released from hold and filed. Enter a no-growth code. • Enter the code as the first observation in the culture results by pressing the key defined as no growth. Note Do not attempt to enter a second observation with no-growth codes containing the letters NG. The system does not allow it. Flag a result as significant. Place a result on hold. • In the SIG column, select the check box. • To remove the significant finding, clear the check box. The result no longer qualifies for the Significant Findings report. • In the HLD column, select the check box. For more information, see Placing Results on Hold on page 77. Rules may be assigned to perform an action when an observation is entered. For more information, see About Rules for Direct Exam and Culture Entry on page 55. If the site parameter [Restrict text codes to match department of test code?] is set to yes, the text code must either match the department of the test code or be specifically defined for microbiology. For more information, see the Site Parameters Administrator’s Guide. 4 To enter another code for the same cell, do the following: a Press the TAB key. A new line appears for the second result. A new line appears for another result. b Enter another result. c When you are finished entering codes, click another cell or press the TAB key on a blank line. The multiple codes appear on a single line, separated by a hyphen. 5 After you enter a direct exam or culture result, you can do the following: • Enter a colony count. For more information, see Entering Colony Count on page 70. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 70 Chapter 4: Entering Direct Exam and Culture Results • Enter composed text. For more information, see Entering and Modifying Composed Text on page 76. • Change the print order. For more information, see Changing the Print Order of Observations on page 74. • Hide a result. For more information, see Hiding Direct Exam or Culture Results on Patient Reports on page 80. 6 To save the result, click Save. For more information, see Saving Microbiology Result Data on page 97. Related Topics Recording Online Workup Data on page 82 Viewing Laboratory and Microbiology Results in Inquiry on page 105 Accepting Online Results on page 127 Assigning a Tech Final Status to a Battery on page 174 Assigning a Final Status to a Battery on page 176 Entering Colony Count Description The test code CNT indicates that a colony count has been requested as part of a culture battery. You can enter colony count observations for the specimen on the Culture Entry tab. Note The colony count code is determined by the site parameter [Replacement code for colony count (CNT)]. If your facility uses a code other than CNT, that code should be included in the battery if colony count data is ordered for a specimen. Special culture keyboard keys and a count factor are used to enter colony count results. The count factor is a value of 1, 10, or a multiple of 10 by which the colony count entry is multiplied. The following special keys are defined on the culture keyboard for recording colony count observations: • Count Indicator—Indicates that the numeric result which follows is multiplied by the count factor. • Count Terminator—Indicates the termination of a colony count result and appends the statement defined in maintenance to the numeric result, for example, COL/ ML. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take On the Culture Entry tab, 1 Click the Colony Count button. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Direct Exam and Culture Observations 71 2 In the Result box, enter colony count results in any of the following formats. Note The following key definitions are used in examples in this procedure. M = Count Indicator T = Count Terminator P = >100,000 , = Other The count factor is defined as 1,000. To enter … Do this … Results predefined to a key. Use the following codes as defined on your Culture keyboard. For more information, see Getting to Know Customized Keyboards on page 20. • >100,000 • Count Terminator key (CLML) For example, type P T to mean >100,000 COL/ML. Numbers not predefined to a key. 1 Press the Count Indicator key. 2 Type one of the following: • A numeric result. • A numeric result preceded by a less than sign (<). • A numeric result preceded by a greater than sign (>). 3 Press the Count Terminator key. For example, type M >90 T to mean >90,000 COL/ML. A result not predefined and not multiplied by a count factor. 1 Press the Other key. 2 Enter a numeric result. For example, type ;512, press the TAB key, and then type T to mean 512 COL/ML. 3 Click Save. Related Topics Recording Direct Exam and Culture Observations on page 66 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 72 Chapter 4: Entering Direct Exam and Culture Results Viewing Recorded Information About a Culture Specimen If you are entering observations for a culture exam, you can view information that has already been entered for the specimen. For more information, see … Viewing Direct Exam Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Viewing Susceptibility, Hold, Online, or Biotype Data. . . . . . . . . . . . . . . . . . . . . . . . . 72 Viewing Direct Exam Observations Description On the Culture Entry tab, you can view direct exam observations that have been entered for a specimen. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, on the Culture Entry tab, • Locate the direct exam observations list in the lower-right corner of the window. This list appears only if direct exam results were entered for the order. Identifies the type of direct exam, as defined in MA 1. + indicates that composed text has been entered for the direct exam. Any of the following information recorded for each direct exam observation appears in the list: • Observation reference number. • Data entered for the observation. • Whether the result is on hold. • Whether composed text has been entered for the exam. • Whether workup results have been entered on the direct exam. Related Topics Viewing a Summary of Results on page 94 Viewing Susceptibility, Hold, Online, or Biotype Data Description On the Culture Entry tab, you can view check boxes to determine whether susceptibility, online, or biotype data exists for an observation and whether an observation has been placed on hold. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Setting a Print Order for Observations 73 To access online results processed by instruments, you must have the proper security level to enter culture observations, delete results, and apply final results to a test. For more information, see the Windows-Based Applications Installation Guide. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, on the Culture Entry tab, 1 Under Observations, locate the S, H, O, and B check boxes. A check mark indicates data is available, such as susceptibility results (S column), susceptibility results on hold (H column), online (O column) and biotype (B column). 2 Do the following: A check mark in the … Means you can view … Do this … S column. Susceptibility results on file. Click the Susceptibility tab. H column. Susceptibility results on hold. O column. Results sent from an instrument. Click the Online tab. B column. Biotype or biochemical data. Click the Biotype tab. Related Topics Viewing a Summary of Results on page 94 Setting a Print Order for Observations You can specify the order in which observations appear on patient reports. For more information, see … About the Print Order of Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Changing the Print Order of Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 74 Chapter 4: Entering Direct Exam and Culture Results About the Print Order of Observations The print order of observations specifies the sequence in which observations appear on patient reports and in Laboratory Inquiry and Microbiology Inquiry. You can reorder the sequence of observations so that the most significant observation appears first. Example If observation 1 is Normal Flora and observation 2 is E COLI, you can change the order in which the observations print, such as 2, 1. By reordering the observations, significant organism results can be viewed first. The new print order appears on external patient reports and on the Previous Culture report, and in Microbiology Inquiry and Laboratory Inquiry. Susceptibility results on the Previous Culture report also appear in the new print order. The new print order is reported to the hospital information system (HIS). Microbiology internal reports continue to show results in the sequence in which they were entered. The new print order does not appear on the following reports: • • • • Culture Review Direct Exam Quality Assurance Nosocomial Audit Trail, when paperless microbiology is activated Site parameter settings determine whether you can change the sequence of observations. For more information, see Print Order Site Parameter on page 320. Related Topics Changing the Print Order of Observations on page 74 Changing the Print Order of Observations Description You can change the sequence of observations so that the most significant observation appears first on patient reports and in Inquiry applications. You Need to Know If you delete a direct exam, culture, or susceptibility result, you must correct the print order. Before You Begin Search for an existing microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering Comments Using Composed Text 75 2 Under Observations, in the # column, note the observation number for the result. Shows an observation number for each result. Type the observation numbers in the new order in which observations will appear on patient reports and in Inquiry applications. 3 In the Print Order box, type the observation numbers in the new order in which observations will appear, such as 4, 3, 1, 2. • To delete the entire print order for the observation, select the print order, and then press the DELETE key. • To delete an individual print order, select the reference number, and then press the DELETE key. 4 To save the new print order, click Save. Entering Comments Using Composed Text You can use composed text to enter comments about a direct exam or culture and save the additional information with the observation. For more information, see … About Composed Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Entering and Modifying Composed Text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 76 Chapter 4: Entering Direct Exam and Culture Results About Composed Text You can include more information about an observation by entering text-comment codes or typing comments. The composed text is saved with the observation and is available in Microbiology Inquiry and on the following reports: • All patient reports including client reports, requisition-based reports (RBRs), and autosends. • Internal reports, such as the Culture Review, Nosocomial, Direct Exam QA, and Epidemiology. • The Paperless Microbiology Audit Trail report for sites that use paperless microbiology. If default composed text is associated with a test code, you can open the composed text box and add to or modify the text. Composed text results do not appear on the Significant Findings report. The text code %FT is translated and appears in Inquiry and on patient interim reports. Site parameters control how composed text appears on patient reports and how many characters you can enter. For more information, see Composed Text Site Parameters on page 310. The following graphic illustrates the text box you use to type additional comments about a result. Shows the line and column number of composed text. Type text or codes. Related Topics Entering and Modifying Composed Text on page 76 Entering and Modifying Composed Text Description You can use composed text to add predefined comment codes or text to an observation and save the additional information. You can also modify composed text and default composed text. Before You Begin Enter or search for a direct exam or culture observation. For more information, see Recording Direct Exam and Culture Observations on page 66. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Placing Results on Hold 77 Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. 2 Click Composed Text. 3 Type your comments or observations using alphanumeric characters, symbols, or predefined text codes. Do any of the following: To … Do this … Translate a text code into text. Press Ctrl+T, type one or more text codes, and then press Ctrl+T. Enter multiple codes on one line. Use a hyphen between each code. Insert a page break. Type .TP or .tp to indicate a new page on a report. Modify text. Enter or delete text or add text codes, as described in this table. 4 When your entries are complete, click Observations to return to entering results. Related Topics About Composed Text on page 76 Entering Composed Text for Susceptibility Results on page 148 Placing Results on Hold Description Results for a direct exam, a colony count, or an organism ID that need a review by a microbiology supervisor can be placed on hold. A result on hold means that the result data exists in a temporary file pending internal review and acceptance. Results on hold can be viewed on the Direct Exam, Culture Entry, and Susceptibility tabs. Results on hold do not appear on reports or in Inquiry. Your security level determines if you can place observations on hold. For more information, see the Windows-Based Applications Installation Guide. If a direct exam, culture, or colony count result has multiple entries, you can place an individual result or all results on hold. Example You enter a result, such as Few GNR, and save the entry. Later another technologist selects the same result, makes another entry, and puts the entry on hold, such as Few E coli. Sunquest Laboratory checks the microorganism group results for the preliminary entry and the entry on hold. Sunquest Laboratory alerts you if the organism groups do not match. Before You Begin Enter an observation. For more information, see Recording Direct Exam and Culture Observations on page 66. Steps to Take On the Direct Exam tab or the Culture Entry tab, 1 Under Observations, in the Result column, select a result. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 78 Chapter 4: Entering Direct Exam and Culture Results 2 In the HLD column, select the check box that corresponds to the result that you want to place on hold. Click the check box in the HLD column to place a result on hold. 3 To save your entries, click Save. Related Topics Releasing Direct Exam or Culture Results from Hold on page 78 Releasing Direct Exam or Culture Results from Hold Description You can release direct exam, colony count, or organism ID results from hold after internal laboratory review. After you release results from hold, the HLD check box is cleared, and the results are considered regular results by Sunquest Laboratory. The results appear on patient reports, internal microbiology reports, and in Microbiology Inquiry and Windows-based and terminal-based Inquiry. You must release direct exam or culture results from hold before you can apply a Final status to the results. To release susceptibility results from hold, see Releasing Susceptibility Results from Hold on page 151. Site parameter settings determine whether correction statements are applied when a filed organism is replaced with an organism on hold. For more information, see Correction Statement Site Parameters on page 310. You need the proper security level to release direct exam or culture results from hold. For more information, see the Windows-Based Applications Installation Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Releasing Direct Exam or Culture Results from Hold 79 Steps to Take On the Direct Exam or Culture Entry tab, 1 Locate the HLD check box for an organism. If the box contains a check mark, then direct exam, culture, or colony count results have been placed on hold. A check mark indicates results have been placed on hold. 2 Do one of the following: • To release an individual result from hold, in the HLD column, clear the check box. • To release all results from hold, click Release. The Release Hold window opens. Click to select all check boxes in the Org # column. A check mark indicates an organism and its associated results are selected for release from hold. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 80 Chapter 4: Entering Direct Exam and Culture Results 3 Do any of the following: To … Do this … Release all culture results from hold. Click All Cultures. Release all direct exam results from hold. Click All Direct Exams. Release all susceptibility results from hold. Click All Susceptibilities. Release all colony count results from hold. Click All Colony Count. Release only selected results from hold. 1 In the Org # column, do the following: • Select the check box if you want to release a result from hold. • Clear the check box if you want to retain a result on hold. 2 Click Selected Only. 4 After results are released, the following events occur: • A message appears that lists each direct exam, culture, or colony count result released from hold. • Results released from hold replace any previously entered or filed results. • On the Direct Exam or Culture tab, in the HLD column, check marks are removed if all results for the organism are released from hold. 5 To save your entries, click Save. Related Topics Assigning a Tech Final Status to a Battery on page 174 Assigning a Final Status to a Battery on page 176 Hiding Direct Exam or Culture Results on Patient Reports Description You can apply a predefined code that hides an individual result for a direct exam or culture test, or you can hide all results for direct exam or culture tests. You can apply the code by selecting a check box or by manually appending the code to the result or results you want to hide. Hidden results do not appear on patient reports or in Microbiology Inquiry, and are not reported to the HIS interface. Note Your security level for Microbiology Inquiry determines whether you can view hidden results. If your security level is defined for MCIQ, you can view hidden results. If your security level is defined for MCI, you cannot view hidden results. For more information about security levels, see the Windows-Based Applications Installation Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Hiding Direct Exam or Culture Results on Patient Reports 81 You can add susceptibility and biotype data to a result even after it has been hidden. If a laboratory supervisor needs to review a hidden result, you can place the hidden result on hold. You can also hide results at order time. For more information, see Result Entry Help. You Need to Know Site parameter settings determine whether you can hide individual results. At most hospital and laboratory facilities, when you hide a result it appears as <<DO NOT REPORT>>. For more information, see Suppressing Results Settings on page 321. Your system manager can define maintenance to suppress results based on the battery. In this case, results for this type of battery are not reported. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take On the Direct Exam or the Culture Entry tab. To hide results • Under Observations, do one of the following: To … Do this … Hide an individual observation. In the row of the observation, select the SUP check box. The predefined code appears in the Result column appended to the result. Hide the direct exam or culture. Select the Suppress test check box. If an individual observation has a check mark in the SUP check box, the system asks whether you want to remove the suppression from the individual observation and apply it to the entire test. Do one of the following: • To hide the direct exam or culture, click Yes. • To hide individual observations, click No. The predefined code appears in the Result column as the last result for the test. To remove the result suppression • Do one of the following: • To remove the suppression from an individual direct exam or culture observation, clear the SUP check box for the observation. • To remove the suppression applied to the direct exam or culture, clear the Suppress test check box. The predefined code is removed from the Result column. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 82 Chapter 4: Entering Direct Exam and Culture Results Recording Online Workup Data Workup data specifies the number and type of media used to process a specimen. You can record comments about the workup under Description. You can enter one or more sets of workup data for each new observation or modify workup data for an existing observation. For more information, see … About Paperless Microbiology and Workup Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 About Workup Data Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Entering Workup Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Viewing Workup Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Modifying Workup Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 About Paperless Microbiology and Workup Data If your site uses paperless microbiology, you can enter workup data that in a nonpaperless environment would be entered on a workcard. For each workup entry, you can enter the culture media, a colony description, a preliminary identification, and the results for biochemical tests performed. Workups can be entered for direct exam batteries that do not include a culture. For culture batteries, workups can be entered prior to reporting any culture observations. Your system manager defines direct exam and culture workup codes and assigns the codes to customized keyboards. Site parameter settings determine if paperless microbiology is active for your site and if workup data is listed by reference number or by media. For more information, see Paperless Microbiology Settings on page 316. When selecting an order, the Online workcard check box must be selected for the Workup button to be available on the Direct Exam or Culture Entry tab. For more information, see About Online Workcards and Searching for an Order on page 62. Related Topics About Workup Data Entry on page 83 Entering Workup Data on page 83 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Online Workup Data 83 About Workup Data Entry You use the Workups button in the Microbiology Result Entry window to enter workup data for direct exams and cultures. The following graphic illustrates the workup data entry process. Enter a name and description of the media used to process the direct exam or culture and an organism ID. Enter a biochemical code, results, and workload. Shows symbols used for previously entered workups. Lists previously entered workup data. Entering Workup Data Description You can enter workup data by using customized keyboards or by manually typing text codes. Maintenance definitions determine the customized keyboards you use for workup data. In the Workup Component matrix, you can move to the Add Wkld cell by typing Shift+2 (@). Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know You can accrue extra workload for non-revenue producing tests and confirmatory testing on the online workcard. If your site uses nonpaperless microbiology, you can add extra workload. For more information, see Entering Extra Workload for Nonpaperless Orders on page 88. A nightly background job accrues the workload units that are then available for workload statistical reports. The system manager defines workload codes and worksheets. The workload codes correspond to the workload categories for the type of culture being performed. The workload codes are associated with the workload type for a specified worksheet. For more information, see Paperless Microbiology Settings on page 316. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 84 Chapter 4: Entering Direct Exam and Culture Results 2 Click Workups. The Workups data entry grid opens. Shows the default keyboard. Enter workup data for a direct exam or culture. Enter a biochemical code, result, and workload. Note Each data field may require a different customized keyboard. When you move to a field, such as Media, the name of the default keyboard appears in the Keyboard box. You cannot select a different keyboard. 3 Under Workup, enter the following data. In this box … Do this … Wkup # Enter a whole number or a decimal number, such as 1 or 1.0. The number you enter identifies the set of workup results. Note When you enter a workup number, verify that the number is entered sequentially. Sunquest Laboratory does not check that workup numbers are entered correctly or that the workup numbers follow a sequential order. Media Do one of the following: • • Description Press a key that represents the media code you want to enter. Press the Other key and do one of the following: • Type codes. • To look up a media code, click . Do one of the following: • Press a key that represents the description you want to enter. • Press the Other key and do one of the following: • Type a semicolon and then type free text to describe the workup. • Type a semicolon and then press F2 to open the Edit Text window. Type free text to describe the workup. • Enter text codes. • To look up a workup code, click UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems . Microbiology User’s Guide Sunquest Laboratory Recording Online Workup Data 85 In this box … Do this … ID Do one of the following: • Press a key that represents the ID you want to enter. • Press the Other key and do one of the following: • Type a semicolon and then type free text to identify the organism. • Enter text codes. • To look up an organism code, click . Note Sunquest Laboratory compares the ID field entry with maintenance definitions to verify that the workup group code is associated with an organism group code or an organism code and a culture battery. 4 Under Workup components, enter the following data. In this box … Do this … Code • If a workup code appears in this box, move to the Result box. • In a blank workup code box, press a key that represents the workup you want to enter. • Press the Other key and do one of the following: • Type one or more workup workload codes. • To look up a workup workload code, click . Note One or more codes may automatically appear based on maintenance definitions. Result Do one of the following: • Press a key that represents the result you want to enter. • Press the Other key and do one of the following: • Type one or more comment codes. • Type a semicolon and then type free text. • To look up a result code, click . Note After you enter a result, the Tot Wkld cell automatically shows workload of 1. Add Wkld Type a number to specify how many additional times the test was performed and then press the TAB key. The number in the Tot Wkld cell is updated. 5 To delete a code, select the code, and then press the DELETE key. 6 Click Add to include the workup data in the Workups summary list. 7 To save the workup data, click Save. Related Topics About Paperless Microbiology and Workup Data on page 82 About Workup Data Entry on page 83 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 86 Chapter 4: Entering Direct Exam and Culture Results Viewing Workup Results Description You can view previously filed workup results, such as the workup number, workup data, date the workup was filed, and the tech codes of the technologists who filed the results. Site parameter settings determine if workup results appear by workup number or by media. For more information, see Paperless Microbiology Settings on page 316. You Need to Know You can view a history of workup data. Sunquest Laboratory maintains a file of workup data that has been saved during two or more data entry sessions. The following table describes the symbols used for workup history. This symbol … Means that the workup data was … * Saved earlier in the day. + Entered during the current data entry session. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. 2 Click Workups. The Workups window opens. Click Modify to revise the selected workup. Click History to view the selected workup. View a summary of workload data or select a workup from the list to view a workup history. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Online Workup Data 87 3 In the Workups summary list, select a workup, and then click History. The Workups History window opens. 4 When you are done viewing the history, click OK. 5 To continue entering direct exam or culture results, click Observations. Related Topics Entering Workup Data on page 83 Modifying Workup Results Description You can modify workup results for a microbiology order, such as the media, description, ID, and biochemical data. Any previously entered workload numbers are tallied and appear in the Tot Wkld column. Before You Begin Search for the microbiology order that includes workup data that you want to modify. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 88 Chapter 4: Entering Direct Exam and Culture Results 2 Click Workups. The Workups window opens. 3 In the Workups summary list, select the workup that you want to modify, and then click Modify. The workup data appears in the matrix. 4 Do one of the following: • Modify the media, description, ID, or biochemical results. • To delete a code, select the code, and then press the DELETE key. 5 To add the workup to the Workups summary list, click Add. The modified workup appears in the list. 6 To save your entries, click Save. Related Topics Entering Workup Data on page 83 Entering Extra Workload for Nonpaperless Orders Description If you are working in a nonpaperless microbiology environment, use this procedure to enter extra workload for an order. For information about entering extra workload in a paperless microbiology environment, see Entering Workup Data on page 83. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Under Accession/Battery list, locate the Workload worksheet box. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Biotype Data 89 Note If you do not see the Workload worksheet box under the Accession/Battery list, clear the Online workcard check box to indicate that you are entering nonpaperless results. The Workload worksheet box appears. 2 Do one of the following: • Type the code that identifies the worksheet to which you want to apply workload. • To look up a workload worksheet code, click or press F3. 3 Click the Direct Exam or Culture Entry tab. 4 Enter your observations for the selected order. 5 Click Save. The Enter Non-Paperless workload window opens. 6 In the Workload Types box, do one of the following: • Type the code that identifies the type of workload you want to add. • To look up a workload type code, click or press F3. 7 In the Value box, type the number of times the test was performed. 8 Click Save. Recording Biotype Data You can record biotype data to identify an organism for a culture. Biotype results can be received from an instrument that transmits data to Sunquest Laboratory or can be entered manually from a non-device-type biotype. Biotype data recorded in Microbiology Result Entry appears on the Audit Trail report and the Culture Review report. On Epidemiology reports, you have the option to print biotype data or to filter biotype data based on biotype method or biotype number. Biotype data does not print on patient reports. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 90 Chapter 4: Entering Direct Exam and Culture Results You can enter the following biotype data: • Method code. The instrument or non-device-type method used for organism identification. • Card type. A card or panel containing an assortment of biochemicals for organism identification purposes. • Biotype number. A number sent from an instrument interface or derived manually from an ID strip that represents reaction results of different biochemicals and is used to identify an organism. • Percent probability. The accuracy of the identification as determined by the vendor of the instrument. If biotype data has been filed for a selected order, on the Culture Entry tab, a check mark appears in the B column. You can view biotype data on the Biotype tab. The system administrator defines Laboratory Maintenance (MA) for method codes and Microbiology Maintenance (MMA) for non-device-type biotypes (API strips). In Instrument Maintenance (IXM) and Microbiology Instrument Maintenance (MIM), the card definition is defined for the device biotype, such as those sent from the Vitek. For more information, see Keyboard Maintenance Settings for Cultures on page 312. For more information, see … Entering and Modifying Biotype Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Viewing Biotype Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Deleting Biotype Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Entering and Modifying Biotype Data Description You can enter or modify biotype data for a culture observation. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Biotype tab. The Biotype matrix appears. 2 In the Org # box, type the number of the organism observation for which you want to enter biotype data. The description of the organism entered on the Culture Entry tab appears in the Organism Description column. 3 In the Method box, enter a code that represents the instrument or non-device-type method used to identify the organism. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Recording Biotype Data 91 4 In the Card box, do one of the following: 5 6 7 8 • Type a card or panel type code. • To look up a card or panel type code, click or press F3. In the Organism box, do one of the following: • Type an organism code. • To look up an organism code, click or press F3. In the Biotype Number box, enter the number sent from an instrument interface or from an ID strip that represents reaction results of different biochemicals. To indicate the percent probability that the organism result is accurate, in the Percent Probability box, enter a number from 0% to 100%. To indicate whether the biotype is the primary biotype used to identify the organism, select or clear the Primary check box. If multiple biotypes exist for an observation, only one may be designated as the primary biotype. Note To delete a biotype, select the check box to the left of the organism record, and then click Delete. 9 To save your biotype entries, click Save. Viewing Biotype Data Description You can view a summary of biotype data for a culture observation. Biotype data is either entered manually or uploaded from a microbiology instrument. If biotype data is available for an organism ID, on the Culture Entry tab, in the B column, a check mark appears. You can view the data on the Biotype tab. Any previously entered biotype data is retained when an organism ID is accepted from a microbiology instrument. The biotype data received from a microbiology instrument appears as the primary organism, and the previously entered biotype appears underneath. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Biotype tab. The Biotype window opens. 2 Review the summary of biotype data. 3 To return to the culture observation, click the Culture Entry tab. Related Topics Entering and Modifying Biotype Data on page 90 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 92 Chapter 4: Entering Direct Exam and Culture Results Deleting Biotype Data on page 92 Deleting Biotype Data Description You can delete biotype data that was entered manually or uploaded from online microbiology instruments. Steps to Take In Microbiology Result Entry, 1 On the Culture tab, locate the B check box for an organism. A check mark in the B column indicates biotype data is available for the organism. 2 Click the Biotype tab. Biotype data appears. 3 Click or use the space bar to select the check box of the biotype data that you want to delete. Click or use the space bar to select the check box. Click to delete the selected biotype data. 4 Click Delete. Clearing Data in Microbiology Result Entry Description You can clear any new unsaved entries made during data entry and return to the previously saved data. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Another Microbiology Order 93 You Need to Know The information cleared depends on which tab is selected and which type of data you are entering. On this tab … If you click Clear … Direct Exam While entering: Culture Entry • Observations, direct exam observations, direct exam workups and composed text are cleared. • Workups, only direct exam workups are cleared. • Composed text, only direct exam composed text is cleared. While entering: • Observations, culture observations, culture workups, culture composed text, sensitivities and bio-type data are cleared. • Workups, only culture workups are cleared. • Composed text, only culture composed text is cleared. • Colony counts, only colony counts are cleared. Susceptibility Susceptibility results are cleared. Biotype Biotype data is cleared. Misc. Updates Setup date and time, specimen description (SDES), and special request (SREQ) results are cleared. Billing Bill-only test codes are cleared. If you have applied or removed a final status, note the following: • If you clear data after applying a final to a a battery, the final date is cleared regardless of which tab you are on. • If you clear data after removing a final, the final date is re-applied only if all the necessary tests are resulted. The Clear button is not available on the Online tab. Steps to Take In the Microbiology Result Entry window, • Click Clear. Unsaved entries are cleared from the tab. Selecting Another Microbiology Order Description You can cancel your data entry session in Microbiology Result Entry and select another worksheet, batch, or specimen. Any unsaved entries made during the data entry session are removed. Steps to Take In the Microbiology Result Entry window, 1 Select a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Information about the order appears in the second Microbiology Result Entry window. 2 Click Cancel. The first Microbiology Result Entry window opens again. You can select another worksheet, batch, or specimen. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 94 Chapter 4: Entering Direct Exam and Culture Results Viewing a Summary of Results Description From the Direct Exam, Culture Entry, or Other Tests tab, you can view a summary of the results that have been entered for a specimen. The information on the summary depends on the type of results available. A section for culture observations is always available on the results summary. This section also includes colony count (if ordered) and a culture summary. You can view detailed information about all recorded observations or about an individual observation. In addition, any of the following sections may appear in the Results Summary window, depending on the orders included in the battery you are reviewing: • The section for other test results appears only if the battery includes tests defined in Other Testing Maintenance. The section displays results entered on the Other Tests tab. • The section for direct exam observations appears if the battery includes a direct exam. Note that a caret (^) indicates that an organism identification has been flagged as significant. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing a Summary of Results 95 • The Biotype results section appears if the battery includes biotype tests. The sections displays results entered on the Biotype tab. • The Workups section appears if the battery includes workups. This section displays workup results entered on the Direct Exam tab or the Culture Entry tab. • Notes appear only if your site uses Clinical Validation and internal notes were entered for the specimen. For more information, see Exchanging Notes about Clinical Results on page 286. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click any of the following tabs: • Direct Exam • Culture Entry • Other Tests Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 96 Chapter 4: Entering Direct Exam and Culture Results 2 Click Results Summary. The Results Summary window opens, showing a list of observations entered for the selected culture under Culture Observations and detailed information about each observations under Culture Summary. Other sections may also appear, depending on the types of tests included in the battery. Depending on the tests on the battery, different sections may appear. Notes appear only if internal notes have been entered. 3 To switch between viewing all and selected culture observations, do one of the following: • To view detailed information about all recorded observations, select the View all culture observations check box. • To view detailed information about an individual observation, clear the View all culture observations check box, and then under Culture Observations, click an observation. 4 Notice that any of the following information recorded for an organism appears under Culture Observations: • Numbered list of organism identifications or culture observations. • Elapsed time (if filed for the battery). • Each organism identification and any modifiers, such as enumeration codes, corrections statements, comments, or free text. • ^ to indicate an organism identification has been flagged as significant. • Any organism identification on hold. • The following susceptibility data for each organism: • ZZ battery number. • Drug results grouped by interpretation. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Saving Microbiology Result Data 97 • Extended MIC interpretations grouped by interpretation. • Indication if susceptibility is on hold. • # to indicated composed text is entered for the drug result. • + to indicate comment text or free text is entered for the drug result. • If biotype data exists, the Biotype section displays the following for each organism: • Organism identification number. • Method code. • Micro card type. • Biotype identification number. • Organism identification, including enumerations. • Percent probability. 5 To close the Results Summary window, click Close. Saving Microbiology Result Data Description When your observations are complete, you can save the direct exam or culture observations. Before You Begin Enter an observation. For more information, see Recording Direct Exam and Culture Observations on page 66. Steps to Take In the Microbiology Result Entry window, with any tab active, • Click Save. After you save the observation, one or more of the following events may occur: • If a battery is defined to include a bill-only test, the Billing tab activates so you can enter a bill-only test. For more information, see Entering Bill Only Data on page 100. • If callback codes are appended to an observation to request a callback, a Callback window opens. For more information, see Chapter 4, Generating and Processing Call Requests in Order or Result Entry in the Callback User’s Guide. • Rules may be assigned to perform an action when the observation is saved. For more information, see About Rules for Direct Exam and Culture Entry on page 55. Modifying the Setup Time Description You can modify a specimen setup date and time. If you entered a setup time in Microbiology Setup Time, the date and time appear for the selected order. For more information, see Entering a Setup Time on page 33. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 98 Chapter 4: Entering Direct Exam and Culture Results Steps to Take In the Microbiology Result Entry window, 1 Click the Misc. Updates tab. If a setup date and time have been entered for the order, they appear in the Setup date and Setup time boxes. Note If the battery has a receive date and time in the future, no setup date or time appears, and the Setup date and Setup time boxes are disabled. 2 In the Setup date box, do one of the following: • Type the date the specimen was transferred to a plate. • To select a date, click or press F3. Enter the setup date and time. 3 In the Setup time box, enter the time the specimen was transferred to a plate, in a valid time format. Note If your site permits the entry of a setup date or time in the future, the future time must be within the number of hours from the current system time specified by site parameter [Number of hours to allow for future setup time (<0>)]. For more information, see, Future Setup Time Site Parameter on page 311. 4 To save your entries, click Save. The setup data appears in the specimen header. View the modified setup date and time in the specimen header. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying Specimen Description and Special Request 99 Modifying Specimen Description and Special Request Description You can modify the specimen description (SDES) and special request (SREQ). If you entered SDES or SREQ at order time, the data appears for the selected order. Modified entries for SDES or SREQ appear in the specimen header. You can also group entries for the SDES or SREQ so that they appear on one line on patient reports. Before You Begin You search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know If you modify SDES or SREQ data, a correction statement may be applied, based on site parameter settings. For more information, see Applying Correction Statements on page 103. If the site parameter [Restrict text codes to match department of test code?] is set to yes, the text code must either match the department of the test code or be specifically defined for microbiology. For more information, see the Site Parameters Administrator’s Guide. Steps to Take In the Microbiology Result Entry window, 1 Click the Misc. Updates tab. The SDES and SREQ data appears. Enter specimen description and special request text codes. 2 In the SDES box, do one of the following: • Type a text code. • Type a semicolon and enter free text. • To look up a text code, click or press F3. 3 In the SREQ box, do one of the following: • Type a text code. • Type a semicolon and enter free text. • To look up a text code, click Microbiology User’s Guide Sunquest Laboratory or press F3. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 100 Chapter 4: Entering Direct Exam and Culture Results 4 To have multiple result components print on one line in inquiry and on reports, select the Group check box to the right of the component that should appear as the last component. This and all preceding components will appear on one line. Example If you enter four codes and select the Group check box for the third one, the translations of the first three codes will appear on the same line, while the fourth code will appear on a separate line. 5 To save your entries, click Save. The SDES and SREQ data appear in the specimen header. If a correction statement is applied, it appears in the Correction Statement column for the entry. View specimen description and special request codes in the specimen header. Entering Bill Only Data Description You can add a bill-only test to a battery to generate billing charges. The bill-only tests you enter qualify for the billing extract and appear on the subsequent billing report and in Laboratory Inquiry. The bill-only tests do not appear on internal microbiology reports, patient reports, or in Microbiology Inquiry. The Culture Review report can be set up to include bill-only tests. Note Billing codes appear on the microbiology audit trail if paperless microbiology is enabled. For more information, see About Paperless and Nonpaperless Microbiology on page 53. The system administrator defines the direct exam and culture batteries that generate additional charges. A “zero” battery can be defined to allow entry of bill-only tests for all undefined batteries. Maintenance settings also determine if bill-only tests are mandatory. If the generation of a bill-only test is mandatory for a battery, the system automatically opens the Billing tab when results are saved from any of the other tabs. For more information, see Bill-Only Tests Maintenance Settings on page 309. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying Direct Exam and Culture Observations 101 You must modify or delete previously saved bill-only tests in terminal-based Credit Test Request (CR) or Windows-based Credit. A dollar sign appears in angle brackets <$> for tests credited through Credit Test Request. For more information, see the Laboratory User’s Guide. Before You Begin Enter observations for a direct exam or a culture. For more information, see Recording Direct Exam and Culture Observations on page 66. Steps to Take In the Microbiology Result Entry window, 1 Click the Billing tab. 2 In the Code box, do one of the following: • Type a bill-only test code. • To look up a bill-only test code, click or press F3. Note To delete a bill-only test code from the list, select its check box, and then click the DELETE key. 3 Click Save. The bill-only test code is added to the microbiology battery. Modifying Direct Exam and Culture Observations Description You can make changes to results for a direct exam or a culture. Depending on the type of change and site parameter settings for your site, a correction statement may be appended to the change. For more information, see … Changing a Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Applying Correction Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Deleting an Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Deleting an Observation with Associated Online Results . . . . . . . . . . . . . . . . . . . . . 105 Changing a Result Description Your security level determines if you can modify observations after they have been assigned a Final result. For more information about security levels, see the Windows-Based Applications Installation Guide. You can also modify the Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 102 Chapter 4: Entering Direct Exam and Culture Results specimen description, special request, and setup time. For more information, see Modifying the Setup Time on page 97 and Modifying Specimen Description and Special Request on page 99. You can use common keyboard commands to navigate in the application rather than using a mouse. For more information, see Using Common Keyboard Commands on page 16. You Need to Know Modifying an observation can affect one or more of the following: • If you modify an observation, a correction statement may be applied to the result based on site parameter settings. For more information, see Applying Correction Statements on page 103. • If you modify an observation and re-apply a Final result to the battery, the battery qualifies for the Epidemiology report on the next day. • If you modify an observation, any rules assigned to perform an action will be reapplied to the modified direct exam or culture observation. • If you are using Syndrome Index and you modify the result that initiated creation of a syndrome so that the result no longer qualifies for creation of a syndrome, the system deletes the syndrome and the occurrence from the patient’s syndrome record. However, if subsequent occurrences exist for the syndrome, the system retains the syndrome record and the occurrence. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. 2 Under Observations, in the Result column, do any of the following: To … Do this … Add a new observation. 1 Click in an empty cell. 2 Enter an observation. Add a new entry to an observation. 1 Click in the same cell as the existing observation. 2 Press the TAB key to add a blank line for the new entry. 3 Enter an observation. Change an observation. 1 Select the observation you want to change. 2 Press a key that represents the code you want to enter. The code replaces the previous entry. For more information, see Entering Direct Exam and Culture Observations on page 67. 3 To save your modifications, click Save. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying Direct Exam and Culture Observations 103 Note If you modify an organism ID that has a filed susceptibility result, you may receive the message, “Do you want to update susceptibility results? Yes/No”. For more information, see About Automatic Susceptibility Updates on page 158. Related Topics Assigning a Tech Final Status to a Battery on page 174 Assigning a Final Status to a Battery on page 176 Applying Correction Statements Description Correction statements can be applied to a modified result or a final result. The correction statement includes the entire previous result and the result date and time. You can specify the tests in a battery that receive a correction statement, such as specimen description (SDES), special request (SREQ), direct exam, colony count, or culture. Site parameter settings determine if a correction statement is applied to all modified results or only to final results. For more information, see Correction Statement Site Parameters on page 310. A correction statement is not applied to an observation if you: • Add or remove the HIDE text code for an observation. • Modify free text. You can define maintenance to verify whether a change to a culture result is a logical or expected modification. To determine whether a correction statement is applied, Sunquest Laboratory follows the maintenance definitions for logical progression in Microbiology Maintenance and checks site parameter settings. For more information, see Logical Progression Definition (MMA 20) on page 40-1 in the Microbiology Administrator’s Guide. In order for a correction statement to be applied, the site parameter [Components in microbiology battery to append correction statement (SDES,SREQ/DE/CNT/CULT/ SENS/OTHER TESTS)] must be set to Y for the type of result you are changing. The following table defines other conditions that determine whether a correction statement is applied: If … A correction statement may apply if … The original result is no growth. The site parameter [Should the no growth group code(s) prevent a correction statement?] is set to N. A logical progression is defined in MMA 20. The modification is not included in the logical progression definition. The culture is not in final status. The site parameter [Append correction statement to microbiology results in final status only] is set to N. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 104 Chapter 4: Entering Direct Exam and Culture Results If … A correction statement may apply if … The culture is in final status. • You have the security level to modify results in final status. • You select Yes at the Append Correction Statement? prompt. This prompt appears only if the site parameter [Confirm correction statement change] is set to Y. Steps to Take In the Apply Correction Statement window, 1 Do one of the following • To apply correction statements to all organisms in the list, click the Select All check box. • To apply correction statements to individual organisms, in the list, select a check box. 2 Click Apply to Selected. Deleting an Observation Description Your security level determines if you can delete observations for a direct exam or a culture. For more information about security levels, see the Windows-Based Applications Installation Guide. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Direct Exam or Culture Entry tab. 2 Under Observations, click the observation number you want to delete. 3 Click Delete Observation. Caution In some cases, if you delete a culture observation and online data is present, the system reshuffles observation numbers, causing a mismatch between online organism ID numbers and observation numbers. The system warns you when this mismatch is going to occur and asks if you still want to delete the observation. Sunquest recommends that you reply No to this message. For more information, see Deleting an Observation with Associated Online Results on page 105. Note If you are using Syndrome Index and you delete the result that initiated creation of a syndrome, the system deletes the syndrome and the occurrence from the patient’s syndrome record. However, if subsequent occurrences exist for the syndrome, the system retains the syndrome record and the occurrence, but indicates in the patient’s syndrome record that no data is available for the test. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Laboratory and Microbiology Results in Inquiry 105 Deleting an Observation with Associated Online Results Description Sunquest strongly recommends that you follow this procedure to delete a culture observation that has associated online results. Caution In some cases, if you delete a culture observation and online data is present, the system reshuffles observation numbers, causing a mismatch between online organism ID numbers and observation numbers. If the mismatched information is retained, the next technologist working on this accession number could be confused by the original numbering of the online data cards or panels. Before You Begin Delete a culture observation. For more information, see Deleting an Observation on page 104. If online results are associated with the battery, a message alerts you when the deletion will cause a mismatch between online organism ID numbers and observation numbers. Steps to Take In the Microbiology Result Entry window, with the caution message about the presence of online data displayed, 1 Click No to reply to the message. 2 On the Online tab, accept the online data you want to file. For more information, 3 4 5 6 7 see Accepting Individual Online Results for an Observation on page 130. On the Culture Entry tab, delete the observation. For more information, see Deleting an Observation on page 104. The system redisplays the caution message. This time, respond Yes. The system deletes the observation and reshuffles and renumbers the remaining observation results as needed. Make a note of the changed numbers. On the Online tab, delete the data that has a mismatch between online organism ID numbers and the observation. For more information, see Deleting Online Data on page 135. To save your modifications, click Save. Viewing Laboratory and Microbiology Results in Inquiry Description In Microbiology Result Entry, you can view laboratory or microbiology results for the selected patient while entering observations. Your security level determines whether you can view results in Laboratory Inquiry or Microbiology Inquiry. To determine if you have the proper security level, Sunquest Laboratory checks: • The security level assigned to you for MCE and MCER. • The highest security level assigned to you for Laboratory Inquiry or Microbiology Inquiry. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 106 Chapter 4: Entering Direct Exam and Culture Results Note Your security level for Microbiology Inquiry determines if you can view hidden results. If your security level is defined for MCIQ, you can view hidden results. If your security level is defined for MCI, you cannot view hidden results. For more information about security levels, see the Windows-Based Applications Installation Guide. For more information, see Setting Security for Microbiology Result Entry on page 302. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, To view Laboratory Results for the selected patient • Click Go To…, and then click Lab Inquiry. The Laboratory Inquiry window opens, displaying the record for the selected patient. For more information, see Chapter 11, Using Collection Batches in the Laboratory for Windows User’s Guide. To view Microbiology Results for the selected patient • Click Go To…, and then click Micro Inquiry. The Microbiology Inquiry window opens and displays a list of accessions/batteries for the selected patient, including the accession for which you are currently entering observations. For more information, see Selecting Results to View on page 223. Printing a Patient Cumulative Report Description You can print a Patient Cumulative report and specify the patients, tests, and departments that appear on the report. Your security level determines whether you can print a Patient Cumulative report and the HIDs you are authorized to view. For more information about security, see the Windows-Based Applications Installation Guide. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Printing a Patient Cumulative Report 107 Steps to Take In the Microbiology Result Entry window, 1 Click Go To…, and then click PTCUM. The Patient Cumulative Report window opens. 2 Do any of the following: To … Do this … Add another patient to the report. 1 In the Patient ID box, do one of the following: • Type a patient ID. • To look up patient data, click or press F3. 2 Click Add. Add tests or batteries to the report. 1 In the Test box, do one of the following: • Type a test code. • To look up a test code, click or press F3. 2 Click Add. Include specific departments on the report. 1 In the Department box, do one of the following: • Type a department code. • To look up a department code, click or press F3. 2 Click Add. Delete information from the report. • Select the information that you want to delete, and then click Remove. Remove any new entries. • Click Clear. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 108 Chapter 4: Entering Direct Exam and Culture Results 3 To print the report, click Print. The Print window opens. 4 In the Device box, do one of the following: • Type the device code of the printer you want to use to print the report. • To look up a device code, click or press F3. 5 In the Start date and End date boxes, do one of the following: • Type the date range you want to include in your report. • To select a date range, click or press F3. 6 Do one of the following: • To print the report, click OK. • To return to Microbiology Result Entry, click Cancel. Note After you have printed a report for the selected patient, you have the option to print another report for patients in a different HID. To clear current report data and activate the HID field, press Clear. Select an HID and repeat steps through 6 to print the report. Working with Results Requiring Clinical Validation If your site uses Clinical Validation for secondary reviews of results before they are released to Inquiry and patient reports, results can be sent to reviewers manually or automatically using rules. You cannot final an accession that has been assigned to a validation queue; only a reviewer in Clinical Validation can do so. For accessions that will be reviewed in Clinical Validation, you can create and view internal notes. These notes provide a means for lab technicians and reviewers to communicate about accessions being reviewed. For more information about Clinical Validation, see Chapter 13, Reviewing and Validating Clinical Results. For more information, see … Manually Assigning Results to a Validation Queue . . . . . . . . . . . . . . . . . . . . . . . . . . 109 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Working with Results Requiring Clinical Validation 109 For more information, see … Resolving Rule Conflicts for Validation Queues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Viewing and Entering Internal Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Manually Assigning Results to a Validation Queue Description Depending on your login security, from any of the tabs in Microbiology Result Entry, you can send the results of an accession to validation queue so they can be reviewed in Clinical Validation. This is useful if your site requires a secondary review of results before they are released to Inquiry and patient reports, and if the results were not automatically assigned to a queue. Before you can assign the accession, you must enter new results for direct exam, cultures, or other tests. Until you do so, the Queue button is unavailable. Note the following: • If you assign an accession which had existing result from a previous session but which had not been assign to a queue, only new results and results on hold from the previous session are assigned to the queue. • If an accession has been previously assigned to a queue, you must remove it from the queue before you can assign it to another queue. • If you manually assign an accession that a rule qualifies for a different queue, the manual assignment supercedes the rule’s assignment. If the results entered in this session and manually assigned to a validation queue are not in Hold, a message is appended as defined by a site parameter. For more information, see Clinical Validation Site Parameters on page 329. Before You Begin Select the accession you want to assign to a validation queue. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In Microbiology Result Entry, To assign an accession to a validation queue 1 Click Queue. The Queue Results window opens. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 110 Chapter 4: Entering Direct Exam and Culture Results 2 In the Select queue box, enter the group tech code of the validation queue, or click to look up a queue. 3 Click OK. The code for the selected queue appears above the result entry tabs. The queue is shown here. To remove an accession from a validation queue 1 Click Queue. The Queue Results window opens, displaying the currently selected queue in the Select queue box. 2 Click Remove from Queue. You can select a different queue, if necessary. 3 Click OK. Resolving Rule Conflicts for Validation Queues Description If your site uses rules to assign accessions to validation queues, rules may assign an accession to more than one queue or action. The same accession may qualify for: • Multiple validation queues • Multiple actions, such as Hold or Release, in the same queue • Multiple actions in multiple queues. If any of these situations occur, you must manually select the queue and/or action for the accession. Steps to Take In Microbiology Result Entry, 1 When you save results, if an accession qualifies for more than one validation queue or action, the Microbiology Result Entry window lists the queues and/or actions that the accession qualifies for. The type of conflict is shown here. Depending on the situation, this list may be called Select action or Select queue, instead. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Working with Results Requiring Clinical Validation 111 2 In the Select queue and action list, click the queue and/or action to which you want the accession assigned. 3 Click OK. Viewing and Entering Internal Notes The process of reviewing results in Clinical Validation requires easy communication between reviewers and lab technicians. Internal notes enable lab technicians and reviewers to communicate about accessions being reviewed. They are available only if your site uses Clinical Validation. The Notes button shows the type of internal notes that are present and whether new notes have been entered: • P for patient-level notes. • S for specimen-level notes. • + for notes that have not been viewed by anyone other than the person who entered the note. The Notes button appears at the bottom of the window after you have selected an accession. The Notes button is available if your site uses Clinical Validation. For example, a reviewer might send an accession back to the bench for additional testing and then create an internal note explaining what is needed. You can respond to the reviewer’s note by clicking the Notes button to create a note of your own. Internal notes can be entered from Microbiology Result Entry and Clinical Validation, as well as Administrative Data Entry, Order Entry, ORM, and Windowsbased Inquiry. You must have the appropriate login security to view, enter, or edit notes. For more information on using internal notes, see Exchanging Notes about Clinical Results on page 286. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 112 Chapter 4: Entering Direct Exam and Culture Results Using Accession Result Comments You can create text comments that apply to an entire accession. These comments, known as accession result comments, can be viewed or edited from the Direct Exam, Culture, and Other Tests tabs in Microbiology Result Entry, and from Clinical Validation. For more information, see … About Accession Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Opening Accession Result Comments in Microbiology Result Entry . . . . . . . . . . . . . 112 Entering Accession Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Editing or Deleting Accession Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 About Accession Result Comments You can enter a comment that covers all the batteries of an accession. You can enter accession result comments as any combination of the following: • Free text • Text codes • Composed text Accession result comments are treated like results. For example, entering an accession result comment qualifies a patient report to print. Also, if you change either the free text or text codes in a comment, a correction statement may be appended. However, if only the composed text is changed, no correction statement is added. Depending on site parameter settings, accession result comments can be viewed in Inquiry and patient reports. For information about the site parameters that affect accession result comments, see Accession Result Comment Site Parameters on page 311. You must have the appropriate login security to view, enter, or delete accession result comments. For information about security levels affecting Accession Result Comments, see Setting Security for Microbiology Result Entry on page 302. Related Topics About Composed Text on page 76 Entering Accession Result Comments on page 113 Opening Accession Result Comments in Microbiology Result Entry Description In Microbiology Result Entry, you can enter accession result comments from the Culture Entry, Direct Exam, or Other Tests tabs. For more information about accession result comments, see About Accession Result Comments on page 112. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Accession Result Comments 113 Before You Begin Select a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In Microbiology Result Entry, • On the Culture Entry, Direct Exam, or Other Tests tabs, click Accession Results Comments. Existing comments and fields for entering new comments appear on the selected tab. For information on entering comments, see Entering Accession Result Comments on page 113. Entering Accession Result Comments Description You can enter accession result comments in Clinical Validation or Microbiology Result Entry. The comments can be entered as any combination of codes, free text, or composed text. Codes and free text are displayed in the order they are entered. For more information about accession result comments, see About Accession Result Comments on page 112. Before You Begin Open the accession results comments. For more information, see Opening Accession Result Comments in Microbiology Result Entry on page 112 or Opening Accession Result Comments in Clinical Validation on page 293. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 114 Chapter 4: Entering Direct Exam and Culture Results Steps to Take To enter accession results comments, 1 Do any of the following: To enter … Text codes Do this … 1 In the Comment box, enter the comment code or click to look up a code. Enter or look up a code. Click to add the code to the list. 2 Click Add. The code and its translation are added to the list. Free text 1 in the Free text box, enter up to 140 characters 2 Click Add. The text, preceded by a semicolon, is added to the list. Composed text 1 Click anywhere in the Composed Text box. 2 Type your comments or observations using alphanumeric characters, symbols, or predefined text codes. Do any of the following: • To translate a text code into text, press CTRL+T, type one or more text codes, and then press Ctrl+T. • To enter multiple codes on one line, use a hyphen between each code. • To insert a page break, type .TP or .tp to indicate a new page on a report. 2 When you are finished entering accession result comments, do one of the following: • If you are working in Microbiology Result Entry, the accession result comments are automatically saved. Continue entering results. • If you are working in Clinical Validation, click Save to save the accession result comments. Editing or Deleting Accession Result Comments Description Depending on your login security, you may be able to modify or delete accession result comments. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Responding to QA Failures for Direct Exams and Cultures 115 Note If your login security includes deleting, you can remove the entire accession result comment. If your login security includes only modifying accession result comments, you can remove an individual code, free text, or composed text, as long as others remain. You cannot, however, remove the last remaining code, free text, or composed text, as this is equivalent to deleting the entire accession result comment. Before You Begin Open the accession result comments window in either Microbiology Result Entry or Clinical Validation. For more information, see one of the following: • Opening Accession Result Comments in Microbiology Result Entry on page 112 • Opening Accession Result Comments in Clinical Validation on page 293 Steps to Take To edit or remove either comment codes or free text • Do any of the follobwing: To … Do this … Edit existing codes or free text 1 In the list, click the line you want to edit. 2 Click Edit. The code or text appears in the Comment or Free text boxes. 3 Edit the code or text, then click Add. Remove a single line of text • Click the line of text, then click Remove. Remove all comment codes or free text • Click Clear. To edit or remove composed text • Do any of the following: • To edit the text, under Composed Text, use standard text editing features to change the text. • To remove all composed text, under Composed Text, click Clear. Responding to QA Failures for Direct Exams and Cultures Sunquest Laboratory checks the direct exam or culture results against the user-defined pattern for the culture, specimen type, and organism. If any results fail pattern checks during Quality Assurance (QA) checking, a message appears in the QA Warnings Found window. Results that are associated with a failure are indicated by a check box. You can review the QA failures and accept or reject them. Description Accession numbers qualify for the Direct Exam Quality Assurance report when the result fails QA checking and the microbiology battery report status is Final. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 116 Chapter 4: Entering Direct Exam and Culture Results Your system manager defines susceptibility pattern checking for all organism identification methods in Microbiology Maintenance. Steps to Take In the QA Warnings Found window, 1 Review the QA failures. 2 Do one of the following: • To accept the organism ID pattern check, click Accept. Sunquest Laboratory updates the patient’s record. • To reject the organism ID pattern check, click Reject. The organism ID pattern check is rejected and the Culture Entry tab appears so you can modify the observation. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview When microbiology tests are run on online instruments, results are uploaded to Sunquest Laboratory. You can either autofile online results or review and accept organism identifications and susceptibilities provided by the instrument on the Online tab in Microbiology Result Entry. This section includes the following topics Getting to Know Online Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 About Previously Filed Codes and Online Results . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Combining and Overlaying Drug Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Autofiling Results from Online Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Viewing Results Sent from Online Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Accepting Online Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Locating Autofiled or Accepted Online Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Saving Online Results to a Patient Record . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Deleting Online Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Getting to Know Online Results Organism identifications and susceptibility results sent from online instruments can be automatically filed in the patient’s file or reviewed on the Online tab in Microbiology Result Entry. On the Online tab, you can accept all online data or individual results sent from microbiology instruments. If a test sent from the online instrument is defined as an Other test, all results for the test must be accepted manually; you can neither autofile these results nor accept individual result components. For more information, see … About Online Organism Identifications and Susceptibility Results . . . . . . . . . . . . . . 118 About Online Instrument Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 About Quality Assurance Checking for Online Results . . . . . . . . . . . . . . . . . . . . . . . 120 Chapter 5 Accepting Results from Online Instruments 118 Chapter 5: Accepting Results from Online Instruments About Online Organism Identifications and Susceptibility Results Prior to running instrument tests, observations can be entered for a specimen on the Culture Entry tab in Microbiology Result Entry, and an organism identification can be filed. Online data can be accepted and filed without an observation on the Culture Entry tab. However, if you are autofiling online data, an observation must be entered on the Culture Entry tab before autofiling takes place. For more information, see Entering Direct Exam and Culture Observations on page 67. You can review, add, and delete organism identification and susceptibility results uploaded from online instruments. You can also view biotype data that may be sent with the online results. The data from online instruments can be automatically filed directly into the patient’s file or reviewed and accepted on the Online tab. You must have the proper security level to view and accept online data. For more information, see the Windows-Based Applications Installation Guide. Data that is automatically filed into the patient’s file appears on the Culture Entry and Susceptibility tabs. Drug classification is applied automatically when susceptibility results are autofiled from an online instrument. When data is autofiled, a message appears on the Online Instrument Error report in terminal-based Online Device Reports (ORP). When online instrument data is available for review, on the Culture Entry, Susceptibility, or Other Tests tabs, a check mark appears in the O column for an observation. A check mark in the O column indicates that online data is available. You can review organism identifications and susceptibility results on the Online tab. For more information, see Viewing Results Sent from Online Instruments on page 126. You can also accept all or selected results. For more information, see Accepting Online Results on page 127. After you accept online instrument data, the online data replaces or is combined with previously saved culture or susceptibility results, including text codes or correction statements. For more information, see About Previously Filed Codes and Online Results on page 120. Data uploaded from online instruments remains on the Online tab until the culture is finaled or until the data is deleted by the technologist. For more information, see Online Instrument Result Settings on page 315 and Deleting Online Data on page 135. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Online Results 119 About Online Instrument Data The instruments at your hospital or laboratory facility determine the type of organism identification or susceptibility result data that appear on the Online tab. The following data can appear for organism identification: • • • • • Card type Instrument method Biochemical numeric pattern (biotype) Organism identification Percent probability The following information can appear for susceptibility results: • Card type • Instrument method • Drug and susceptibility interpretation (for example, SS, I, R) The following illustrates the data that can appear on the Online tab. View the online organism identification in the left pane. Reference number. View the organism identification entered on the Culture Entry tab. View online susceptibility results in the right pane. Susceptibility interpretation by body fluid. Results sent from online instruments use a two-part reference number separated by a period. In the reference number: • The first number is the culture observation number from the Culture Entry tab. • The second number is the number of the result sent from the instrument for that observation and panel. If expanded interpretive definitions for body fluid and route or body fluid only are used, these results appear in a box below other susceptibility results on the Online tab. For more information, see Online Instrument Result Settings on page 315. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 120 Chapter 5: Accepting Results from Online Instruments If online results are available for other testing, the Online tab includes the following section: Cup number Placeholder test Method Other tests and their online results Related Topics Viewing Results Sent from Online Instruments on page 126 About Quality Assurance Checking for Online Results As online results are accepted, Sunquest Laboratory checks the susceptibility pattern against the user-defined drug pattern for the culture, specimen type, organism, and susceptibility method. If any results fail Quality Assurance (QA) pattern checking, a message appears in the QA Warnings Found window. You can review the QA failures and accept or reject them. Your system manager defines susceptibility pattern checking for all susceptibility methods in Microbiology Maintenance. For more information, see Responding to QA Failures for Susceptibilities on page 156. The system first references the QA range defined for the instrument method. If that is not defined, the system references the default QA range for the test. If neither exist, QA checking is not performed. For information about QA definitions, see Chapter 7, Quality Assurance Data, in the Laboratory Administrator’s Guide. About Previously Filed Codes and Online Results Results accepted from an online instrument become part of the currently entered data on the appropriate tab. After the results are saved, they are added to the patient record. Depending on the type of result and site parameter settings, the system replaces, retains, or discards previously filed results for an observation. If an observation has no previously filed organism ID or susceptibility data, you can accept an online organism ID. However, you can only accept an online susceptibility result if you also accept the organism ID. If you try to accept an online susceptibility result for an observation without accepting an organism ID, the system rejects the result. You must have entered an organism ID for an observation to accept an online susceptibility result. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory About Previously Filed Codes and Online Results 121 The following sections explain how the system replaces, retains, or discards previously filed results when you accept different types of online data. For more information, see … Replacing Organism IDs and Enumeration Codes with Online Results . . . . . . . . . . 121 Replacing Organism IDs on Hold with Online Results . . . . . . . . . . . . . . . . . . . . . . . 122 Replacing Biotype Data with Online Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Replacing Susceptibility Data with Online Results . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Replacing Susceptibility Data on Hold with Online Results. . . . . . . . . . . . . . . . . . . . 122 Replacing Organism IDs and Enumeration Codes with Online Results If you accept an organism ID from an online instrument, any organism ID previously entered on an observation is updated with the online data. As online results are filed for an observation, the system reviews previously filed results and performs the following actions: • Discards any free text or non-enumeration text codes, including correction statements and elapsed time statements. • Discards any results placed on hold. • Reviews the setting for the site parameter [Retain Enumeration Code After Organism Code] to determine whether the enumeration codes, such as FEW or MANY, are retained before or after the organism code. If this site parameter is set to Y, the system selects the last organism ID code in the result string and replaces it with the online data organism ID code. All other organism ID codes in the result string are discarded. The system retains any enumeration codes that follow the selected organism ID and discards any other enumeration codes in the result string. Example The original filed result was “;FREE TEXT 1+ GNR FEW Corrected on 7/7/2004 at 1515. Previously reported as GPC FEW.” The accepted online organism code is ECOL. The system discards the free text, the enumeration code 1+, and the correction statement and files the result as ECOL FEW. If this site parameter is set to N, the system selects the first organism ID code in the result string and replaces it with the online data organism ID code. All other organism ID codes in the result string are discarded. The system retains any enumeration codes that precede the selected organism ID and discards any other enumeration codes in the result string. Example The original filed result was “;FREE TEXT-ASAP- 1+ GNR FEW (ET:2 hours.)” The accepted online organism code is ECOL. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 122 Chapter 5: Accepting Results from Online Instruments The system discards the free text, the non-enumeration code ASAP, the enumeration code FEW, and the elapsed time entry and files the result as 1+ ECOL. Note Depending on your facility’s procedures, you may need to reenter correction statements discarded by the acceptance of online data. Replacing Organism IDs on Hold with Online Results If you accept a corresponding result from an online instrument for an organism ID that is on hold, the system ignores the data on hold, updates the organism ID with the online data results, and discards the original organism ID hold data. If you try to accept only the online susceptibility data for an organism ID on hold, the system displays the message, “#n.n (Rejected) No Organism Results Entered.” You must either accept both the online organism ID and the susceptibility results or remove the hold from the original organism ID before accepting susceptibility results. Replacing Biotype Data with Online Results If you accept results from an online instrument that provides biotype data, any biotype data previously entered on an organism is updated with the online biotype data as the primary organism for the organism number. The system retains the previously entered biotype data, removing the primary flag, if set, and makes it available for viewing on the Biotype tab. For more information, see Viewing Biotype Data on page 91. Replacing Susceptibility Data with Online Results You can accept online susceptibility data for an observation as long as an organism identification has been entered. If previously filed susceptibility data exists for the observation, the system updates the previously filed susceptibility data based on site parameter settings for automatic susceptibility updates. For more information, see About Automatic Susceptibility Updates on page 158. Replacing Susceptibility Data on Hold with Online Results If you accept an online susceptibility result for a microbiology battery that has a susceptibility result on hold, the system discards the original hold data and updates the susceptibility with the online results. If an observation has both organism ID and susceptibility data on hold and you accept all data for an observation, the system updates both the organism ID and the susceptibility with the online results and discards hold data. Replacing Other Testing Results on Hold with Online Results If you accept online results for a test defined in Other Testing Maintenance for which results exist in hold, the system discards the original hold results and updates the other tests on the Other Tests tab with the online results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Combining and Overlaying Drug Results 123 Combining and Overlaying Drug Results If online susceptibility results are accepted and previously filed susceptibility results exist for an observation, you must decide whether to combine the online results with the existing results and whether to overlay existing values. For more information, see … About the Combine Data Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Choosing Not to Combine Susceptibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Combining Susceptibilities with No Drugs in Common . . . . . . . . . . . . . . . . . . . . . . . 123 Combining Susceptibilities with Drugs in Common . . . . . . . . . . . . . . . . . . . . . . . . . . 124 About the Combine Data Message If you accept an online susceptibility result for an observation that has a previously filed susceptibility with the same method code, the system displays the following message: “#n.n Susceptibility has been previously accepted. Combine data to existing susceptibility? Yes/<No>.” This message appears usually because a single online instrument susceptibility card could not accommodate all the antibiotics that need to be tested on a single organism. The microbiology lab sets up two cards for the organism. The second card may have additional antibiotics as well as some of the same drugs that are on the first card. If the system determines that the method code of the old susceptibility is different from the method code of the new susceptibility, it does not display the combine data message. Instead it adds the new susceptibility as another ZZ battery to the observation. Choosing Not to Combine Susceptibilities If you reply No to the combine data message, the system does not combine the new susceptibility with the old. It displays the message, “The #n.n online susceptibility has been rejected.” It retains the filed susceptibility with the original results and interpretations and stores the online susceptibility data on the Online tab. Combining Susceptibilities with No Drugs in Common If you reply Yes to the combine data message and the old and new susceptibilities have no drugs in common, the system combines the susceptibilities as follows: • For drugs that were on the old susceptibility but are not on the new susceptibility, the system retains the drugs and their existing numeric values and interpretations. • For drugs that are on the new susceptibility but were not on the old susceptibility, the system adds the drugs to the susceptibility along with their numeric values and interpretations. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 124 Chapter 5: Accepting Results from Online Instruments Combining Susceptibilities with Drugs in Common If you reply Yes to the combine data message and at least one of the same drugs appears on the old and new susceptibilities, the system displays the following message: “Overlay existing drugs? Yes/<No>.” You can choose whether or not you want to replace previously filed susceptibilities. If you reply Yes to the overlay message, the For drugs that are … system … If you reply No to the overlay message, the system … On the old susceptibility but not the new. Retains the drugs and their existing numeric values and interpretations. Retains the drugs and their existing numeric values and interpretations. On both the old and the new susceptibilities. Retains the drugs but updates the values and interpretations based on the new susceptibility. Retains the drugs with their original values and interpretations. On the new susceptibility but were not on the old. Adds the drugs to the susceptibility along with their numeric values and interpretations. Adds the drugs to the susceptibility along with their numeric values and interpretations. Autofiling Results from Online Instruments The automatic filing of online instrument data, also known as autofile, is determined by definitions in Microbiology Maintenance and Microbiology Instrument Maintenance. For more information, see Online Instrument Result Settings on page 315. Note Autofiling of online results is not available for tests defined in Other Testing Maintenance. For more information, see … About Autofiling of Organism Identification Results . . . . . . . . . . . . . . . . . . . . . . . . . . 124 About Autofiling of Susceptibility Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 About Applying Correction Statements When Autofiling. . . . . . . . . . . . . . . . . . . . . . . 126 About Autofiling of Organism Identification Results When organism identification results are uploaded from an online instrument, Sunquest Laboratory follows these filing parameters: • The organism number must follow sequentially within the culture results. For example, if there is an identification to be filed for organism number 2, it cannot be filed without organism number 1 being identified. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Autofiling Results from Online Instruments 125 • If the instrument control parameter [Matching MO codes when Autofiling] is set to Y, the organism ID from the online instrument must match the ID in the culture when autofiling. If the organism IDs do not match, the online result is not filed to the patient file, but is held in the online instrument data file for review on the Online tab. • If an organism identified is listed in the exclusion list in Microbiology Maintenance (MMA 12:1), the online result is not filed to the patient file, but is held in the online instrument data file for review on the Online tab. Related Topics Modifications Resulting from Accepted Results on page 132 About Applying Correction Statements When Autofiling on page 126 About Autofiling of Susceptibility Results When susceptibility results are uploaded from an online instrument, Sunquest Laboratory follows these filing parameters: • The organism identification must be filed on the Culture Entry tab before autofiling can occur. • The organism group of the susceptibility must match the organism group of the culture ID, or the susceptibility results will be held in the online instrument data file. If the organism identification is received from the online instrument after receiving the susceptibility results, both will be automatically filed if all parameters for filing have been met. • The susceptibility results are not filed if there are current susceptibility results for the same organism number and susceptibility method previously filed for a culture. • The susceptibility results for selected organisms defined in your site’s maintenance are not reported. The susceptibility is placed into the online instrument data file, and autofiling does not occur. • The susceptibility results for selected organism, drug, and result combinations defined in your site’s maintenance are suppressed. This does not prevent autofiling. • The susceptibility pattern is checked against the drug pattern for the culture, specimen type, organism, and susceptibility type defined in your site’s maintenance. If the pattern does not match, the results are not filed directly but are available for review and filing by the technologist. The susceptibility pattern checking is repeated when the online instrument data is accepted for filing by the technologist. Related Topics Modifications Resulting from Accepted Results on page 132 About Applying Correction Statements When Autofiling on page 126 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 126 Chapter 5: Accepting Results from Online Instruments About Applying Correction Statements When Autofiling Correction statements are not automatically applied to results which are autofiled from an online instrument. A microbiology culture or susceptibility result from an instrument does not autofile over a previous result that contains a correction statement; instead, the result is directed to the online instrument data file and is available for review on the Online tab. For more information, see Viewing Results Sent from Online Instruments on page 126. Related Topics About Autofiling of Organism Identification Results on page 124 About Autofiling of Susceptibility Results on page 125 Viewing Results Sent from Online Instruments Description You can review the organism identification, susceptibility results, and other testing results uploaded from online instruments before accepting the data. On the Culture Entry, Susceptibility, or Other Tests tab, a check mark in the O column indicates online instrument data is available for an observation. The instrument can also send biotype data along with the organism identification and the susceptibility results. The percent probability is sent by older versions of the Vitek and may or may not be present in the biotype data. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. If online instrument data exists for the order, the Online tab is available. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Accepting Online Results 127 Steps to Take In Microbiology Result Entry, 1 Click the Online tab. Online data for the selected microbiology order appears. The following shows an example of organism identifications and susceptibility results. ID card code Device code Organism ID Bio ID from instrument Susceptibility card code Body fluid and route Device code Susceptibility results Click to select all or individual online results. 2 Review the online results. For more information, see About Online Instrument Data on page 119. 3 Do one of the following: • To accept all online results, click Accept All Online Data. For more information, see Accepting All Online Results for an Order on page 128. • To accept individual results, click Select Online Results to Accept. For more information, see Accepting Individual Online Results for an Observation on page 130. 4 To review biotype data, click the Biotype tab. For more information, see Viewing Biotype Data on page 91. Accepting Online Results You can review online instrument data and either accept all organism identification and susceptibility results or select individual results to accept. For more information, see … Accepting All Online Results for an Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Displaying and Selecting Individual Online Results. . . . . . . . . . . . . . . . . . . . . . . . . . 129 Accepting Individual Online Results for an Observation . . . . . . . . . . . . . . . . . . . . . . 130 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 128 Chapter 5: Accepting Results from Online Instruments For more information, see … Modifications Resulting from Accepted Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Selecting an Organism ID for Susceptibility Interpretation . . . . . . . . . . . . . . . . . . . . . 132 Actions Resulting from Accepting Online Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Accepting All Online Results for an Order Description You can accept all organism identification and susceptibility results that are sent by an online instrument for an order. If online results exist for tests defined in Other Testing Maintenance, they are accepted along with the organism identification and susceptibility results. If results of other testing exist for more than one method (cup) per test, the Accept All option is not available and you must select which results to accept. Note After you accept data from an online instrument and save the data to the patient record, you can delete it from the online instrument data file. For more information, see Deleting Online Data on page 135. Before You Begin Display and review online results for an order on the Online tab. For more information, see Viewing Results Sent from Online Instruments on page 126. Steps to Take On the Online tab, 1 Click Accept All Online Data. Actions may occur and may require your input. For more information, see Actions Resulting from Accepting Online Results on page 133. 2 If necessary, respond to any messages for individual results that require your input. A final message appears, identifying any organism IDs or susceptibilities that have been accepted and do not require your input. 3 Click OK. The following actions occur: • The organism identification is updated on the Culture Entry tab. • The susceptibility results are updated on the Susceptibility tab. • The biotype data, if sent, is updated on the Biotype tab. • The other testing results are updated on the Other Tests tab. Note If you click Select Online Results to Accept, you still have the option to accept all online results from the individual results display. Related Topics Saving Online Results to a Patient Record on page 135 Accepting Individual Online Results for an Observation on page 130 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Accepting Online Results 129 Displaying and Selecting Individual Online Results Description You can display online data grouped by individual organism identification and susceptibility result so that you can choose the specific results that you want to accept. Before You Begin Display and review online results for an order on the Online tab. For more information, see Viewing Results Sent from Online Instruments on page 126. Steps to Take On the Online tab, 1 Click Select Online Results to Accept. Results appear grouped by organism identification and susceptibility results. Select the observation for which you want to accept results. View susceptibility results. To select all organism IDs for the selected observation, select this check box. To select all susceptibilities for the selected observation, select this check box. To select individual organism identifications, click the appropriate items on the list. To select individual susceptibilities, click the appropriate items on the list. If online results are available for other testing, the tab also includes an Other Testing results section. 2 Select individual results. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 130 Chapter 5: Accepting Results from Online Instruments Note For other testing, you must accept all results for a test at one time. You cannot select individual result components. 3 Accept the results you want to file for the patient. For more information, see Accepting Individual Online Results for an Observation on page 130. Related Topics Saving Online Results to a Patient Record on page 135 Accepting Individual Online Results for an Observation Description You can review results sent from an online instrument and select and accept individual organism identification or susceptibility results for an observation. You Need to Know You must have entered an organism ID for an observation to accept an online susceptibility result. If an observation has no previously filed organism ID or susceptibility data, you can accept an online organism ID. However, you can only accept an online susceptibility result if you also accept the organism ID. Before You Begin Display individual online results for an order. For more information, see Displaying and Selecting Individual Online Results on page 129. Steps to Take On the Online tab, 1 Under Culture Observation, select the observation for which you want to accept results. 2 Under Organism ID result, use the scroll bar to review the organism results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Accepting Online Results 131 3 If you want to specify organism ID results to accept, do one of the following: • To accept an individual organism ID for this observation, select the check box next to the result number. • To accept all organism IDs for the selected observation, select the Select all online organism results check box. If multiple organism IDs are present, the last organism in the list appears on the Culture Entry tab. 4 Under Susceptibility results, use the scroll bar to review the drug susceptibility results. 5 If you want to specify susceptibility results to accept, do one of the following: • To accept an individual result, select the check box of the susceptibility result that you want to accept. • To accept all susceptibility results for the selected culture observation, select the Select all online susceptibility results check box. 6 Under Other Testing results, use the scroll bar to review the other testing results. 7 To accept results of other tests, do one of the following: • To accept the result for an individual test, select the check box next to the test you want to accept. • To accept the results of all other tests listed, select the Select all online other testing results check box. 8 Do one of the following: • To accept all results for a selected observation, click Accept All for Observation. • To accept only those results selected in the check boxes, click Accept Selected. Actions may occur and may require your input. For more information, see Actions Resulting from Accepting Online Results on page 133. 9 If necessary, respond to any messages for individual results that require your input. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 132 Chapter 5: Accepting Results from Online Instruments A final message appears, identifying any organism IDs or susceptibilities that have been accepted and do not require your input. 10 Click OK. The following actions occur: • The organism identification is updated on the Culture Entry tab. • The susceptibility results are updated on the Susceptibility tab. • The biotype data, if sent, is updated on the Biotype tab. • The other testing results are updated on the Other Tests tab. Related Topics Saving Online Results to a Patient Record on page 135 Accepting All Online Results for an Order on page 128 Modifications Resulting from Accepted Results Online instrument data can modify the organism ID associated with a previously filed susceptibility result. If online instrument data modifies an organism name, Sunquest Laboratory re-evaluates the susceptibility interpretations based on the site parameter [Automatic susceptibility update/suppression removal/rule execution]. For more information, see the Susceptibility Update Site Parameter on page 322. When the system re-evaluates the susceptibility interpretations, it displays the previous as well as the new interpretive values. If the organism name change refers to a new drug battery, the system retains or removes drug suppression as appropriate, and prompts for results to the additional antibiotics. If rules have been defined and are enabled through the susceptibility update site parameter, the rules will be executed, with the exception of Callback rules, which are not executed for autofiled results. For more information, see About Automatic Susceptibility Updates on page 158. Note With most instruments, the online instrument has already referenced the system maintenance tables and evaluated the MIC interpretations for the organism identified. If so, acceptance of the susceptibility data requires no changes or updates. These susceptibility interpretations are based on either the ID/susceptibility card or panel or the organism ID from the culture entered on the Culture Entry tab. Selecting an Organism ID for Susceptibility Interpretation Description If your site parameter is set to automatically update susceptibility results and you accept an online susceptibility for an organism that is different from the organism observation on the Culture Entry tab, you must select the organism you UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Accepting Online Results 133 want the system to use to interpret susceptibility results. For more information about the automatic susceptibility update site parameter, see About Automatic Susceptibility Updates on page 158. Example A microbiology observation has a filed result for organism SAUR. While accepting the online organism SAUR and the corresponding susceptibility results, you notice that the methicillin result is resistant. On the Culture Entry tab, you change the organism identification from SAUR to MRSA (methicillin resistant SA). Before saving the identification change, you return to the Online tab and accept the susceptibility. The system determines that the organism ID on the Culture Entry tab differs from the online organism ID, and the Select Organism window opens. Steps to Take On the Online tab, 1 Accept an online susceptibility result. If the online organism identification is different from the identification on the Culture Entry tab, the Select Organism window opens showing the two different organism IDs. For more information, see Accepting Individual Online Results for an Observation on page 130. 2 Select the check box of the organism that you want to use to interpret online susceptibilities, and then click OK. Actions Resulting from Accepting Online Results After you accept online results, the following actions may occur: • If an online organism ID does not match the organism group of the filed observation, the message, “The new entry is not in the same organism group. Accept? Yes/No” appears. You must either accept or reject the online result. • If you accept online susceptibility results and a rule is assigned to order additional drugs, the Result Additional Susceptibilities window opens. For more information, see Entering Additional Drug Results on page 144. • If you accept an entry for an organism ID that has been previously filed on a different observation number, the system displays the message, “#<organism number n.n> is a duplicate entry. Please enter a code that hasn’t previously been entered.” • If you accept an organism ID for an observation that has previously filed susceptibilities without accepting online susceptibility results, you may receive the message, “Do you want to update susceptibility results? Yes/No.” For more information, see About Automatic Susceptibility Updates on page 158. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 134 Chapter 5: Accepting Results from Online Instruments • If your site parameter is set to automatically update susceptibility results and you accept a susceptibility result for an online organism identification that is different from the organism identification on the Culture Entry tab, you must select the organism you want the system to use to interpret susceptibility results. For more information, see Selecting an Organism ID for Susceptibility Interpretation on page 132. • If you accept a susceptibility result that is different from a filed susceptibility result of the same method code, you receive the message, “#n.n Susceptibility has been previously accepted. Combine data to existing susceptibility? Yes/<No>.” For information about responding to this message, see Combining and Overlaying Drug Results on page 123. • If any results fail susceptibility pattern checking, the QA Warnings Found window opens. For more information, see Responding to QA Failures for Susceptibilities on page 156. • Drug reporting classification schemes are automatically applied if maintenance has been defined and the result has not been previously saved. For more information, see Applying Drug Classification on page 154. • Rules may be assigned to perform an action when an organism ID or a drug susceptibility is accepted. For more information, see About Rules for Direct Exam and Culture Entry on page 55, About Rules for Susceptibility Entry on page 139, or the Rules Administrator’s Guide. Related Topics Accepting All Online Results for an Order on page 128 Accepting Individual Online Results for an Observation on page 130 Saving Online Results to a Patient Record on page 135 Locating Autofiled or Accepted Online Data After online results have been autofiled or accepted on the Online tab, you can find the results data in the following locations in Microbiology Result Entry. In this location … Find this data … Culture Entry tab Organism ID Results Summary window Organism ID and susceptibility Susceptibility tab Organism ID and susceptibility Susceptibility Summary window Organism ID and susceptibility Biotype tab Organism ID Related Topics Autofiling Results from Online Instruments on page 124 Accepting Online Results on page 127 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Saving Online Results to a Patient Record 135 Saving Online Results to a Patient Record Description After you have accepted the online results you want to retain, you can save the results to the patient record. Before You Begin Accept the online results you want to save. For more information, see Accepting All Online Results for an Order on page 128 or Accepting Individual Online Results for an Observation on page 130. Steps to Take In the Microbiology Result Entry window, • Click Save. After you save the order, the following occurs: • The organism identifications, susceptibility results, and biotype data that you accepted are saved to the patient’s file. • The Delete Online Data window opens. For more information, see Deleting Online Data on page 135. One or more of the following events may occur: • If a battery is defined to include a bill-only test, the Billing tab opens so you can enter a bill-only test. For more information, see Entering Bill Only Data on page 100. • If callback codes are appended to an observation or a susceptibility result to request a callback, a Callback window opens. For more information, see Chapter 4, Generating and Processing Call Requests in Order or Result Entry in the Callback User’s Guide. Deleting Online Data Description After online identification and susceptibility results are accepted and filed, you can retain the online data for future reference, delete it at culture final by site parameter definition, or delete it from the online instrument data file. For more information about site parameters that affect the retention of online data, see Online Instrument Result Settings on page 315. Caution After you have accepted and saved online data, if the numbering sequence for the organisms has changed, Sunquest recommends that you delete online results that were accepted during the entry session. Otherwise, during a subsequent entry session, another technologist could be confused by the original numbering of the online data cards or panels. If all online data is deleted for an observation, on the Culture Entry and Susceptibility tabs, the check mark in the O column is removed. Before You Begin Accept and save the online instrument results you want to retain. For more information, see Accepting All Online Results for an Order on page 128, Accepting Individual Online Results for an Observation on page 130, and Saving Online Results to a Patient Record on page 135. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 136 Chapter 5: Accepting Results from Online Instruments Steps to Take In Microbiology Result Entry, 1 To display the Delete Online Data window, do one of the following: • Click Cancel or Exit. • Select a tab other than the Online tab. • On the Online tab, click Select Online Results to Accept, and then click Delete Online Data. • On the Online tab, click Save. The Delete Online Data window opens. 2 Do one of the following: • To delete online data, select one or more observations, and then click Delete. The data is removed from the database. • To retain the online data, click Cancel. The data is retained in the database for 10 days or until the culture receives a Final status. Note When you select an individual observation in the Delete Online Data window, and then click Delete, only that data is deleted from the file. On the Culture Entry and Susceptibility tabs, the check mark is deleted from the O column for the appropriate observation. Related Topics Saving Online Results to a Patient Record on page 135 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview You can record drug susceptibilities for culture observations. This section includes the following topics Getting to Know Microbiology Susceptibility Entry . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Selecting a Keyboard and an Organism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Entering Susceptibility Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Entering Composed Text for Susceptibility Results . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Placing Drug Results on Hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Releasing Susceptibility Results from Hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Hiding Drug Results on Patient Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Applying Drug Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Viewing Susceptibility, Hold, Online, or Biotype Data . . . . . . . . . . . . . . . . . . . . . . . . 154 Viewing a Summary of Susceptibility Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Filing and Saving a Drug Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Responding to QA Failures for Susceptibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Modifying a Susceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Getting to Know Microbiology Susceptibility Entry You use Microbiology Susceptibility Entry to enter drug susceptibility results for a culture observation. You can also apply a drug classification scheme to susceptibilities and place susceptibilities on hold. For more information, see … About Entering Susceptibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 About Susceptibility Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 About Rules for Susceptibility Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Chapter 6 Entering Susceptibility Results 138 Chapter 6: Entering Susceptibility Results About Entering Susceptibilities You use Microbiology Susceptibility Entry to enter drug susceptibility results by keyboard method or by accepting online results from a microbiology instrument. Microbiology Susceptibility Entry displays a drug battery based on the identity of the organism and the keyboard method you select, such as Kirby Bauer. The drug battery appears on the Susceptibility tab so that you can quickly enter results. For more information, see Keyboard Maintenance Settings for Susceptibilities on page 312. Susceptibility results can consist of a numeric result, such as a zone size or a minimal inhibitory concentration (MIC) value, or an interpretive value, such as susceptible, resistant, or intermediate. Sunquest Laboratory interprets numeric results based on criteria defined in Microbiology Maintenance. For more information about standard and extended susceptibility interpretations, see Sensitivity Interpretation Definition (MMA 3) on page 26-1 in the Microbiology Administrator’s Guide. Results can be placed on hold to allow a laboratory supervisor to review them. If you need to include additional observations for a susceptibility result, you can add text comments. A drug classification is applied automatically the first time the susceptibility results are saved or placed on hold. You can reapply a drug classification to previously filed susceptibility results. You can view microbiology results, laboratory results, or a summary of susceptibility results anytime during result entry. If you need a report of patient results, you can print a patient cumulative report. You need the proper security level to enter susceptibility results. For more information about security, see Setting Security for Microbiology Applications on page 301 and the Windows-Based Applications Installation Guide. Maintenance definitions and site parameter settings control how you enter susceptibility results and text comments. For more information, see Microbiology Result Entry Settings on page 308. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Susceptibility Entry 139 About Susceptibility Entry You use the Susceptibility tab of the Microbiology Result Entry window to enter drug susceptibilities. The following illustrates the susceptibility entry process. Select a keyboard method and then select an organism. Click to view a summary of susceptibility results. Enter drug susceptibilities for the selected organism. Click to apply drug classification. Enter text comments for the susceptibility result. Click to place results on hold. Click to apply susceptibility results. About Rules for Susceptibility Entry Rules can perform the following actions: • • • • • • • Display informative messages. Append comments to a result. Append a HIDE code to a result. Append a text code to a drug. Generate a callback request. Override and change interpretations. Remove a HIDE code from a result. If your site uses rules, your system manager assigns them to perform an action after you enter or file a drug susceptibility. Rules may also execute when susceptibility results are placed on hold. Consult your system manager with any questions about the rules in your application or see the Rules Administrator’s Guide. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 140 Chapter 6: Entering Susceptibility Results Selecting a Keyboard and an Organism Description The customized keyboards you use to enter drug results include zone size, value, or interpretive result keys specific to susceptibility results. The keyboard you choose determines the method for the susceptibilities to be entered, such as Kirby Bauer, MIC, or minimal bacteriocidal concentration (MBC). You can select a keyboard by using the down arrow key or by typing the first letter of the keyboard name. For more information, see About Customized Keyboards on page 20. You Need to Know You must file results or place results on hold before selecting a different keyboard. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Susceptibility tab. A list of culture observations appears for the selected patient. Select a keyboard method. The word “On” indicates the keyboard is active. Click the organism for which you want to enter susceptibility results. 2 In the Keyboard box, type or select from the list the keyboard that you want to use to enter susceptibility results. 3 In the Organism list, select an organism to display the associated drug battery and enter drug susceptibilities. Note If you select a previously filed susceptibility result, the Susceptibility Summary window opens. Review the summary and then click OK. Related Topics Entering Drug Results on page 142 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering Susceptibility Results 141 Entering Susceptibility Results You can record an organism’s susceptibility to drugs and place the results on hold. You can also apply a drug reporting classification scheme to the results. For more information, see About Keyboard Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 About Applying Tech Final or Final Status to a Battery . . . . . . . . . . . . . . . . . . . . . . . 141 Entering Drug Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Entering Drug Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Entering Additional Drug Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Using Alternate Susceptibility Interpretive Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Using the Kirby Bauer Result Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Using MIC or MBC Result Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 About Keyboard Methods You can use the Kirby Bauer, MIC, or MBC keyboard methods with print format variations to enter susceptibility results. While the keyboard methods vary, several data entry conventions remain the same. For information about defining keyboard methods for susceptibilities, see the Microbiology Administrator’s Guide. About Applying Tech Final or Final Status to a Battery You can apply a Tech Final or Final status to a battery during susceptibility entry. Site parameter settings determine whether or not you can apply a Tech Final or Final status during susceptibility entry. For more information, see Keyboard Maintenance Settings for Susceptibilities on page 312. To apply a Tech Final or Final status during susceptibility entry, you must have the proper security level, such as the level associated with MCE or MCER. For more information, see the Windows-Based Applications Installation Guide. A battery qualifies for Tech Final or Final status during susceptibility entry if one of the following occurs: • Susceptibility results have not been entered for the battery. • Susceptibility results have been filed for one or more but not all organisms on the battery. • Susceptibility results have been filed for all organisms on the battery. • Susceptibility results have been entered but not filed for the battery. • Susceptibility results have been entered and placed on hold but not filed for one or more organisms on the battery. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 142 Chapter 6: Entering Susceptibility Results Entering Drug Results Description Drug susceptibility results can include one or more drug batteries and either a numeric result, such as a zone size or an MIC value, or an interpretive result. The identity of the organism and the keyboard method you select determines whether the drug battery is loaded automatically or entered manually. This procedure includes instructions for entering susceptibility results for an organism. Site parameter settings and maintenance definitions determine if you can add text comments to results. Site parameters can also control the placement of susceptibility comments on cumulative reports. For more information, see Composed Text Site Parameters on page 310. Site parameters settings also determine whether you can enter multiple susceptibility results for an accession number or apply a Tech Final or Final status to a battery during susceptibility entry. For more information, see Keyboard Maintenance Settings for Susceptibilities on page 312. You Need to Know While typing entries, you can use the TAB or down arrow key to move to the next cell in a column. For more information, see Using Common Keyboard Commands on page 16. You can bypass entry of a drug result depending on the settings for the site parameter [Require confirmation if drug is left unresulted in MSN]. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. Note If a drug battery does not automatically appear after you select a keyboard and an organism, you can enter drug codes. For more information, see Entering Drug Codes on page 144. 2 In the Result column, enter a numeric result or an interpretive value for each drug. Do one of the following: • Press a key that represents the value that you want to enter, or press F8 to view a map of predefined keys for the selected keyboard. • Type a numerical value, such as a whole number. • Press the Other key and then do one of the following: • Type a code or numeric result. • To look up a code, click or press F3. Note Rules may perform an action after you enter a drug result and press the TAB key. For more information, see About Rules for Susceptibility Entry on page 139. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering Susceptibility Results 143 3 To enter another value for the same drug, do the following: a Press the TAB key. A new line appears for the second result. A new line appears for another result. b Enter another result, such as a drug suppression code. For more information, see Hiding Drug Results on Patient Reports on page 153. c To end entering additional results, click another cell or press the down arrow key. 4 To enter a comment for the susceptibility, in the Comment box, do one of the following: To enter … A comment code. Do this … Enter a code or to look up a code, click or press F3. Free text comments. Type a semicolon followed by up to 140 characters of free text. Composed text using the text editor. Type # to open the Edit Composed Text window and then type text comments. For more information about composed text or default composed text, see Entering Composed Text for Susceptibility Results on page 148. A request for a callback. Enter a callback (CB) code or document callback (CD) code. When you save the result, you are prompted to enter callback contact information. Note If you enter drug suppression codes in the Comment cell, such as HIDE, the result will not be suppressed. 5 Do any of the following: • To place drug results on hold, click Hold. For more information, see Placing Drug Results on Hold on page 149. • To enter another drug battery for the same organism, repeat steps 1 through 4. • To apply the current susceptibility entries, click File. Rules may be assigned to perform an action, such as order additional drugs. For more information, see Entering Additional Drug Results on page 144. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 144 Chapter 6: Entering Susceptibility Results Entering Drug Codes Description Maintenance definitions determine if a drug battery is associated with a keyboard and an organism. If a drug battery does not automatically appear after you select a keyboard method and an organism, you can enter drug codes. You can also add drug codes to an existing drug battery. Before You Begin Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. Steps to Take On the Susceptibility tab, • To add drug codes, in an empty cell in the Drug Code column, do one of the following: • Press a key that represents the drug code you want to enter or press F8 to view a map of predefined keys for the selected keyboard. • Press the Other key and then do one of the following: • Type a drug code. • To look up a code, click or press F3. Entering Additional Drug Results Description Sunquest Laboratory can prompt you to update susceptibility results after a culture is released from hold, when a rule is assigned to order additional drugs, or after accepting susceptibility results from an online instrument. For more information, see About Automatic Susceptibility Updates on page 158. You can use the Result Additional Susceptibilities window to review drug codes and to enter drug results and comments. You cannot select the organism ID, change the keyboard method, or modify existing results. Any previously filed susceptibility results appear in the Desc column and are flagged with the prefix PREV. Steps to Take In the Result Additional Susceptibilities window, 1 In the Results column, enter a numeric result or an interpretive value for each drug. Do one of the following: • Press a key that represents the value that you want to enter or press F8 to view a map of predefined keys for the selected keyboard. • Press the Other key and then do one of the following: • Type a code or numeric result. • To look up a code, click UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems or press F3. Microbiology User’s Guide Sunquest Laboratory Entering Susceptibility Results 145 Note Rules may perform an action after you enter a drug result and press the TAB key. For more information, see About Rules for Susceptibility Entry on page 139. Enter a result and then click OK. 2 To enter another value for the same drug, do the following: a Press the TAB key. A new line appears for the second result. A new line appears for another result. b Enter another result, such as a drug suppression code. For more information, see Hiding Drug Results on Patient Reports on page 153. c To end entering additional results, click on another cell or press the down arrow key. 3 To enter a comment for the susceptibility, in the Comment box, do one of the following: To enter … A comment code. Free text comments. Microbiology User’s Guide Sunquest Laboratory Do this … Enter a code or to look up a code, click or press F3. Type a semicolon followed by up to 140 characters of free text. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 146 Chapter 6: Entering Susceptibility Results To enter … Do this … Composed text using the text editor. Type # to open the Edit Composed Text window and then type text comments. For more information about composed text or default composed text, see Entering Composed Text for Susceptibility Results on page 148. A request for a callback. Enter a callback (CB) code or document callback (CD) code. When you save the result, you are prompted to enter callback contact information. 4 Do one of the following: • To apply your additional susceptibility entries, click OK. The following events occur: • Drug classification is applied automatically to the susceptibility results. • QA pattern checking is applied to the susceptibility results. If any results fail susceptibility pattern checking, the QA Warnings Found window opens. • Rules may be assigned to perform an action when you click OK. • Sunquest Laboratory returns to the previous window and adds your entries to the microbiology battery. • To reject your entries, click Cancel. No additional susceptibility entries are added to the microbiology battery. Using Alternate Susceptibility Interpretive Codes Description Alternate susceptibility interpretive codes allow you to enter text codes with comments in place of interpretation codes. The codes and text can be used when no interpretation is available or a special notation about the susceptibility is required. Example You can define the text code SRF for “Special Report Follows.” The special report relates your comments about the susceptibility. Alternate susceptibility codes, such as SRF, are defined in English Text Code Definition (MA 4) and in the site parameter [Alternate susceptibility interpretive codes]. For more information, see the Site Parameters Administrator’s Guide. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. 2 In the Result cell, do one of the following: • Enter a text code, such as SRF. • To look up a code, press the Other key and click or press F3. 3 To add a comment about the susceptibility, in the Comment cell, do one of the following: To enter … A comment code. Do this … Enter a code or to look up a code, click UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems or press F3. Microbiology User’s Guide Sunquest Laboratory Entering Susceptibility Results 147 To enter … Do this … Free text comments. Type a semicolon followed by up to 140 characters of free text. Composed text using the text editor. Type # to open the Edit Composed Text window and then type text comments. For more information about composed text or default composed text, see Entering Composed Text for Susceptibility Results on page 148. A request for a callback. Enter a callback (CB) code or document callback (CD) code. When you save the result, you are prompted to enter callback contact information. 4 To apply the current susceptibility entries, click File. Using the Kirby Bauer Result Method Description Use the Kirby Bauer result entry format to enter a susceptibility result. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. 2 In the Result column, do any of the following: To enter … Do this … A zone size interpretation. Type a whole number representing a zone size. (Zone size must include an interpretable value based on the definitions in Microbiology Maintenance.) An interpretive value. Do one of the following: A text code. • Press a key that represents a code, such as SS (susceptible), I (intermediate), or R (resistant). • Press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. Type an alternate interpretive code, such as TF (to follow). 3 To apply the current susceptibility entries, click File. Using MIC or MBC Result Format Description Use the MIC result format or MBC result format to enter a drug result. The numeric values you enter must be interpretable based on the definitions made in Microbiology Maintenance. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 148 Chapter 6: Entering Susceptibility Results 2 In the Result column, do any of the following: To enter … Do this … A numeric result. Type a number. Greater than, less than, or equal to symbol along with a numeric result. Type <, >, =, <=, or, >= with a numeric result. A ratio. Type n.n/n.n. A combination of a greater than, less than, or equal to symbol and a ratio. Type <, >, =, <=, or, >= with a ratio. An interpretive value. Do one of the following: • Press a key that represents a code, such as SS (susceptible), I (intermediate), or R (resistant). • Press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. 3 To apply the current susceptibility entries, click File. Entering Composed Text for Susceptibility Results Description You can use composed text to enter additional comments or text about susceptibility results. You can also add to or modify default composed text. The composed text is saved with the result and is available in Microbiology Inquiry and on the following reports: • All patient reports including client reports, requisition-based reports (RBRs), and autosends. • Internal reports, such as the Culture Review, Nosocomial, Direct Exam QA, and the Epidemiology. • The Audit Trail report for sites that use paperless microbiology. If default composed text is associated with a test code, you can open the composed text box and add to or modify the text. A site parameter determines whether you can enter composed text for drug susceptibilities. For more information, see Composed Text Site Parameters on page 310. Before You Begin Enter a susceptibility result. For more information, see Entering Susceptibility Results on page 141. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Placing Drug Results on Hold 149 Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 In the Comment cell associated with the drug result, type a number sign (#). The Edit Composed Text window opens. Press CTRL+ T to change to Code Mode, type a text code, and then press CTRL+T again to translate the code into text. 2 Enter your comments or observations using codes, alphanumeric characters, and symbols. Do any of the following: To … Do this … Translate a text code into text. Press CTRL+T to change to Code Mode, type one or more text codes, and then press CTRL + T. Enter multiple text codes on one line. Press CTRL+T, type text codes using a hyphen between each code, and then press CTRL+T. Insert a page break. Press .TP or .tp to indicate a new page. Insert a blank line. Press RETURN to insert a blank line. Delete composed text. Select the text you want to remove and then press the DELETE key. Modify text. Enter or delete text, add text codes, or insert blank spaces or lines, as described in this table. 3 When your composed text entries are complete, click OK to return to entering susceptibility results. Placing Drug Results on Hold Description You can place the susceptibility results for a selected microbiology drug battery on hold. A result on hold means that the result data exists in a temporary file pending internal review and acceptance. Rules may execute when a susceptibility result is placed on hold. Drug classification is applied automatically when susceptibility results are placed on hold. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 150 Chapter 6: Entering Susceptibility Results You can view susceptibility results placed on hold in Microbiology Result Entry. On the Direct Exam, Culture Entry, and Susceptibility tabs, a check mark appears in the H check box to indicate susceptibility results that have been placed on hold. Susceptibility results on hold also qualify as activity on the No Activity Log in terminal-based Microbiology Reports. Susceptibility results placed on hold do not appear on patient reports, internal microbiology reports, Microbiology Inquiry, or Windows-based or terminal-based Inquiry. Previously filed susceptibility results cannot be placed on hold. You can append a callback code to a susceptibility result before placing the result on hold. You can also append a HIDE code to a susceptibility result on hold. Note If you delete a culture observation that includes a susceptibility result placed on hold, Sunquest Laboratory deletes both the culture observation and the susceptibility result on hold. Before You Begin Enter drug susceptibility results. For more information, see Entering Drug Results on page 142. Steps to Take On the Susceptibility tab, 1 Click Hold. Click to place susceptibility results on hold. 2 After you place susceptibility results on hold, a check mark appears in the H column. A check mark indicates a susceptibility result has been placed on hold. 3 To apply the current susceptibility entries, click Save. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Releasing Susceptibility Results from Hold 151 Releasing Susceptibility Results from Hold Description You can release susceptibility results from hold after internal laboratory review. After you release susceptibility results from hold, the H check box is cleared, and the susceptibility results are considered regular results by Sunquest Laboratory. The results appear on patient reports, internal microbiology reports, and in Microbiology Inquiry and Windows-based and terminal-based Inquiry. To release direct exam, culture, and colony count results from hold, see Releasing Direct Exam or Culture Results from Hold on page 78. Note You must release susceptibility results from hold before you can apply a Final status to the results. Site parameter settings determine whether correction statements are applied when you replace a filed result with a result on hold. For more information, see Correction Statement Site Parameters on page 310. Steps to Take On the Susceptibility tab, 1 Locate the H check box for an organism. If the box contains a check mark, then a battery has susceptibility results that have been placed on hold. A check mark indicates a susceptibility result has been placed on hold. 2 Do one of the following: • To release an individual susceptibility result from hold, in the Organism list, select the organism on hold, and then click File. You can repeat this procedure for each susceptibility result on hold. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 152 Chapter 6: Entering Susceptibility Results • To release all results from hold, click Release. The Release Hold window opens. Click to select all check boxes in the Org # column. A check mark indicates an organism and its associated results are selected for release from hold. Do any of the following: To … Do this … Release only selected results from hold. 1 In the Org # column, do the following: • Select the check box if you want to release a result from hold. • Clear the check box if you want to retain a result on hold. 2 Click Selected Only. Release all susceptibility results from hold. Click All Susceptibilities. 3 After results are released, the following events occur: • A message appears that lists each susceptibility result released from hold. • On the Susceptibility tab, in the H column, check marks are removed if all drug batteries for the organism are released. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Hiding Drug Results on Patient Reports 153 Hiding Drug Results on Patient Reports Description You can apply a predefined code that hides drug susceptibility results so that they do not appear on cumulative or interim reports. You can apply the code by selecting a check box or by manually appending it to the result you want to hide. The susceptibility results do appear on internal laboratory reports. You can view hidden drug susceptibility results in Inquiry and Microbiology Inquiry if you have the proper security level. For more information, see Inquiring on Microbiology Results on page 207. You can also view hidden drug susceptibility results in the Susceptibility Summary window. You Need to Know At most hospital or laboratory facilities, when you hide a result it appears as <<DO NOT REPORT>>. For more information, see Suppressing Results Settings on page 321. Your system manager can define maintenance to suppress drug results based on the drug battery. Note If you enter drug suppression codes in the Comment cell, the result will not be suppressed. Before You Begin Enter susceptibility drug results. For more information, see Entering Drug Results on page 142. Steps to Take On the Susceptibility tab, To hide drug susceptibility results • Do one of the following: To … Do this … Hide an individual result. In the row of the drug result, select the SUP check box. Hide all results entered so far. Select the Suppress all check box. The predefined code appears in the Result column, appended to the individual results. To remove the result suppression • Do one of the following: • To remove the suppression from an individual drug result, clear the SUP check box for the result. • To remove the suppression for all drug results, clear the Suppress all check box. The predefined code is removed from the Result column. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 154 Chapter 6: Entering Susceptibility Results Applying Drug Classification Description You can reapply a drug classification scheme to previously filed susceptibility results and to results placed on hold. Your laboratory supervisor defines drug classifications so that certain antibiotics, such as more toxic drugs, are suppressed from printing on patient reports if less toxic drugs can be prescribed. Drug classification is applied automatically the first time the susceptibility results are saved. For more information, see Drug Reporting Classification (MMA 15) on page 35-1 in the Microbiology Administrator’s Guide. Before You Begin Enter drug results. For more information, see Entering Susceptibility Results. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, • To reapply a drug reporting classification to susceptibility results, click Classify. A message appears that lists the drug classifications applied. Viewing Susceptibility, Hold, Online, or Biotype Data Description Sunquest Laboratory indicates if previously saved results are available for you to review, such as previously filed susceptibility results, susceptibility results on hold, data sent from online instruments, or biotype data. For more information about accepting susceptibility results uploaded from microbiology instruments, see Accepting Results from Online Instruments on page 117. Before You Begin Select a keyboard method and an organism. For more information, see Selecting a Keyboard and an Organism on page 140. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 Locate the S, H, O, and B check boxes for an organism. A check mark indicates results are available. 2 To view previously filed results, do the following: A check mark in the … Means you can view … Do this … S column. Susceptibility results on file. Click the Susceptibility tab. H column. Susceptibility results on hold. O column. Results sent from an instrument. Click the Online tab. B column. Biotype or biochemical data. Click the Biotype tab. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing a Summary of Susceptibility Results 155 Viewing a Summary of Susceptibility Results Description You can review a summary of identified organisms and their associated susceptibility results. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take On the Susceptibility tab, 1 Locate the S check box for an organism. If the box contains a check mark, then susceptibility results have been filed for the organism. A check mark indicates results are available. 2 Click Summary. The Susceptibility Summary window opens. Click this check box to view all identified organisms and susceptibility results for the selected order. 3 In the Susceptibility Summary window, review any of the following susceptibility results recorded for the identified organisms: • Colony count information • One or more culture observations entered on a battery • Numbered list of organism identification or culture observations • Susceptibility method • ZZ battery number • Drug code • Result Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 156 Chapter 6: Entering Susceptibility Results • Extended MIC interpretation • Online data • Drugs grouped by interpretation 4 When you are done reviewing the results, click OK. The system returns to the previous window. Filing and Saving a Drug Result Description You can file the current susceptibility results for the selected observation before saving them in the patient file. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, To apply the current susceptibility entries • Click File. One or more of the following events may occur: • If any results fail susceptibility pattern checking, the QA Warnings Found window opens. For more information, see Responding to QA Failures for Susceptibilities on page 156. • Drug classification schemes are automatically applied to the susceptibility results if the results have not been previously saved. A message appears that lists the drug classifications applied. • Rules may be assigned to perform an action when a drug susceptibility is filed. For more information, see About Rules for Susceptibility Entry on page 139 or the Rules Administrator’s Guide. To save susceptibility results in the patient file • Click Save. One or more of the following events may occur: • If callback codes are appended to a susceptibility result to request a callback, a Callback window opens. For more information, see Chapter 4, Generating and Processing Call Requests in Order or Result Entry in the Callback User’s Guide. Responding to QA Failures for Susceptibilities Description Sunquest Laboratory performs Quality Assurance (QA) checking to compare the susceptibility pattern against the defined drug pattern for the culture, specimen type, organism, and susceptibility method. If any results fail the pattern check, the QA Warnings Found window appears. You can review the antibiotics that have failed the QA pattern checking and accept or reject the pattern check failure. If you accept a pattern check failure, the accession number associated with the pattern check failure qualifies for the Susceptibility Quality Assurance report. Your system manager defines the susceptibility patterns for all susceptibility methods in Microbiology Maintenance. For more information, see Quality Assurance (MMA 10) in the Microbiology Administrator’s Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying a Susceptibility 157 Steps to Take In the QA Warnings Found window, 1 Review the QA failures. View the organism, drug, interpretation, and expected result that failed susceptibility pattern check. 2 Do one of the following: • To accept the susceptibility pattern check, click Accept. Sunquest Laboratory updates the patient’s record. • To reject the susceptibility pattern check, click Reject. The susceptibility pattern check is rejected and the Susceptibility tab appears so you can modify the drug result. Modifying a Susceptibility You can modify drug susceptibility results for a selected culture observation. For more information, see … About Correction Statements and Modified Drug Results . . . . . . . . . . . . . . . . . . . . . 158 About the Not Done Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 About Crediting a Microbiology Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 About Automatic Susceptibility Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Modifying a Drug Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 158 Chapter 6: Entering Susceptibility Results About Correction Statements and Modified Drug Results Modified drug results can include a correction statement. Correction statements are free text statements that can be applied to a modified drug result or a final drug result to record the previous result and the date and time it was filed. Correction statements for susceptibilities are controlled by site parameters. For more information, see Correction Statement Site Parameters on page 310. The correction statement appears on patient reports, in Inquiry, and in Microbiology Result Entry. The correction statement is appended to the susceptibility comment. About the Not Done Code When you delete a previously filed result and do not replace it with another entry, Sunquest Laboratory automatically applies a Not Done (ND) code as the result. About Crediting a Microbiology Battery You use terminal-based or Windows-based Credit to delete a previously filed susceptibility battery. Crediting the battery ensures that the susceptibility battery and its results are deleted from the system. For more information about Credit, see the Laboratory User’s Guide or General Laboratory Help. About Automatic Susceptibility Updates The site parameter [Automatic susceptibility update/suppression removal/rule execution] determines whether susceptibility results are updated when an organism ID is updated on the Culture Entry tab or when an online organism ID is accepted. This is a three-part site parameter. If the first part is set to N, the other two parts are ignored and no automatic susceptibility update, suppression removal, or rule execution occurs when an organism ID is updated or an online result is accepted. There are four other possible settings for this site parameter: Y/Y/Y, Y/N/Y, and Y/Y/ N, and Y/N/N. Updating Susceptibilities If part one of the site parameter is set to Y and you update an organism ID or accept an online organism ID, the system displays the message, “Do you want to update susceptibility results? Yes/No.” If you click Yes, the system updates the susceptibility results for the observation as follows: • For drugs that were on the old battery but not the new, the system updates the interpretation. • For drugs that are on the new battery but not the old, the system adds the drugs to the susceptibility battery. • For drugs that are on both the old and new batteries, the system updates the susceptibility battery with the existing result and new interpretation. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying a Susceptibility 159 Note If the system performs a susceptibility update against a second organism ID, and the update results in no modifications to the original susceptibility, the system does not notify the user. For example, a susceptibility update with no changes can occur in the following situation. The second organism ID (an MO code) is associated with the first organism ID (an MG code) and the second organism ID has no drugs defined for the method in Microbiology Maintenance for interpretations. Therefore, the system references the drugs defined for the same method for the MG code. Since those definitions are identical to the ones already filed for the susceptibility, no changes result from the susceptibility update. Note If a rule is assigned to order additional drugs, the Result Additional Susceptibilities window opens. For more information, see Entering Additional Drug Results on page 144. If you click No, the online susceptibility result is not filed, and any previously filed susceptibility result is retained and associated with the updated organism ID. Updating Susceptibilities with Suppressions If parts one and two of the site parameter are set to Y, when you update an organism ID or accept an online organism ID and reply Yes to the update susceptibility message, the system retains comments, composed text, or free text previously appended to a drug result on the old battery and applies or removes HIDE results as follows: • The system retains any suppression that was previously applied to a drug at the test level. • The system discards any suppression that was previously applied to a drug by one of the following means: • Defined at the battery level (MA 1) • Appended manually (via hyphen HIDE) • Appended as a result of drug classification (MMA 15) • Appended as a result of a susceptibility rule (APPEND_HIDE action) defined in Rule Maintenance and Report • The system reapplies drug suppression to the modified susceptibility based on MA 1 definitions, as follows: • If the drug was on the old battery but not the new, and • maintenance is set to strip off old suppression, the system does not reapply suppression. • maintenance is not set to strip off old suppression, the system leaves the suppression in place. • If the drug is on the new battery but not the old, and the drug is defined to be suppressed on the new MA 1 battery, the system applies suppression. • If the drug is on both the old and new batteries, and the drug is defined to be suppressed on the new MA 1 battery, the system applies suppression. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 160 Chapter 6: Entering Susceptibility Results Updating Susceptibilities and Executing Rules If parts one and three of the site parameter are set to Y, when you update an organism ID or accept an online organism ID and reply Yes to the update susceptibility message, the system executes any rules assigned to perform an action when a drug susceptibility is filed. Modifying a Drug Result Description You can change or delete a drug result, add a drug code, or modify text comments. Sunquest Laboratory replaces the old result with the new result and the interpretation. You can add free text comments to the modified susceptibility result. You can also re-apply drug classification schemes to a modified susceptibility result. Site parameters control whether a correction statement is applied to modified susceptibility results. For more information, see Correction Statement Site Parameters on page 310. The security level assigned to you determines whether you can delete drug results. To determine if you have the proper security level, Sunquest Laboratory checks the security level assigned to you for MSN and MSNR. If your security is limited to MSNR, you cannot delete drug results. For more information, see Setting Security for Microbiology Applications on page 301 and the Windows-Based Applications Installation Guide. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know To modify a previously filed susceptibility result, you must select the same keyboard used to enter the result. Steps to Take In the Microbiology Result Entry window, on the Susceptibility tab, 1 In the organism list, click the identified organism and associated susceptibility result that you want to modify. Click a result. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying a Susceptibility 161 The Susceptibility Summary window opens. Lists the organism reference number, keyboard method, and battery. View previously filed susceptibility results for the selected organism. 2 Review the summary, note the keyboard method listed under the organism reference number, and then click OK. 3 In the Keyboard box, enter the keyboard method. The previously filed results for the selected organism appear. 4 Do any of the following: To … Do this … Add a drug code. In the Drug Add a result. Delete a result. Add or modify composed text. Code column, do one of the following: • Press a key that represents the drug code that you want to enter. • Press F8 to view a map of predefined keys for the selected keyboard and enter the appropriate drug code. In the Result column, do one of the following: • Press a key that represents the susceptibility result you want to enter. • Press F8 to view a map of predefined keys for the selected keyboard and enter the appropriate result code. In the Result column, select the entry, and then press the DELETE key. • If the result has not yet been saved, the result is deleted. • If the result was previously saved and was part of a ZZ battery, the result is replaced with the code ND (Not Done). The message ND appears in the susceptibility summary. In the Comment column, type a number sign (#). The Composed Text window opens. For more information, see Entering Composed Text for Susceptibility Results on page 148. For more information, see Entering Drug Results on page 142. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 162 Chapter 6: Entering Susceptibility Results 5 To accept your modified susceptibility entries, click Save. Related Topics Placing Drug Results on Hold on page 149 Hiding Drug Results on Patient Reports on page 153 Applying Drug Classification on page 154 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview If your site uses the other testing feature, you can order and result nonmicrobiology tests, such as urine microscopies and rapid strep screens, as part of a microbiology battery. For example, you can result a rapid strep screen as part of the same battery as the throat culture. The screen and culture results appear together under the same accession number on the patient report. You must have the proper security to enter other testing results. For more information, see Setting Security for Microbiology Applications on page 301 in the Windows-Based Applications Installation Guide. This section contains the following topics Getting to Know Other Testing Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Entering Other Testing Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Responding to QA Failures for Other Testing Results. . . . . . . . . . . . . . . . . . . . . . . . 168 Placing Other Testing Results on Hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Releasing Other Testing Results from Hold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Hiding Other Testing Results on Patient Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Saving Microbiology Result Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Getting to Know Other Testing Result Entry If your site uses the other testing feature, your microbiology laboratory can result non-microbiology tests defined as “other testing” together with microbiology tests. For example, a urine microscopy defined as other testing can be added to a Chapter 7 Entering Results for Other Testing 164 Chapter 7: Entering Results for Other Testing microbiology battery and resulted together with the urine culture. When entered as part of one battery, the microbiology and non-microbiology results appear together in inquiry and on reports. The results for other tests resulted as part of a microbiology battery appear after special requests (SREQ). Manual Result Entry When a microbiology battery includes non-microbiology tests, you enter the results to these tests in Microbiology Result Entry using the Other Tests tab. As a rule, you enter results for mandatory tests and add optional tests using a customized keyboard defined for the other testing battery. The system requires that at least one customized keyboard be defined for the placeholder test in Other Testing Keyboard Definition (MMA 22). For more information, see Getting to Know Customized Keyboards on page 20. As needed, you can temporarily make the customized keyboard inactive. This allows you to enter free text and to enter or look up result or test codes. For more information, see Entering Free Text and Codes Not Defined on a Customized Keyboard on page 27. The placeholder test for other testing remains pending if no result is entered and saved for it. If an autoanswer result is defined for the placeholder test in Other Testing Maintenance, the result appears in the result column and can be modified as needed. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Other Testing Result Entry 165 Online Result Entry If other testing is performed by an instrument, a check mark appears in the O column for the test if online results are available for review test on the Online tab. For more information, see Chapter 5, Accepting Results from Online Instruments. A check mark in the O column indicates that online data is available. Note Autofiling, preprocessing, and calculations are not available for online results of other testing. Result components cannot be accepted individually. Accession-Level Comments For information about entering accession result comments, see Using Accession Result Comments on page 112. Correction Statements In addition to general laboratory settings applied when determining whether to apply correction statements, the system uses some microbiology site parameters. Site parameter settings determine whether correction statements are applied to other testing results. For more information, see Correction Statement Site Parameters on page 310. Rules Based on the results entered and rule definitions at your site, the battery results may be sent to a clinical validation queue. For more information, see Chapter 13, Reviewing and Validating Clinical Results. For information about setting up rules for Clinical Validation, see the Rules Administrator’s Guide. Maintenance Settings and Site Parameters For a brief summary of the settings affecting other testing, see Other Testing Settings on page 314. For detailed information about other testing, see Chapter 5, Setting Up Non-Microbiology Tests for Microbiology Result Entry, in the Laboratory for Windows Administrator’s Guide. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 166 Chapter 7: Entering Results for Other Testing Maintenance definitions and site parameter settings control how you enter results and text comments. For more information, see Microbiology Result Entry Settings on page 308. Entering Other Testing Results Description Use this procedure to record results to non-microbiology tests included in a microbiology battery via a placeholder test for other testing. The list of test codes on the Other Tests tab includes tests associated with the placeholder test in Other Testing Maintenance and marked as mandatory. Tests not marked as mandatory are not listed, but can be added during result entry as needed. For information about maintenance for other testing and site parameters affecting result entry for other tests, see Other Testing Settings on page 314. Steps to Take Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. Steps to Take In the Microbiology Result Entry window, 1 Click the Other Tests tab. The mandatory tests appear in the Test Code column and the default keyboard appears in the Keyboard box. The word “On” indicates that the keyboard is active. Click Results. Select a keyboard. To view the key assignments on a keyboard map, press F8. To add a non-mandatory test associated with the current placeholder test, in the Test Code column, in the blank row, press the appropriate test key. You can also press the Other key and type or look up a test code not defined to the keyboard. To enter a result, in the Result column, press the appropriate result key. You can also press the Other key and enter text codes and free text as needed. A check mark in the O column indicates that instrument results are available for review on the Online tab. 2 To select a different keyboard, in the Keyboard box, type or select a keyboard name. For more information, see Selecting a Customized Keyboard on page 25. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Entering Other Testing Results 167 Note To view a map of the assigned keys, press F8. For more information, see Entering Codes Using a Customized Keyboard on page 27. 3 In the Test Code column, find the test you want to result. If the test is not in the list, to add the test, place the cursor in the blank cell, and do either of the following: • Press the key defined for the test on the customized keyboard, or • If the test is not defined on the keyboard, press the Other key, and then type the test code or click to look it up. 4 To enter a result, in the Result column, click the result entry cell for the test, and then do any of the following: To … Do this … Enter a result using the customized keyboard. Either of the following: Temporarily make the customized keyboard inactive to enter a result not defined on the keyboard. • Press the key assigned to the result, or • To view and use a map of the assigned keys, press F8. For more information, see Entering Codes Using a Customized Keyboard on page 27 1 Press the Other key. 2 Do one of the following: • To enter a text code result, type a text code or • To enter a number, type a semicolon (;) followed by the number. • To enter free text, type a semicolon followed by up to 140 characters of free text. • To enter composed text, type a pound sign (#) followed by the text comment. click Enter another result. to look it up. 1 Press the TAB key. A new line appears for the next result. A new line appears for another result. 2 Enter the next result on or off the keyboard. For example, you may want to append a callback (CB) code or document callback (CD) code. If a result you entered fails QA, see Responding to QA Failures for Other Testing Results on page 168. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 168 Chapter 7: Entering Results for Other Testing 5 To put the results for a test on hold, in the row of the test, select the HLD check box. For more information about results on hold, see Placing Other Testing Results on Hold on page 169. 6 To suppress the results for a test, in the row of the test, select the SUP check box. For more information, see Hiding Other Testing Results on Patient Reports on page 171. 7 To have multiple result components print on one line in inquiry and on reports, select the Group check box to the right of the component that should appear as the last component. This and all preceding components will appear on one line. Example If you enter four codes and select the Group check box for the third one, the translations of the first three codes will appear on the same line, while the fourth code will appear on a separate line. Note If the result key is defined as a terminator key, the group check box next to the result is selected automatically. 8 To save the result, click Save. For more information, see Saving Microbiology Result Data on page 172. Related Topics Accepting Online Results on page 127 Assigning a Final Status to a Battery on page 176 Assigning a Tech Final Status to a Battery on page 174 Responding to QA Failures for Other Testing Results on page 168 Viewing Laboratory and Microbiology Results in Inquiry on page 105 Viewing a Summary of Results on page 94 Responding to QA Failures for Other Testing Results Description After you move the cursor away from the result entry cell, the system performs QA checking on the first result. The system first references the QA range defined for the method associated with the keyboard in Other Testing Keyboard Definition (MMA 22). If the keyboard is not associated with a method, the system references the default QA range for the test. If neither exist, QA checking is not performed. For information about QA definitions, see Chapter 7, Quality Assurance Data in the Laboratory Administrator’s Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Placing Other Testing Results on Hold 169 When a result fails QA checking, an information message similar to the following appears: For information about QA failures when entering results for general laboratory tests, see Responding to Quality Assurance Failures on page 10-4 in the Laboratory User’s Guide. You Need to Know If site parameter [Confirm acceptance of technically failed results in ME/OE] is set to Y, a second confirmation message appears requiring you to confirm that the results entered failed the technical limit check. Steps to Take To respond to a QA failure message: • Determine whether the result is correct and then do one of the following: • If the result is correct and you want to proceed with entering results, click OK. • If the result is not correct, click Cancel. The result is automatically selected and can be deleted or modified. Placing Other Testing Results on Hold Description Results for other testing that need to be reviewed by a supervisor before they are reported outside of the laboratory can be placed on hold. When a test is placed on hold the result data exists in a temporary file pending internal review and acceptance. Results on hold do not appear on reports or in Inquiry. The results can be viewed on the Other Tests tab. Your security level determines if you can place observations on hold. For more information, see the Windows-Based Applications Installation Guide. If a test has multiple entries, you can place the test on hold, but not selected result components. Before You Begin Enter results for other testing. For more information, see Entering Other Testing Results on page 166. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 170 Chapter 7: Entering Results for Other Testing Steps to Take On the Other tests tab, 1 In the row of the test, in the HLD column, select the check box. Click the check box in the HLD column to place a result on hold. 2 To save your entries, click Save. Related Topics Releasing Other Testing Results from Hold on page 170 Releasing Other Testing Results from Hold Description You can release other testing results from hold after internal laboratory review. After you release results from hold, the results are considered regular results by Sunquest Laboratory. The results appear on patient reports, internal microbiology reports, in Microbiology Inquiry, and in Windows-based and terminal-based Inquiry. You must release other testing results from hold before you can apply a Final status to the battery. You need the proper security level to release other testing results from hold. For more information, see the Windows-Based Applications Installation Guide. Steps to Take On the Other Tests tab, 1 Locate the HLD check box for the test. If it contains a check mark, then the results of the test have been placed on hold. A check mark indicates results have been placed on hold. 2 To release the results of the test from hold, in the HLD column, clear the check box. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Hiding Other Testing Results on Patient Reports 171 3 To save your entries, click Save. Related Topics Assigning a Tech Final Status to a Battery on page 174 Assigning a Final Status to a Battery on page 176 Hiding Other Testing Results on Patient Reports Description You can apply a predefined code that hides results so that they do not appear on patient reports. You can apply the code by selecting a check box or by manually appending it to the result you want to hide. The hidden results do appear on internal laboratory reports. You can view them in Inquiry and Microbiology Inquiry if you have the proper security level. For more information, see Inquiring on Microbiology Results on page 207. You can also view hidden results in the Results Summary window. You Need to Know At most hospital or laboratory facilities, when you hide a result it appears as <<DO NOT REPORT>>. For more information, see Suppressing Results Settings on page 321. Before You Begin Enter the results. For more information, see Entering Other Testing Results on page 166. Steps to Take On the Other Tests tab, To hide other testing results • Do one of the following: To … Do this … Hide the results of an individual test. In the row of the test, select the SUP check box. Hide all results entered so far. Select the Suppress all check box. The predefined code appears in the Result column, appended to the individual results. To remove the result suppression • Do one of the following: • To remove the suppression from an individual other testing result, clear the SUP check box for the result. • To remove the suppression for all other testing results, clear the Suppress all check box. The predefined code is removed from the Result column. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 172 Chapter 7: Entering Results for Other Testing Saving Microbiology Result Data Description You can save results without finaling them. For example, if the placeholder test or any other test has not be resulted, you cannot final the battery, but you can save the result data entered for the battery. If you added and resulted optional other tests, these tests are added to the battery at this time. Before You Begin Enter other results. For more information, see Entering Other Testing Results on page 166. Steps to Take In the Microbiology Result Entry window, with any tab active, • Click Save. After you save the observation, one or more of the following events may occur: • If a battery is defined to include a bill-only test, the Billing tab activates so you can enter a bill-only test. For more information, see Entering Bill Only Data on page 100. • If callback codes are appended to an observation to request a callback, a Callback window opens. For more information, see Chapter 4, Generating and Processing Call Requests in Order or Result Entry, in the Callback User’s Guide. • Rules may be assigned to perform an action when the observation is saved. For more information, see About Rules for Direct Exam and Culture Entry on page 55. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview This section contains information about applying a Tech Final or Final status to the results of a microbiology battery. This section includes the following topics About Tech Final Status and Final Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Assigning a Tech Final Status to a Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Assigning a Final Status to a Battery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 About Tech Final Status and Final Status A Tech Final status means that the direct exam, culture, or other testing results qualify for the Culture Review report when requested for Tech Finals, and are available for internal lab review, modification, and release in Microbiology Tech Final Release. The results are available for review in both Inquiry and Microbiology Inquiry. The report status test (RPT) shows as “pending” in Laboratory Inquiry and as “preliminary” in Microbiology Inquiry. A Final status means that the direct exam, culture, or other testing results passed internal review (if Tech Final was used) and appear on patient reports and in Laboratory Inquiry as finaled results. You can assign a Tech Final or Final status to a battery if the following tasks have been completed: • Results have been released from hold. • A result is entered for both specimen description (SDES) and special request (SREQ). • All tests have been resulted on the battery, such as direct exam, culture, colony count, or other testing. Applying a Tech Final or Final status to a result updates the report status test code (RPT) component of the microbiology battery. The test RPT appears as: • Report Status Preliminary (Tech Final) in Microbiology Inquiry. • Report Status Pending (Tech Final) in terminal-based and Windows-based Inquiry and patient reports. • Report Status Final in terminal-based and Windows-based Inquiry, Microbiology Inquiry, and patient reports. Chapter 8 Assigning Tech Final and Final Results 174 Chapter 8: Assigning Tech Final and Final Results The test RPT also updates the Report field in the specimen header. The following illustrates the Report field in the specimen header for a Tech Final status. Shows the status and the date and tech code of the person who applied the result. The following illustrates the Report field in the specimen header for a Final status. Shows the status and the date and tech code of the person who applied the result. You need the proper security level to assign a Final status to a battery. For more information, see the Windows-Based Applications Installation Guide. Assigning a Tech Final Status to a Battery When results are complete and ready for internal review, you can assign a Tech Final status. The Tech Final status qualifies the results for the Culture Review report and alerts the microbiology laboratory supervisor or pathologist that the results are ready for internal review. For more information, see … About Quality Assurance Checking for Tech Final Status. . . . . . . . . . . . . . . . . . . . . . 174 Assigning a Tech Final Status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Deleting a Tech Final Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 About Quality Assurance Checking for Tech Final Status Your system manager defines Quality Assurance maintenance definitions to identify results in a direct exam test that must also be identified in a culture test. For each desired organism group code, such as gram negative rods, the maintenance UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Assigning a Tech Final Status to a Battery 175 definitions contain quantifications in the direct exam, such as 3+, 4+, that require identification of an organism of that same group and quantity in the culture results. Sunquest Laboratory compares the Quality Assurance maintenance definitions with the following direct exam data: • • • • Battery code Specimen type Organism code or group code entered as a result in the direct exam Quantification of the organism entered as a result in the direct exam Sunquest Laboratory uses the data to determine whether the culture results in the battery match the same organism code or belong to the same group code entered for the direct exam. If the quantification resulted in the direct exam is listed in the Quality Assurance maintenance definitions, then QA failure occurs if the organism is not found in the culture. Any results that fail quality assurance checking appear in the QA Warnings Found window: • If you accept the failures, the test RPT changes to Tech Final. • If you reject the failures, Sunquest Laboratory cancels the Tech Final and returns to the cell for entering culture results. Assigning a Tech Final Status Description When results are ready for internal review, you can apply a Tech Final status. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know You use customized keyboards to assign a Tech Final to a battery. For more information, see About the Tech Final Key on page 23. Steps to Take On the Direct Exam, Culture Entry, or Other Tests tab, 1 In the Result column, press the TAB key or the down arrow key to move to an empty cell. 2 Press a key that represents Tech Final or press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. If Quality Assurance is defined for direct exams, Sunquest Laboratory verifies that each result in the direct exam has a corresponding culture result. 3 After you apply the Tech Final status, Sunquest Laboratory: • Places battery results in Tech Final status. • Updates the Report field in the specimen header with Tech Final, the date the battery was assigned Tech Final, and the tech code of the person who assigned the Tech Final. • Displays the Report Status as Pending in Inquiry and patient reports. • Displays the Report Status as Preliminary in Microbiology Inquiry. 4 To save your entries, click Save. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 176 Chapter 8: Assigning Tech Final and Final Results Deleting a Tech Final Status Description If you have the proper security level, you can delete a Tech Final status that has been assigned to a battery. After you delete a Tech Final status, the status Prelim appears in the Report field in the specimen header. For more information on security levels, see the Windows-Based Applications Installation Guide. Steps to Take On the Direct Exam, Culture Entry, or Other Tests tab, 1 In the Result column, press the TAB key or the down arrow key to move to an empty cell. 2 Press a key that represents Tech Final or press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. 3 After you enter the result, the following message appears: “Battery already has <Tech Final> result. Do you want to delete?” • To delete the Tech Final status, click Yes. • To return to the blank Result line and retain the existing Tech Final status, click No. 4 To save your entries, click Save. Assigning a Final Status to a Battery When direct exam, culture, drug susceptibility, and other testing results are ready to be released to appear on patient reports and Inquiry functions, you can apply a Final status. For more information, see … About Quality Assurance Checking for Final Status . . . . . . . . . . . . . . . . . . . . . . . . . . 176 About Final Status and Deleting Online Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Assigning a Final Status to a Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Assigning a Final Status to a Battery with Tech Final Status . . . . . . . . . . . . . . . . . . . 178 Deleting a Final Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 About Quality Assurance Checking for Final Status Your system manager defines Quality Assurance maintenance definitions to identify results in a direct exam test that must also be identified in a culture test. For each desired organism group code, such as gram negative rods, the maintenance definitions contain quantifications in the direct exam, such as 3+, 4+, that require identification of an organism of that same group and quantity in the culture results. Sunquest Laboratory compares the Quality Assurance maintenance definitions with the following direct exam data: • Battery code UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Assigning a Final Status to a Battery 177 • Specimen type • Organism code or group code entered as a result in the direct exam • Quantification of the organism entered as a result in the direct exam Sunquest Laboratory uses the data to determine whether the culture results in the battery match the same organism code or belong to the same group code entered for the direct exam. If the quantification resulted in the direct exam is listed in the Quality Assurance maintenance definitions then QA failure occurs if the organism is not found in the culture. Any results that fail quality assurance checking appear in the QA Warnings Found window: • If you accept the failures, the status changes to Final and the accession number qualifies for the Direct Exam Quality Assurance Report. If you reject the failures, Sunquest Laboratory cancels the Final and returns to the cell for entering culture results. About Final Status and Deleting Online Data After online instrument data is accepted and a Final status is applied to a battery, Sunquest Laboratory checks the setting for the site parameter [Delete on-line instrument data upon culture final]: • If the site parameter is set to Y, Sunquest Laboratory deletes all online instrument data. • If the site parameter is set to N, Sunquest Laboratory retains all online instrument data for ten days. Assigning a Final Status to a Battery Description You can assign a Final status to a battery after you have finished entering observations and the results are ready to be released to appear on patient reports and in Inquiry. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know When you assign a Final status to a battery, you press a predefined key on your PC keyboard. For more information, see About the Final Key on page 23. You cannot apply a Final status if the battery is still assigned to a Clinical Validation queue. Steps to Take On the Direct Exam, Culture Entry, or Other Tests tab, 1 In the Result column, press the TAB key or the down arrow key to move to an empty cell. 2 Press a key that represents Final or press F8 to view a map of predefined keys for the selected keyboard, and then enter the appropriate result. 3 After you apply a Final status, Sunquest Laboratory: • Invokes Quality Assurance checking. • Places the battery results in Final status. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 178 Chapter 8: Assigning Tech Final and Final Results • Results the test RPT with the tech code of the person who assigned the Final status and the date the battery was assigned Final status. • Updates the Report field in the specimen header with Final, the date the battery was assigned Final, and the tech code of the person who assigned the Final. • Displays the Report Status as Final in Microbiology Inquiry, Inquiry, and patient reports. 4 To save your entries, click Save. Assigning a Final Status to a Battery with Tech Final Status Description When direct exam, culture, drug susceptibility, and other testing results have passed internal review, are assigned Tech Final status, and are ready to be released to appear on patient reports and in Inquiry, you can apply a Final status. Before You Begin Search for a microbiology order. For more information, see Searching for a Microbiology Order on page 55. You Need to Know When you assign a Final status to a battery, you press a predefined key on your PC keyboard. For more information, see About the Final Key on page 23. You cannot apply a Final status if the battery is still assigned to a Clinical Validation queue. Microbiology laboratory supervisors can assign a Final status to a battery in Microbiology Tech Final Result. For more information, see Releasing a Batch of Microbiology Batteries on page 184. Steps to Take On the Direct Exam, Culture Entry, or Other Tests tab, 1 In the Results column, press the TAB key or the down arrow key to move to an empty cell. 2 Press a key that represents Final or press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. 3 After you apply the Final status, Sunquest Laboratory: • Invokes Quality Assurance checking. • Deletes the Tech Final status for test RPT. • Places the battery in Final status. • Updates the test RPT with the tech code of the person who assigned a Final status and the date the battery was assigned a Final status. • Updates the Report field in the specimen header with Final, the date the battery was assigned Final, and the tech code of the person who assigned the Final. • Displays the Report Status as Final in Microbiology Inquiry, Inquiry, and patient reports. 4 To save your entries, click Save. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Assigning a Final Status to a Battery 179 Deleting a Final Status Description If you have the proper security level, you can delete a Final status that has been assigned to a battery. For more information about security levels, see the Windows-Based Applications Installation Guide. After you delete a Final status, the status Prelim appears in the Report field in the specimen header. Steps to Take On the Direct Exam, Culture Entry, or Other Tests tab, 1 In the Results column, press the TAB key or the down arrow key to move to an empty cell. 2 Press a key that represents Final or press F8 to view a map of predefined keys for the selected keyboard and then enter the appropriate result. 3 After you enter the result, the following message appears: Battery already has <Final> result. Do you want to delete? • To delete the Final status, click Yes. • To return to the blank Observation box and retain the existing Final status, click No. 4 To save your entries, click Save. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 180 Chapter 8: Assigning Tech Final and Final Results UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview Use Microbiology Tech Final Release to release batteries that have been assigned Tech Final status. You can work from either a culture review batch or a sequence worksheet batch. This section includes the following topics Getting to Know Microbiology Tech Final Release . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Starting Microbiology Tech Final Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Releasing a Batch of Microbiology Batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Modifying a Batch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Getting to Know Microbiology Tech Final Release Use Microbiology Tech Final Release to release batteries that have been assigned Tech Final status. You can work from either a culture review batch or a sequence worksheet batch. When you release a battery, the status of the battery is updated from Tech Final to Final. To use Microbiology Tech Final Release, you must have the proper security. For more information, see Setting Security for Microbiology Tech Final Release on page 303. For more information, see … About Releasing Batteries and Tech Final Status . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 About the Microbiology Tech Final Release Window . . . . . . . . . . . . . . . . . . . . . . . . 182 About Releasing Batteries and Tech Final Status A microbiology battery is ready to be reviewed and released after the test RPT (report test code) is assigned a Tech Final status. You can release batteries in Tech Final status by batch in Microbiology Tech Final Release, using a culture review batch or a sequence worksheet batch, depending on the mode setting at your site. For more information about settings, see Microbiology Tech Final Release Settings on page 323. Chapter 9 Releasing Microbiology Results 182 Chapter 9: Releasing Microbiology Results The following table shows how batteries may appear in Microbiology Tech Final Release for the culture review batch and the sequence worksheet batch. If … Then in Microbiology Tech Final Release … Not all of the batteries on an accession number are assigned a Tech Final status. Only the batteries with Tech Final status appear and qualify for release. In Microbiology Result Entry, the Tech Final status is removed for one of the batteries. The battery is not updated to Final status or counted when the battery is released. If you are using a sequence worksheet, the batteries must also be assigned to that worksheet. Note Sunquest recommends reviewing and releasing batches on a timely basis so the system can release the results to Final status and reassign batch numbers as needed. Culture review batches older than seven days are removed by file cleanup. If a batch number is reassigned, Sunquest Laboratory overwrites the old batch data with the new batch data. About the Microbiology Tech Final Release Window You can use the Microbiology Tech Final Release window to select a batch to review, modify (by adding or removing accession numbers), and release batteries. You can also modify the shift or add tech codes. You can select the Culture Review Batch tab or the Sequence Worksheet Batch tab, depending on the setting for the site parameter [Allow updates in Micro Tech Final using Sequence Worksheet Batch (SWB) /Culture Review Batch (<CRB>)/Both (B)] at your site. When the site parameter is set for both, the Culture Review Batch tab displays by default when you start the application. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Microbiology Tech Final Release 183 The following example shows the elements of the Culture Review Batch tab. Select a batch with batteries in Tech Final status. Accession details. Shows the number of batteries in the batch. Modify tech code or shift. Click to release. Add or remove accessions. The following example shows the elements of the Sequence Worksheet Batch tab. Select a sequence worksheet and batch. Accession details. Microbiology User’s Guide Sunquest Laboratory Shows the number of batteries in Tech Final status. Add or remove accessions. Modify tech code or shift. Click to release. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 184 Chapter 9: Releasing Microbiology Results Starting Microbiology Tech Final Release Description Use this procedure to start Microbiology Tech Final Release. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Logging On to Sunquest Laboratory on page 22. 2 In the Sunquest Gateway window, on the Microbiology tab, double-click Microbiology Tech Final Release. The Microbiology Tech Final Release window opens. Releasing a Batch of Microbiology Batteries You can release all batteries in Tech Final status using either a culture review batch or a sequence worksheet batch. For more information, see … About Locked Accession Numbers and Releasing Batteries . . . . . . . . . . . . . . . . . . . 184 About Crediting Accession Numbers and Releasing Results . . . . . . . . . . . . . . . . . . . 184 Looking Up a Batch Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Releasing Batteries in a Culture Review Batch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Releasing Batteries in a Sequence Worksheet Batch . . . . . . . . . . . . . . . . . . . . . . . . 187 About Locked Accession Numbers and Releasing Batteries If an accession number is locked while a battery is being released, the accession number appears in the batch, but is not released. A low priority message is logged, and the battery is not included in the count in the Number of batteries field. A locked accession number in a culture review batch re-qualifies for another culture review batch. If the accession is on a sequence worksheet batch, it remains in the same batch. About Crediting Accession Numbers and Releasing Results Accession numbers that received a credit and are assigned to a batch appear in Microbiology Tech Final Release. In Microbiology Inquiry, you can view a message that indicates which accession numbers received a credit. You can credit a test or battery using either terminal-based or Windows-based Sunquest Laboratory. For more information about crediting, see the Laboratory User’s Guide for terminal-based Sunquest Laboratory or see Help for the General Laboratory application. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Releasing a Batch of Microbiology Batteries 185 The application you use to credit a battery determines whether a Final is applied or not applied to a result. If you credit a battery in … Then in Microbiology Tech Final Release … • Terminal-based Credit Test without Removing Results (CRW) • Credited accession number appears in the batch and is released. • Windows-based Credit Retain Results • Final result is applied. • Number of batteries field includes the credited batteries. • Terminal-based Credit Test Request (CR) • Credited accession number appears in the batch but is not released. • Windows-based Credit Remove Results • Final result is not applied. • Number of batteries field does not include the credited batteries. Looking Up a Batch Number Description You can select a batch from a list of batches created within the past seven days for culture review and within the last 365 days for a sequence worksheet. Steps to Take In the Microbiology Tech Final window, 1 Under Batch selection, do one of the following: • For a culture review batch, click . • For a sequence worksheet batch, select a worksheet, and then click . The Select Batch window opens. 2 In the How many days? box, enter the number that specifies the number of days before today’s date from which to search, and then click Search. The Select Batch lookup window opens. The culture review batch list shows the batch number, creation date and time, release date and time, and the number of batteries previously released. Culture Review Batch Lookup Look up a culture review batch created within the past 7 days. Microbiology User’s Guide Sunquest Laboratory Number of batteries already released. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 186 Chapter 9: Releasing Microbiology Results The sequence worksheet batch list shows the batch number, the date and time created and whether the batch is complete. A complete batch is one in which all the batteries are either released (in Final status) or credited (with results not retained). Sequence Worksheet Batch Lookup Look up a sequence worksheet batch created within the past 365 days. Indicates if batch is complete. 3 To select a batch, click it, and then click Select. The Microbiology Tech Final Release window opens, and the accessions on the batch appear in the display list. Releasing Batteries in a Culture Review Batch Description Use this procedure to release batteries in Tech Final status on a culture review batch. Before You Begin You can check the low priority message log to determine whether a batch was previously released. Batch release messages are logged when the update starts and completes. For more information, see Messages for Microbiology Tech Final Release on page 343. Steps to Take In the Microbiology Tech Final Release window, 1 On the Culture Review Batch tab, under Batch selection, in the Batch number box, type the number of an existing batch and then click Search, or to look up a batch number, click or press F3. Enter a batch number. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Releasing a Batch of Microbiology Batteries 187 If you enter a batch number that has already been released, a message appears that lists the batch number and the number of batteries released. Batch number. Number of batteries released. 2 Under Batch Details, a list of the accession numbers associated with the selected batch number appears. Note The accession numbers you can view in the batch data list are determined by your security definitions and site parameter settings. If you do not have the proper security level, no accession number data appears. View data for each accession. 3 To release all batteries in a batch, click Release. A message appears when the batch-release job begins. For each battery in the batch, the test RPT is updated to a status of Final and given the date when the status changed from Tech Final to Final. If your site uses paperless microbiology, the change of status creates an activity that prints on the Microbiology Audit Trail report. Related Topics Looking Up a Batch Number on page 185 Releasing Batteries in a Sequence Worksheet Batch Description Use this procedure to release batteries in Tech Final status on a sequence worksheet batch. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 188 Chapter 9: Releasing Microbiology Results Before You Begin You can check the low priority message log to determine when a batch was last updated. Batch release messages are logged when the update starts and completes. For more information, see Messages for Microbiology Tech Final Release on page 343. Steps to Take In the Microbiology Tech Final Release window, 1 On the Sequence Worksheet Batch tab, under Batch selection, in the Worksheet box, type the code for the sequence worksheet you want to view, and then click Search, or to look up a worksheet code, click or press F3. 2 In the Batch number box, type the number of an existing batch and click Search, or to look up a batch number, click or press F3. Select a sequence worksheet and batch. If there are no batteries in Tech Final status, the system displays the message “There are no batteries ready to be updated to a Final status.” If you enter a batch number that has already been released, a message appears that lists the batch number and the date the batch was updated. This date may be either the last date the batch was released or the last date a batch was modified either in Microbiology Tech Final Release or in Manual Worksheets (MWS). Note The Date Batch Last Updated field may be blank if the batteries were updated to Final status in Microbiology Result Entry. The date the batch was last released or last updated. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying a Batch 189 All active orders assigned to the batch on the sequence worksheet appear in the batch list. Note that if an accession has multiple batteries associated with it, only one battery for that accession can appear. 3 Under Batch Details, a list of the accession numbers associated with the selected batch number appears. Note If you do not have the proper security level for an HID, no accession number data appears for that HID. View data on the sequence worksheet batch. 4 To release all batteries in Tech Final status in the batch, click Release. A message appears when the batch-release job begins. For each battery in Tech Final status in the batch, the test RPT is updated to a status of Final and given the date when the status changed from Tech Final to Final. If your site uses paperless microbiology, the change of status creates an activity that prints on the Microbiology Audit Trail report. Related Topics Looking Up a Batch Number on page 185 Modifying a Batch You can modify a batch by adding or deleting accession numbers. You can add one or more batteries from the same accession number to a culture review batch if your enterprise allows multiple batteries per accession number. For more information, see Assigning Multiple Batteries to an Accession Number Site Parameter on page 324. You can modify sequence worksheet batches in Microbiology Tech Final Release and in Manual Worksheets (MWS). For more information, see … Adding and Removing Accession Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Confirming Changes to a Culture Review Batch . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Confirming Changes to a Sequence Worksheet Batch . . . . . . . . . . . . . . . . . . . . . . . 191 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 190 Chapter 9: Releasing Microbiology Results Adding and Removing Accession Numbers Description After selecting a batch, review the accession numbers. You can use this procedure to add or remove accession numbers before releasing the batch. An accession number must be in Tech Final status to be added. You Need to Know You can add an accession number to a sequence worksheet batch only if it is defined to that worksheet. If an accession has multiple batteries associated with it, only the batteries defined to the selected sequence worksheet appear. Steps to Take In the Microbiology Tech Final Release window, 1 Under Batch Details, do one of the following: • To add an accession, in the Accession number box, type the accession number that you want to add to the batch, and then click Add. • To remove an accession, in the batch list, select the accession you want to remove, and then click Remove. Note You cannot remove the last accession on a sequence worksheet. You must use the Manual Worksheet (MWS) function to delete the last accession. Type an accession number, and then click Add … … or select an accession on the list, and then click Remove. If you added an accession, the accession number is added to the end of the list. 2 To continue adding or removing accessions, repeat step 1. 3 Click Save. The Confirm Modifications to Batch window opens. For more information, see Confirming Changes to a Culture Review Batch on page 190 and Confirming Changes to a Sequence Worksheet Batch on page 191. Confirming Changes to a Culture Review Batch Description The Confirm Modifications window lists the accessions you added and removed during the session. Review the list and confirm or cancel the changes. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Modifying a Batch 191 Steps to Take In the Confirm Modifications to Batch window, 1 Review the accession numbers that were added to the batch or removed from the batch. Added accessions appear here. Removed accessions appear here. Click to confirm changes to the batch. 2 To confirm that you want to modify the batch, click OK. The Microbiology Tech Final Release window opens. • If you confirmed an addition, the accession number appears in the list in the order that it was added to the batch. • If you confirmed a removal, the accession number is removed from the batch. To reject the modifications to the batch, click Cancel. Confirming Changes to a Sequence Worksheet Batch Description The Confirm Modifications window lists the accessions you added and removed during the session. Review the list and confirm or cancel the changes. Steps to Take In the Confirm Modifications to Batch window, 1 Review the accession numbers that were added to the batch or removed from the batch. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 192 Chapter 9: Releasing Microbiology Results Accession numbers previously added or removed in this session, and already confirmed in this window, do not appear. Added accessions. Removed accessions. Click to confirm changes to the batch. 2 To confirm that you want to modify the batch, click OK. The Microbiology Tech Final Release window opens. • If you confirmed an addition, the accession number appears in the list in the order in which it was added to the batch. When you save changes on the Microbiology Tech Final Release window, the next available sequence number will be assigned to the accession. • If you confirmed a removal, the accession number is removed from the batch. When you save changes on the Microbiology Tech Final Release window, the sequence of the remaining accessions is renumbered. To reject the modifications to the batch, click Cancel. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview Use Microbiology Automatic No-Growth Result Entry to add and update nogrowth result statements on cultures assigned to a predefined worksheet. If you want, you can filter the cultures that are eligible for update by collection, receive, or setup date and time.You can also use this application to finalize all cultures that have reached a designated upper age limit. This section includes the following topics Getting to Know Automatic No-Growth Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . 193 About the Automatic No-Growth Result Entry Workflow . . . . . . . . . . . . . . . . . . . . . . 197 Starting Microbiology Automatic No-Growth Result Entry . . . . . . . . . . . . . . . . . . . . . 198 Performing the No-Growth Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Troubleshooting Microbiology Automatic No-Growth Result Entry . . . . . . . . . . . . . . 203 Getting to Know Automatic No-Growth Result Entry Microbiology technologists use Microbiology Automatic No-Growth Result Entry to automatically enter no-growth results for negative cultures on a predefined no-growth worksheet. This batch method of result entry is most often used for cultures such as blood, fungus, and acid fast bacilli, which are typically received in large numbers but seldom have growth. Furthermore, this batch method can be adapted for use with clinic screen-type cultures, which are received in batches but have few positive results. Example After checking your blood cultures each morning, you use Microbiology Result Entry to enter any positive results. You then use Microbiology Automatic No-Growth Result Entry to automatically update the remaining blood cultures with a no-growth result of either: • No-growth nn DAYS (calculated as the time in days that has elapsed since the setup or receive date) • No-growth nn HOURS (calculated as the time in hours, if entry of the setup time is enabled and the culture was set up less than 24 hours ago). Chapter 10 Automatically Updating No-Growth Cultures 194 Chapter 10: Automatically Updating No-Growth Cultures For more information, see … About the Uses of Automatic No-Growth Result Entry . . . . . . . . . . . . . . . . . . . . . . . . 194 About the Scheduling of No-Growth Updates and Final Results . . . . . . . . . . . . . . . . 195 About Basing the No-Growth Update on the Receive or Setup Time. . . . . . . . . . . . . 195 About Filtering the Cultures on a Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 About the Uses of Automatic No-Growth Result Entry Depending on your system’s maintenance settings, you can use Microbiology Automatic No-Growth Result Entry to do the following: • Automatically apply no-growth result statements to eligible cultures on one or more worksheets. • Filter the cultures on your selected worksheets so that only those within a userdefined time frame are eligible for update. • Add a comment code to the no-growth result statement. • Automatically finalize a culture with no tests pending after it reaches an upper age limit. • Add a bill-only test to the culture battery associated with a no-growth worksheet. For a summarized list of the settings that control these Microbiology Automatic NoGrowth Result Entry features, see Appendix A, Settings for Microbiology Applications on page 301. For full instructions about making these settings, see the Microbiology Administrator’s Guide. The following illustration shows a no-growth result statement as it appears on an interim report. 04/27/2004 CZH - COMMUNITY HOSPITAL SYSTEMS 14:53 NAME: H# : HOSP: ACCT: HANSON,MARY ANN 84444 HID1 84444 TUCSON, AZ 85710 TUCSON, AZ 85710 LOC: 1N DR: ROOM: 100 INTERIM REPORT PAGE 1 AGE: 31Y SEX: F ALBERT,FREDERICK T80000331 COLL: 04/27/2004 10:03 REC: 04/27/2004 10:06 BLOOD SCREEN SETUP: 04/27/2004 1007 SPECIMEN DESCRIPTION SPECIAL REQUESTS CULTURE REPORT STATUS BLOOD NONE NO GROWTH 1 DAY PENDING UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems (ET: 0 HOURS) Microbiology User’s Guide Sunquest Laboratory Getting to Know Automatic No-Growth Result Entry 195 About the Scheduling of No-Growth Updates and Final Results For each no-growth worksheet, the system manager specifies the schedule of days on which a no-growth result will be updated for the eligible cultures on the worksheet. After an update, the no-growth results become available for display in both Inquiry and Microbiology Inquiry, as well as for inclusion on patient reports. The update schedule is defined by: • The starting age of the culture at which the no-growth update will begin for the battery associated with the worksheet. This starting age can be zero, which makes it identical with either the receive date or the setup date and time. • The upper age limit at which the cultures on the worksheet will be finalized. The highest possible upper age limit is 84 days. This number is hard-coded. Between the starting age and the upper age limit, the system manager can specify a set of numbers or a numerical range that indicates the different ages at which a nogrowth update will be performed for a culture. Example The schedule 1,2,4,7 indicates that the no-growth result will be updated on days 1, 2, and 4, and may be finalized on day 7 if the worksheet is defined to autofinal. If you do not run Microbiology Automatic No-Growth Result Entry for the worksheet on day 4, when you run it on day 5, any cultures that were eligible for the update of no-growth results after four days will now have their no-growth results updated after five days. Whether or not the system autofinals a negative culture that has no tests pending depends on another option that the system manager sets while setting up the nogrowth worksheet. Depending on this setting, a culture either gets finalized by the system when it reaches a specified upper age limit or you must finalize it yourself in Microbiology Result Entry. The no-growth result triggers an autosend report unless: • The patient does not qualify under autosend criteria. • Autosend is blocked through a site parameter setting. System managers often block autosend to prevent the repeated appearance of negative results on patient reports. However, even when autosend is blocked, a culture that has been autofinaled queues for an autosend report on the day that the autofinaling occurs if the patient qualifies under the autosend criteria. The autosend report serves to notify medical personnel that the culture’s processing is now complete. About Basing the No-Growth Update on the Receive or Setup Time For each hospital or facility ID (HID), the system manager decides whether to base the no-growth update for all batteries on the culture’s setup date and time or its receive date. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 196 Chapter 10: Automatically Updating No-Growth Cultures Basing the No-Growth Update on the Receive Date When the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] is set to N, the system always bases the no-growth update on the date that the culture was received into the system. Basing the No-Growth Update on the Setup Date and Time When the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] is set to Y, you can use Microbiology Setup Entry to enter the time and date that you actually process or plate a specimen. Results that are updated using the setup date and time are more accurate than those that are updated using the receive date. Furthermore, hourly updates are available for the first 24 hours that the culture is in the system. After that, updates are based on days. For more information, see Chapter 3, Entering a Setup Time. Example A specimen has been delayed in the laboratory six hours before processing. By entering its setup date and time instead of using its receive date and time, you avoid distorting the accuracy of its no-growth results by the six hours of delay. Note If a worksheet contains a battery with a setup time in the future, the system does not process the automatic update for that battery. A message is sent to the low priority message log. For more information, see Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203. Your system can be configured by HID to automatically use the receive date and time as the setup date and time for specified Microbiology batteries. This allows you to bypass Microbiology Setup Entry for cultures on those batteries that have a receive date and time that is acceptable for use as the setup date and time. For other cultures, you can manually enter their actual setup dates and times in Microbiology Setup Entry. For more information, see Chapter 3, Entering a Setup Time. About Filtering the Cultures on a Worksheet You can update all the cultures on the selected no-growth worksheets or filter the cultures so that only those that fall within specified date and time restrictions are eligible for update. Filtering is particularly convenient if you have large volumes of cultures on each worksheet and want to update the no-growth results in smaller batches. You can filter the cultures by the collect date and time or the receive date and time. If your site uses setup dates and times, you can also filter the cultures by the setup date and time. The use of setup dates and times depends on the setting of a site parameter. For more information, see Basing the No-Growth Update on the Setup Date and Time on page 196. When you are filtering cultures on multiple worksheets, the system applies the same filter type (for example, the collect date and time) to all selected worksheets. You can, however, set a different date and time restrictions for each worksheet. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory About the Automatic No-Growth Result Entry Workflow 197 Note If you are working in a multi-facility environment and the worksheets are filtered by setup date and time, the system does not update any culture that is associated with an HID that has the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] set to N. To avoid this failure to update, do not filter by setup date and time if some of the HIDs on a worksheet you are processing do not use the setup time. About the Automatic No-Growth Result Entry Workflow The following illustration shows the workflow for Microbiology Automatic NoGrowth Result Entry. Select a filter type (optional). Type the worksheet code. Add a comment code to the worksheet. View the list of selected worksheets. Microbiology User’s Guide Sunquest Laboratory Add/remove a worksheet to/from the available worksheets list. View information about your worksheet entry. Initiate the automatic nogrowth update. If you selected a filter, type your date and time restrictions. Add, modify, or delete a selected worksheet, comment, or filtering date/time. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 198 Chapter 10: Automatically Updating No-Growth Cultures Starting Microbiology Automatic No-Growth Result Entry Before You Begin To start Microbiology Automatic No-Growth Result Entry, you must have the proper security level, along with access to at least one HID. For more information, see Setting Security for Microbiology Automatic No-Growth Result Entry on page 304. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Logging On to Sunquest Laboratory on page 22 of the Laboratory for Windows User’s Guide. 2 In the Sunquest Gateway window, on the All or Microbiology tab, double-click Microbiology Automatic No-Growth Result Entry. The Microbiology Automatic No-Growth Result Entry window opens. Your tech code, shift, and lab location appear in the User Profile header near the top. If you want to change these items, see Modifying Shift, Tech Code, and Lab Location on page 28. Performing the No-Growth Update Description Use this procedure to automatically update negative cultures of a certain age with no-growth results. If the system is set up to do so, this procedure also finalizes the status of cultures that have reached a specified upper age limit and triggers an autosend report for those cultures. For more information, see About the Uses of Automatic No-Growth Result Entry on page 194. Before You Begin In the laboratory, prior to performing the no-growth update, do the following: • If necessary, use Microbiology Setup Entry to enter a setup date and time for each culture you want to update. For more information, see About Basing the NoGrowth Update on the Receive or Setup Time on page 195 and Chapter 3, Entering a Setup Time. • Enter results for any positive cultures on the no-growth worksheet. For more information, see Chapter 4, Entering Direct Exam and Culture Results. For more information, see … About Using No-Growth Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Step 1: Entering One or More Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Step 2: Adding a Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Step 3: Filtering the Cultures on the Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Step 4: Performing the No-Growth Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 About Using No-Growth Worksheets To be eligible for Microbiology Automatic No-Growth Result Entry, the culture battery tests must all be assigned to the same worksheet. The system manager then defines that worksheet as a no-growth worksheet in function MMA 11. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Performing the No-Growth Update 199 When you enter a no-growth worksheet code and start the update in Microbiology Automatic No-Growth Result Entry, the system updates all eligible cultures according to the MMA 11 maintenance for that worksheet. To make it easy for you to process a variety of culture batteries, the system manager can combine multiple individual worksheets under one group worksheet. A group worksheet is usually related to the bench at which you work. Example In your work at the blood culture bench, you use a group worksheet for blood cultures that consists of three individual worksheets—one for pediatric blood cultures, one for blood cultures on patients on antibiotics, and one for routine blood cultures. To perform the no-growth update, you enter the group worksheet code. Each individual worksheet that is a part of the group worksheet is then displayed and evaluated for the no-growth update. Step 1: Entering One or More Worksheets Steps to Take In the Microbiology Automatic No-Growth Result Entry window, 1 To select a filter type for the worksheets you want to update, refer to Step 3: Filtering the Cultures on the Worksheets on page 201. Note that you must select a filter type prior to entering your first worksheet. 2 In the Worksheet box, type the code of the Microbiology no-growth worksheet or click to select a worksheet. 3 Click Add. The worksheet code and its description appear in the available worksheets list to the right, along with information regarding its last update. If a dialog box informs you that the worksheet is still processing, do one of the following: • If the start date and time of the update are appropriate (for example, a few minutes ago), click No to allow the system to continue that original processing request and remove the worksheet from the list. • If the start date and time of the update are inappropriate (for example, yesterday), click Yes to override the original processing. An “Overridden” note appears to the right of the “Still Processing” note. 4 To add a comment to the cultures on the worksheet, see Step 2: Adding a Comment on page 200. 5 To enter filtering start and end dates and times, see Step 3: Filtering the Cultures on the Worksheets on page 201. Note that this option is available only if you selected a filter type in step 1. 6 Click Add. The worksheet code and its associated information move to the selected worksheets list in the lower part of the window. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 200 Chapter 10: Automatically Updating No-Growth Cultures 7 To modify or delete one or more worksheets, do one of the following: To … Do this … Modify a worksheet Click the worksheet in the selected worksheets list and then click Modify. The worksheet and its associated information move back into their respective boxes, where you can change the comment, the date and time restrictions, or both. Delete one or more worksheets Click the worksheets in the select worksheet list, and then click Remove. Delete all worksheets. Click Remove All. 8 To add more worksheets, repeat steps 2 through 6. 9 To start the no-growth update, see Step 4: Performing the No-Growth Update on page 202. Related Topics Step 2: Adding a Comment on page 200 Step 3: Filtering the Cultures on the Worksheets on page 201 Step 4: Performing the No-Growth Update on page 202 Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203 Step 2: Adding a Comment Description This optional procedure adds a single comment code to a worksheet. This comment code then will appear with the no-growth result statement in any application or report that displays Microbiology culture results. If the site parameter [Restrict text codes to match department of test code?] is set to yes, the text code must either match the department of the test code or be specifically defined for microbiology. For more information, see the Site Parameters Administrator’s Guide. Steps to Take With one or more worksheet codes and descriptions in the available worksheets list, do the following: 1 In the Comment box, type the comment code or click to look up a comment code. 2 Click Add. The comment code appears to the right of the worksheet in the selected worksheets list. If more than one worksheet was in the available worksheets list, the comment code accompanies each worksheet. 3 To modify a comment code: a Click the worksheet that has the comment you want to change in the selected worksheets list. b Click Modify. The comment appears in the Comment box. c Edit or delete the comment, or select a different comment code. d Click Add. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Performing the No-Growth Update 201 Related Topics Step 1: Entering One or More Worksheets on page 199 Step 3: Filtering the Cultures on the Worksheets on page 201 Step 4: Performing the No-Growth Update on page 202 Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203 Step 3: Filtering the Cultures on the Worksheets Description You select the filter type and enter a filtering time frame prior to adding the first worksheet to the selected worksheets list. For more information about filtering cultures, see About Filtering the Cultures on a Worksheet on page 196. You Need to Know If you are working in a multi-facility environment and the worksheets are filtered by setup date and time, the system does not update any culture that is associated with an HID that has the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] set to N. To avoid this failure to update, do not filter by setup date and time if some of the HIDs on a worksheet that you are processing do not use the setup time. Steps to Take To filter the cultures on one or more worksheets, do the following: 1 Prior to entering your first worksheet, make one of the following choices in the Filter by box: • To filter the cultures on all selected worksheets by the date and time that the specimens were collected, select Collect Date/Time. • To filter the cultures on all selected worksheets by the date and time that they were received into the system, select Receive Date/Time. • To filter the cultures on all selected worksheets by the date and time that they were set up for processing select Setup Date/Time. Note that this option appears only if the first part of the site parameter [Enable Setup Date/Time (Y/ <N>)\MST Display Hang 1-999] is set to Y for least one HID to which you have access. Note If a worksheet contains a battery with a setup time in the future, the system does not process the automatic update for that battery. A message is sent to the low priority message log. For more information, see Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203. 2 Enter a worksheet as described in Step 1: Entering One or More Worksheets on page 199. 3 With the worksheet in the available worksheets list, do the following: a In the Start Date and End Date boxes, enter a start date and an end date or click to select a date. The start or end date must not be in the future. b In the Start Time and End Time boxes, enter a start time and an end time. The date/time combination must not be in the future. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 202 Chapter 10: Automatically Updating No-Growth Cultures c Click Add. The start date/time and end date/time appear with the worksheet in the selected worksheets list. 4 To change the date and time restrictions: a Click a worksheet in the selected worksheets list, and then click Modify. b With the worksheet in the available worksheets list, perform step 3 again. 5 To change the filter type: a Click Remove All to remove all the worksheets and their associated comments and filters from the Selected Worksheets list. b In the Filter by list, select another filter type. c Reenter your worksheets according to the instructions in Step 1: Entering One or More Worksheets on page 199. d Reenter your date and time restrictions according to step 3 of this section. Related Topics Step 1: Entering One or More Worksheets on page 199 Step 2: Adding a Comment on page 200 Step 4: Performing the No-Growth Update on page 202 Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203 Step 4: Performing the No-Growth Update Description This procedure adds and updates no-growth result statements on all eligible cultures assigned to the selected worksheets. If you defined a filter in step 3, the system updates only those cultures that fall within the specified date and time restrictions. You Need to Know If you are working in a multi-facility environment and the worksheets are filtered by setup date and time, the system does not update any culture that is associated with an HID that has the first part of the site parameter [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] set to N. To avoid this failure to update, do not filter by setup date and time if some of the HIDs on a worksheet you are processing do not use the setup time. Steps to Take To perform the no-growth update, 1 Click Start Update. A message informs you that the automatic no-growth update has started, and the system then returns to the Sunquest Gateway. 2 If necessary, monitor the progress of the no-growth update in low-priority messages, which contain the following information: • Start and finish date and time of the no-growth update • The number of cultures updated on each worksheet • The number of cultures autofinaled on each worksheet • The reason that a culture could not be processed 3 If you see a problem with a worksheet, check high-priority messages, which specify the reason that a worksheet could not be processed. For information on viewing high-priority messages, see the Message Filter Utility User’s Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Troubleshooting Microbiology Automatic No-Growth Result Entry 203 4 For further problem-solving help, see Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203 and Appendix B, Message Reference. Related Topics Step 3: Filtering the Cultures on the Worksheets on page 201 Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203 Troubleshooting Microbiology Automatic No-Growth Result Entry This section provides help with troubleshooting problems with Microbiology Automatic No-Growth Result Entry. If you cannot solve a problem, contact Sunquest. Be ready to provide the accession numbers that failed to update, the code of the worksheet that includes those accession numbers, the date and time that you ran Microbiology Automatic No-Growth Result Entry, and any relevant low or high priority messages that appear in the UTL function. Description Use the following table to troubleshoot problems such as the failure to update a culture. When this occurs … Do this … When you enter a worksheet code, you see this dialog box: Action: An auto no-growth update for <worksheet> was started on <date> <time>. The worksheet is still processing. Do you want to override that update? • If the start date and time of the update are appropriate (for example, a few minutes ago), click No to continue the original processing and remove the worksheet from the available worksheets list. • If the start date and time of the update are inappropriate (for example, yesterday), click Yes to override the original processing. An “Overridden” note appears to the right of the “Still processing” note. Cause: In a multiple CPU linked environment, you see this message when you start the automatic no-growth update: An Auto No-Growth Result Entry is currently being processed: Microbiology No-Growth Update • The worksheet has a large number of accession numbers that require a comparatively long time to process. • The delay is being caused by a system error or network problem. Action: Try to perform the automatic no-growth update later. Cause: Someone else is running Microbiology Automatic No-Growth Result Entry, and only one instance can be run in a multiple CPU environment. User/Process Name: <name> Lab Location: <lab location> Time (sec): <duration of processing> Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 204 Chapter 10: Automatically Updating No-Growth Cultures When this occurs … Do this … When you start the automatic no-growth update, you see this message: Action: Try to perform the automatic no-growth update later. An auto no-growth update request was unsuccessful. Try again later. In high priority messages, you see this message: Cause: The system has encountered a lack of processor slots or a problem with system performance. An auto no-growth update request was unsuccessful because of a lack of processor slots or system performance. After the automatic no-growth update, you see this low priority message: Hospital access is not permitted for this user on <accession number>, <battery>, Worksheet: <worksheet code>. No auto no-growth update was posted. Action: • If appropriate, ask the system manager to grant you access to the accession number’s HID and then run Microbiology Automatic No-Growth Result Entry again. • Ask a technologist who has access to perform the update. Cause: You do not have security access to the HID with which an accession number is associated. After the automatic no-growth update, you see this low priority message: Action: Manually enter the no-growth result in Microbiology Result Entry. Auto No-Growth Update: There is a conflicting lock on <accession number>, <battery code>, Worksheets: <worksheet name(s)>. No auto nogrowth update was posted. Cause: At the time that you requested the nogrowth update, someone else was accessing that accession number in another Sunquest Laboratory application. After the automatic no-growth update, you see this low priority message: No setup date was entered on <accession number>, <battery code>, Worksheets:<worksheet code(s)>. No auto no-growth update was posted. Action: If the problem was produced by the first cause listed below, manually enter the setup date and time for the culture in Microbiology Setup Entry. Then enter the no-growth result in Microbiology Result Entry or run Microbiology Automatic NoGrowth Result Entry again. If the problem was produced by the second cause listed below, run Microbiology Automatic No-Growth Result Entry without setup time filtering for the HID that is not using the setup time. Cause: UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems • A technologist has failed to enter the setup time in Microbiology Setup Entry, or • In a multi-facility environment, you filtered the no-growth worksheets by setup time, and the accession number is associated with an HID that does not have the setup time enabled. Microbiology User’s Guide Sunquest Laboratory Troubleshooting Microbiology Automatic No-Growth Result Entry 205 When this occurs … Do this … After the automatic no-growth update, you see this low priority message: Action: Review the culture in Microbiology Result Entry and determine the status of all tests. Enter valid results for the pending tests or suppress them with a HIDE text code result, and then manually enter the no-growth result and finalize the culture. The culture was not finaled because of pending tests on <accession number>, <battery code>, Worksheet: <worksheet code>. No auto no-growth update was posted. Cause: The culture has pending tests. Action: • Check your maintenance to determine if one or more settings are preventing the automatic no-growth update. • Check the Microbiology Inquiry display or an internal report to determine if the culture has been given a growth result or put into hold status. • In Microbiology Culture Entry, verify that the correct no-growth code has been entered as the first observation to the test CULT. • If you cannot determine the reason for the failure, contact Sunquest with the information specified prior to this table. Cause: Such problems can be caused by a number of system settings and user actions— either singly or in combination. After the automatic no-growth update, you see this low priority message: The setup time is in the future on <accession number>, <battery code>, Worksheet: <worksheet code>. No auto no-growth update was posted. Microbiology User’s Guide Sunquest Laboratory Action: None. This accession number will not qualify for update until its setup time has passed. Cause: Explained in the message. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 206 Chapter 10: Automatically Updating No-Growth Cultures UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview You use Microbiology Inquiry to view the results of laboratory tests ordered in Sunquest Laboratory. This section includes the following topics Getting to Know Microbiology Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Starting Microbiology Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 About the Microbiology Inquiry Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Searching for Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Filtering Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Selecting Results to View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Viewing Detailed Results of a Query . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Modifying a Query . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Viewing the History of a Microbiology Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 Printing Detailed Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 Getting to Know Microbiology Inquiry You use Microbiology Inquiry to view the results of microbiology tests ordered in Sunquest Laboratory. Microbiology Inquiry includes powerful search and filter capabilities, allowing you to single out only those results you are interested in. You can also print the results. Note that Microbiology Inquiry is an internal inquiry tool and does not provide chartable information to satisfy regulatory guidelines. Access to results in Microbiology Inquiry may be restricted in two ways: • Security levels may limit inquiry access to certain results. Suppressed results are automatically not displayed if you do not have the appropriate security. • Report blocking for requisition-based reports (RBRs) may also limit inquiry access to certain results. This affects only sites that use RBRs. For more information, see … About Security Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Chapter 11 Inquiring on Microbiology Results 208 Chapter 11: Inquiring on Microbiology Results For more information, see … About Report Blocking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 About Security Levels The information you can view in Microbiology Inquiry and Microbiology History is determined by the security level defined for your login in Password Assignment (SC 3). You can have one of two levels of security for Microbiology Inquiry and one level of security for Microbiology History: • MCI-level security provides access to results that are not suppressed and results with a report block level of 0 or 3. • MCIQ-level security provides access to all results, including suppressed tests and results, and results with a report block level of 1 or 2. You can also view the tech code of the person who performed the tests. If you have MCIQ security, you have the option of filtering out suppressed tests and results. The results available are then similar to MCI-level security. For more information, see Filtering Out Suppressed Results on page 220. • MHST-level security along with either MCI- or MCIQ-level security provides access to Microbiology History results. If you are unable to view suppressed or blocked results in Microbiology Inquiry, you are prevented from viewing those results in Microbiology History as well. About Report Blocking Report blocking is a way of preventing a requisition-based report from being printed. If your site uses requisition-based reports, and if report blocking has been enabled, inquiry access to some test results is restricted, as described in the following table. If your security level is … And the test or result has a block level of … You … MCI 0, 3 Can view the test results. (Note that when results are on hold, you will see a PENDING message until the results are released.) 1, 2 Cannot see test results. The user can view only the block-level status of this test result and a message that appears in place of the results (if one has been defined for that block level in Site Parameter Maintenance, SIT). 0, 1, 2, 3 Can view the test results. (Note that when results are on hold, you will see a PENDING message until the results are released.) MCIQ Report block levels apply only if your site is using requisition-based reports. The results you see in Microbiology Inquiry depend on which security level you have access to. You can view results according to the highest level of inquiry that your security level permits. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Starting Microbiology Inquiry 209 For more information about report blocking and RBRs, see Understanding Report Block Levels on page 47 in the Requisition-Based Reports User’s Guide. Starting Microbiology Inquiry Description Use this procedure to start Microbiology Inquiry. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information about logging on to Sunquest Laboratory, see Logging On to Sunquest Laboratory on page 22 in the Laboratory for Windows User’s Guide. 2 In the Sunquest Gateway window, on the All tab or Microbiology tab, double-click Microbiology Inquiry. The Microbiology Inquiry window opens. About the Microbiology Inquiry Workflow Inquiring on Microbiology results involves four separate stages: • • • • Searching for results Filtering results Selecting results Viewing results The layout of the Microbiology Inquiry window changes as you progress through the four stages. For more information, see … Step 1: Searching for Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Step 2: Filtering Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Step 3: Selecting Results to View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Step 4: Viewing Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 210 Chapter 11: Inquiring on Microbiology Results Step 1: Searching for Results When you start Microbiology Inquiry, the first window that you see is the query window. From the query window, you search for the patient whose results you want to view. You can search on a number of parameters, such as patient ID, patient name, accession number, and so forth. A list of all items that match your search criteria appears. Search for the patient by entering a search parameter and the value to search for. From the list of patients that match your criteria, click the correct patient. For more information on searching for results, see Searching for Results on page 214. Step 2: Filtering Results After you have selected the patient, you can filter the results in a number of ways, depending on the criteria you used to search for the patient. When you search for an accession number, container ID, or requisition number, you have already focused your search more tightly than if you search by a broader criteria such as patient name. As a result, when you look up a patient by these search criteria, the search window displays fewer filter options. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory About the Microbiology Inquiry Workflow 211 You set filters in the query window. Select filters for the data … … and then click Select. For more information on filtering results, see Filtering Results on page 216. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 212 Chapter 11: Inquiring on Microbiology Results Step 3: Selecting Results to View After you have selected the filters for your query, a list appears, showing all the accession numbers and batteries that match your criteria. Select the items from the list for which you want to view detailed or history results. Select check boxes for the items you want to view … … and then click Get Result. Or, to view a history of all results on an accession, select one check box, and then click Micro History. Note The Micro History button appears only if your security allows you to view microbiology history results. For more information, see About Security Levels on page 208. If you have the proper security, the Micro History button is available when you select a single battery from the Accession/Battery list. For more information on selecting results in order to view details, see Selecting Results to View on page 223. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory About the Microbiology Inquiry Workflow 213 Step 4: Viewing Results After you have filtered and selected results, results are displayed in interim format. If the results include susceptibilities, you can also view results in table format. The following example shows interim format. Click to view results in a different format. Microbiology User’s Guide Sunquest Laboratory Click to print the results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 214 Chapter 11: Inquiring on Microbiology Results If the results include susceptibilities, you can view and sort the results in table format, as in the following example. You can sort the results in table format by sensitivity. For more information on viewing results, see Viewing Detailed Results of a Query on page 226. Searching for Results Description You can search for results you want to view using the following criteria: • • • • • accession number billing account number container ID (CIDs) (if SMART is enabled) episode number HMO ID UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Searching for Results • • • • • • 215 patient ID patient name or exact name MPI number requisition numbers (if Requisition-Based Reports is enabled) social security number soundex A site parameter setting determines the default search criterion. For more information, see Microbiology Inquiry Site Parameters on page 327. Steps to Take In the Microbiology Inquiry query window, 1 In the Lookup by box, enter a patient identifier such as patient ID, patient name, social security number, accession number, Container ID (CID), or requisition number. For more information, see Searching for Patient Data in Windows-Based Sunquest Laboratory on page 52 in the Laboratory Conventions User’s Guide. 2 In the Value box, do one of the following: • Type a search parameter, such as a patient ID, and then click Search. • To apply a filter to the search, click . For more information, see Filtering the Patient Search on page 57 in the Laboratory Conventions User’s Guide. Under Search found, a list of the patients, accession numbers, CIDs, or requisition numbers that match your criteria appears. Note The data fields you can view in the patient list are determined by your security level. For example, you cannot view a patient’s date of birth unless your login security enables you to do so. 3 In the list, click the patient, accession number, CID, or requisition number for which you want to view results. 4 If you are searching by CID or requisition number, do one of the following: If you are searching by … Do one of the following … CID Microbiology User’s Guide Sunquest Laboratory • To view results for all accession numbers associated with the CID you selected, click Get all orders for the selected container. • To view results for only for the CID you selected, click Get all orders for only the selected accession. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 216 Chapter 11: Inquiring on Microbiology Results If you are searching by … Do one of the following … Requisition number • To view results for all accession numbers associated with the requisition number you selected, click Get all accessions for the selected requisition. • To view results for only the requisition number you selected, click Get only the selected accession. Related Topics Filtering Results on page 216. Selecting Results to View on page 223. Filtering Results Description After you have selected the patient, accession numbers, container IDs (CIDs), or requisition numbers for which you want to view results, you can filter the query to limit the results displayed. For more information, see … About Query Filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216 Filtering by Episodes or Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Filtering by Specimen Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Specifying Restrictions on Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Filtering Out Suppressed Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Filtering for a Selected Requisition Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Filtering by Container or Accession Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 About Query Filters After you search for patient results that you want to view, you can filter the query to limit which results are displayed. For example, you can filter out suppressed results, or any results entered outside of a selected date range. You can also include the results from a selected episode or event, or from selected specimen groups. The filters that are available depend on the criteria you use to search for results. If you search by … You can filter on … For more information, see … Accession number Suppressed results Filtering Out Suppressed Results on page 220 Requisition number A selected requisition number Filtering for a Selected Requisition Number on page 221 Suppressed results Filtering Out Suppressed Results on page 220 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Filtering Results 217 If you search by … You can filter on … For more information, see … Container IDs Orders associated with a container or with an accession number Filtering by Container or Accession Number on page 222 Suppressed results Filtering Out Suppressed Results on page 220 Episodes or events Filtering by Episodes or Events on page 217 Specimen groups Filtering by Specimen Groups on page 218 Date Specifying Restrictions on Time on page 219 Suppressed results Filtering Out Suppressed Results on page 220 All other criteria Filtering by Episodes or Events Description Perform this procedure to filter results by the episode or event they are associated with. You can view results for: • A single event • All episodes and all events • All inactive events Before You Begin You must search for the results you want to view by patient, accession number, or requisition number. For more information, see Searching for Results on page 214. Steps to Take In the Microbiology Inquiry query window, under Select episode/ event, 1 Notice that the Search found list displays the events for the selected patient. Alternate episodes and events are darker blue for ease of reading. The colors have no other meaning. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 218 Chapter 11: Inquiring on Microbiology Results 2 Do one of the following: To include results for … Do this … All episodes and all events • Select All A single episode or event • In the list of episodes and events, click the episode or event. Inactive events • Select Include events. inactive events. 3 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 Filtering by Specimen Groups Description Perform this procedure to view results for particular types of specimens for the selected patient. Note The specimen groups that you can filter in Microbiology Inquiry are established in IQ Specimen Description Groups (MMA 18). For more information, see Chapter 38, IQ Specimen Description Groups (MMA 18), in the Microbiology Administrator’s Guide. Before You Begin You must search for the results you want to view by patient, accession number, container ID (CID), or requisition number. For more information, see Searching for Results on page 214. Steps to Take In the Microbiology Inquiry query window, 1 Under Select specimen groups, do one of the following: • Select one or more specimen types whose results you want to view. • To include all specimen groups in the list, select All specimen groups. 2 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Filtering Results 219 Specifying Restrictions on Time Description You can filter results for a particular period of time. To view only the most recent accession numbers, you can specify a number of days prior to the current date. You can also include all accession numbers within a specified a date range. Before You Begin You must search for the results you want to view by patient, accession number, container ID (CID), or requisition number. For more information, see Searching for Results on page 214. Steps to Take In the Microbiology Inquiry query window, under Specify restrictions on time, To specify the number of days prior to the current date 1 Under Specify restrictions on time, click Days prior to current date. The Restrictions section of the window displays Days prior to current date. 2 Do one of the following: To include … Do this … Accessions for a specified number of days prior to today 1 Clear the Include all accessions check box. 2 In the Number of days box, enter a number from 1 to 9999. This number includes the date of last activity. For example, to include results from that date only, enter 1. The beginning and end date appear to the right of the box. The beginning date changes to reflect the number of days you entered. All accessions on file for the patient • Click Include all accessions. 3 When you have set all the filters for the query, click Select. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 220 Chapter 11: Inquiring on Microbiology Results To specify a date range 1 Under Specify restrictions on time, click Date range. The Restrictions section of the window displays Date range. 2 In the From box, enter the beginning of the date range, or click to look up a date. 3 In the To box, enter the end of the date range, or click to look up a date. 4 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 Filtering Out Suppressed Results Description If you have MCIQ-level security, suppressed results, which have HIDE appended, are automatically displayed by default. You can, however, choose to filter out suppressed results. Example You want to print results to show to a physician who is not authorized to see suppressed results. You can filter out suppressed results. For more information about security levels and suppressed results, see About Security Levels on page 208. Before You Begin You must search for the results you want to view. For more information, see Searching for Results on page 214. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Filtering Results 221 Steps to Take In the Microbiology Inquiry query window, 1 Do one of the following: • To include suppressed results, select the Include suppressed results check box. Click to include suppressed results. • To not include suppressed results, clear the Include suppressed results check box. 2 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 Filtering for a Selected Requisition Number Description When you search for patient data by requisition number, you can include data for one of the accession numbers associated with the requisition, or for all accession numbers associated with the requisition. Before You Begin You must search for the results you want to view by requisition number. For more information, see Searching for Results on page 214. Steps to Take In the Microbiology Inquiry query window, 1 Do one of the following: To include … Do this … All accession numbers associated with the selected requisition. • One of the accession numbers. 1 In the list of accession numbers, click the Click Get all accessions for the selected requisition. accession you want to include in the query. 2 Click Get only the selected accession. 2 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 222 Chapter 11: Inquiring on Microbiology Results Filtering by Container or Accession Number Description When you search for patient data by container ID (CID), you can include data for just the orders associated with a container, or for all orders associated with the accession numbers. Before You Begin You must search for the results you want to view by container ID. For more information, see Searching for Results on page 214. Steps to Take In the Microbiology Inquiry query window, 1 Notice that the query window displays a list of container IDs and accession numbers that match your search. Container IDs that match your query. Click to specify all orders for a container or accession. 2 Do one of the following: • To select all orders associated with a container, click Get all orders for the selected container. • To select all orders associated with an accession number, click Get all orders for the selected accession. 3 When you have set this and all other filters for the query, click Select. Related Topics Filtering Results on page 216 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Results to View 223 Selecting Results to View After you have searched for patient data and set the appropriate filters, the Accession/ Battery list displays all the items that match your query. From this list, you choose the items for which you want to view results. For more information, see … About the Accession/Battery List Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223 Selecting Items from the Accession/Battery List to View Detailed Results . . . . . . . . 225 Canceling a Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 About the Accession/Battery List Window When you click Select after searching for patient data and filtering the query, the results of your query appear in the Accession/Battery list. The Accession/Battery list shows information about the status of the microbiology orders in your query. Results header Accession/Battery list Legend The three components of the accession/battery list window (results header, list, and legend) are described below. About the Results Header The results header shows basic demographic information about the patient as well as a summary of the filters used in your current query, if any. The results header is always displayed at the top of the Microbiology Inquiry results window. Location and physician information is taken from the current event for the patient, regardless of the criteria used in the query. For more information, see Filtering Results on page 216. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 224 Chapter 11: Inquiring on Microbiology Results The following is a typical results header. View patient demographic data. Shows whether the query includes all tests or selected tests. View time restrictions placed on the query. If you searched for patient data by accession number or requisition number, which do not need filtering, the lines indicating which filters were used do not appear. About the Accession/Battery List The Accession/Battery list shows the following information: • Accession number. Each specimen type is displayed separately for a given accession number. • Specimen collect date and time. If the specimen has not yet been collected, the scheduled collection time is shown. • Specimen receipt date and time. If the specimen has not been received, <Unreceived> appears. • Order code and modifier. • Specimen description. • Status of direct exam results. • Status of culture results. Note If an accession has some observations that are hidden and some that are not, the culture results column displays both the unhidden observations and the English text code defined to suppress tests from printing on patient reports (typically, HIDE). • Report status. At the left of each accession or battery, notice that there is a check box. You use this check box to select an item’s detailed results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Results to View 225 About the Legend The legend at the bottom of the window explains the symbols and abbreviations used in the Specimen Desc, Direct Exam, and Culture Results columns. This symbol … Means … It can appear in … Ftxt Free text has been entered Specimen description * Susceptibility results are on file Culture results + Free or composed text has been entered Culture results HIDE Results have been suppressed by appending HIDE to the description Selecting Items from the Accession/Battery List to View Detailed Results Description You can select items from the Accession/Battery List in order to view detailed results. Before You Begin Search for the data you want to view and, if necessary, set the appropriate filters. For more information, see Searching for Results on page 214 and Filtering Results on page 216. Steps to Take In the Microbiology Inquiry accession/battery list window, To view detailed results of a query 1 To select the results for which you want to see details, do one of the following: To view … Do this … Results for all items in the Accession/Battery list • Click Select all accessions. 1 Click the box at the left of the accessions you want to Results for selected items view. A check mark appears in the box. in the Accession/Battery list 2 Clear the box at the left of the accessions you do not want to view. 2 Click Get Result. The microbiology results window appears. For more information on detailed results, see Viewing Detailed Results of a Query on page 226. To view a history of microbiology results for a battery 1 In the Accession/Battery list, select an individual microbiology battery. 2 Click Micro History. The Microbiology History window opens. For more information on Microbiology History results, see Viewing the History of a Microbiology Battery on page 230. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 226 Chapter 11: Inquiring on Microbiology Results Canceling a Search Description After you have viewed the summary list of results that meet your search criteria, you can cancel the search. This returns you to the query window so you can start another search. Steps to Take In the Microbiology Inquiry accession/battery list window, • Click Cancel. Viewing Detailed Results of a Query After you have searched for, filtered, and selected order data, you can view detailed results in two types of report formats: interim or table. • Interim format presents an interim report on the microbiology results. This is the default format when you enter the results window. • Table format is available for susceptibility results. You can sort the results according to their susceptibility to drugs. For more information, see … Viewing Results in Interim Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 Switching Between Interim and Table Formats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Viewing Results in Table Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 Viewing Internal Notes in Microbiology Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 Viewing Results in Interim Format When you click Get Result in the accession/battery list window, results are displayed in interim format, as in the following example. Click to view results in a different format. Click to print the results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Detailed Results of a Query 227 Switching Between Interim and Table Formats Description If susceptibility results are available, you can switch between table and interim formats. Before You Begin Search for and select test results. For more information, see Selecting Results to View on page 223. Steps to Take In the Microbiology Inquiry results window, • Under Microbiology Results, do one of the following. • Click View in table format. • Click View in interim format. Note If the results of your query do not include susceptibility results, table format is not available. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 228 Chapter 11: Inquiring on Microbiology Results Viewing Results in Table Format Description Susceptibility results can be viewed in table format, as in the following example. To sort results by sensitivity, click here. Note Table Format cumulative reports maintenance does not apply to table format in Microbiology Inquiry. You can sort results displayed in table format according to their susceptibility to the drugs tested. The results are sorted in the following order: • Susceptible • Intermediate • Resistant Any drugs not resulted as susceptible, intermediate, or resistant (for example, No Interpretation Available) appear in alphabetical order at the bottom of the table. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Detailed Results of a Query 229 Before You Begin Display results in table format. For more information, see Switching Between Interim and Table Formats on page 227. Steps to Take In the Microbiology Inquiry results window, • Select the Sort by sensitivity results check box. Viewing Internal Notes in Microbiology Inquiry Description If your site uses Clinical Validation and your login security provides access, you can view internal notes that are shared between lab technicians and the reviewers who validate final results in Clinical Validation. Because internal notes are specific to the review process, they are not displayed on patient reports. You can view internal notes from either table format or interim format, but you cannot add or modify notes. For more information regarding notes, see About Internal Notes on page 287. Some notes may be suppressed. Depending on your login security, you may not be able to view suppressed notes. Before You Begin Display results in interim or table format. For more information, see Switching Between Interim and Table Formats on page 227. Steps to Take In the Microbiology Inquiry Results window, 1 Click Notes at the bottom left of the window. The Internal Notes window opens, displaying any existing notes on the patient. Existing notes appear here. You cannot add notes from Inquiry. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 230 Chapter 11: Inquiring on Microbiology Results 2 To modify your view of existing notes, do any of the following: To … Do this … Change the order in which the notes appear • Include or exclude types of notes 1 Under Filtering, select or clear the Show Under Sorting, click either Newest entry first or Oldest entry first. Suppressed, Specimen-level, or Patient-level check boxes. 2 Under Dept Filter, select or clear the check boxes in front of the codes of the departments whose notes you want to view. Note Department filters are available only for patient-level notes. Modifying a Query Description At any time while you are viewing results, you can modify your query criteria to show different results. Before You Begin You must search for results. For more information, see Searching for Results on page 214. Steps to Take On the Sunquest Laboratory Inquiry results window, 1 Click Query. The Sunquest Laboratory Inquiry query window opens, displaying the criteria used for your most recent query. 2 Modify your query by changing your search conditions or changing your filter for results. For more information, see Filtering Results on page 216. 3 When you have finished, click Get Result. The Sunquest Laboratory Inquiry results window opens displaying the results of your new query. Viewing the History of a Microbiology Battery Description You can view a history of microbiology results for individual tests or for all tests associated with a selected battery. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing the History of a Microbiology Battery 231 Steps to Take In Microbiology Inquiry, 1 Display test results for a selected battery by clicking Micro History. For more information, see Selecting Items from the Accession/Battery List to View Detailed Results on page 225. Tests for the selected battery appear in the Microbiology History window. Click to view all results for the battery. Click to select individual tests. Orders placed prior to implementation of Microbiology History show a posted date of Unknown. Click to display results for the selected tests. Click to print the displayed results. View the posting date and time for the battery. 2 To select the test results you want to view, do one of the following: • To view all results for the selected battery, click the Select all items check box. • To view results for individual tests, in the Test list, click the box next to each test you want to include in the history. 3 To display results for the selected tests, click Show Details. Related Topics Printing Detailed Results on page 232 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 232 Chapter 11: Inquiring on Microbiology Results Printing Detailed Results Description You can print the results you are viewing to a printer on your network. This allows you to print only those results currently on screen. The results are printed as they appear on the screen, in either table or interim format. Before You Begin You must search for results. For more information, see Searching for Results on page 214. Steps to Take To print detailed results, 1 Do one of the following: • In the Sunquest Laboratory Inquiry results window or the Order Detail dialog box, click Print Detail. • In the Microbiology History window, click Print. 2 Under Printer, in the Name box, notice that the default printer for the PC workstation appears. If you want to use a different printer, enter it. 3 Click OK. The detailed results print. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview You can use Microbiology Maintenance Inquiry (MMIQ) to review the definitions made in Microbiology Maintenance (function MMA). This section includes the following topics Getting to Know Microbiology Maintenance Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . 233 Starting Microbiology Maintenance Inquiry (MMIQ). . . . . . . . . . . . . . . . . . . . . . . . . . 234 Inquiring on Microbiology Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Getting to Know Microbiology Maintenance Inquiry Microbiology Maintenance Inquiry (MMIQ) displays lists of the customized microbiology maintenance items defined at your site. You can use the function to look up definitions for items such as the following: • • • • • • • • • • • • Susceptibility codes, batteries, and interpretations Workcards Worksheets identified for automatic no-growth resulting Keyboards Quality assurance definitions Parameters for automatic online filing of results Specimen groups Drug reporting classifications Bill-only tests Security for organism codes Logical progressions Label print/setup time options You can look at items individually or you can look at all the definitions for each type of item. Chapter 12 Using Microbiology Maintenance Inquiry (MMIQ) 234 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) The following example shows the results of searching for all susceptibility codes. Each line displays a separate code, along with its translation. 08/26/2004 SENSITIVITY CODE INQUIRY 16:56 ---------------------------------------------------------------------SUSCEPTIBLE CODE-1 SUSCEPTIBLE CODE-2 INTERMEDIATE CODE-1 RESISTANT CODE-1 RESISTANT CODE-2 SS NEG I R POS SUSCEPTIBLE NEGATIVE INTERMEDIATE RESISTANT POSITIVE Function MMIQ has numbered options that display all the information entered when maintenance items were defined in Microbiology Maintenance (MMA). Note You can also print the maintenance definitions that MMIQ enables you to see online. To print maintenance definitions, use Microbiology Maintenance Reports. For more information, see Chapter 2, Microbiology Maintenance Reports (MMR), in the Microbiology Reports User’s Guide. Starting Microbiology Maintenance Inquiry (MMIQ) Description When you start Microbiology Maintenance Inquiry (MMIQ), a numbered options menu appears. Before You Begin Open an InterSystems Caché® session in Laboratory. In the Sunquest Gateway, on the Application toolbar, click SmarTerm. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 235 Steps to Take To look up microbiology maintenance definitions, • At the FUNCTION prompt, type MMIQ, and then press ENTER. The Select Option menu appears. The following screen appears: MICROBIOLOGY MAINTENANCE INQUIRY SELECT OPTION 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Sensitivity Code Inquiry 19. Organism Code Security Inquiry Sensitivity Battery Inquiry 20. Logical Progression Inquiry Sensitivity Interpretation Inq 21. Label Print/Setup Time Options MIC Exam Interpretive Values Inq 22. Other Testing Keyboard Inquiry MIC Exam Usual/Dosage Values Inq Workcard Inquiry Culture Keyboard Inquiry Direct Exam Keyboard Inquiry Sensitivity Keyboard Inquiry Quality Assurance Inquiry No Growth Worksheets Inquiry On-Line Filing Parameters for Organism ID Inquiry On-Line Filing Parameters for Sensitivities Inquiry Specimen Description Group Inquiry Drug Reporting Classification Inquiry Online Workcard Inquiry Bill Only Test Inquiry IQ Specimen Group Inquiry ? From this menu, you select the option for the maintenance definitions you want to review. For more information, see Inquiring on Microbiology Maintenance on page 235. Inquiring on Microbiology Maintenance From the Select Option menu in function MMIQ, you can look up Microbiology maintenance definitions. For more information, see … Looking Up Sensitivity Codes (MMIQ 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Looking Up Sensitivity Batteries (MMIQ 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 Looking Up Sensitivity Interpretations (MMIQ 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 Looking Up MIC Exam Interpretive Values (MMIQ 4) . . . . . . . . . . . . . . . . . . . . . . . . 238 Looking Up MIC Exam Usual/Dosage Values (MMIQ 5) . . . . . . . . . . . . . . . . . . . . . . 238 Looking Up Workcards (MMIQ 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Looking Up Culture Keyboards (MMIQ 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239 Looking Up Direct Exam Keyboards (MMIQ 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 Looking Up Sensitivity Keyboards (MMIQ 9). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 236 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) For more information, see … Looking Up Quality Assurance Definitions (MMIQ 10) . . . . . . . . . . . . . . . . . . . . . . . . 241 Looking Up No-Growth Worksheets (MMIQ 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Looking Up Online Filing Parameters for Organism IDs (MMIQ 12). . . . . . . . . . . . . . 242 Looking Up Online Filing Parameters for Sensitivities (MMIQ 13) . . . . . . . . . . . . . . . 243 Looking Up Specimen Description Groups (MMIQ 14). . . . . . . . . . . . . . . . . . . . . . . . 244 Looking Up Drug Reporting Classifications (MMIQ 15) . . . . . . . . . . . . . . . . . . . . . . . 244 Looking Up Online Workcard Definitions (MMIQ 16) . . . . . . . . . . . . . . . . . . . . . . . . . 245 Looking Up Bill-Only Tests (MMIQ 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246 Looking Up Inquiry Specimen Groups (MMIQ 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 Looking Up the Security Settings for Organism Codes (MMIQ 19) . . . . . . . . . . . . . . 247 Looking Up Logical Progressions (MMIQ 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Looking Up Label Print/Setup Time Options (MMIQ 21) . . . . . . . . . . . . . . . . . . . . . . 249 Looking Up Other Testing Keyboards (MMIQ 22). . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Looking Up Sensitivity Codes (MMIQ 1) Description You can look up the category definitions of all the codes defined as interpretations. These codes are defined in Sensitivity Code Maintenance (MMA 1). For more information, see Chapter 23, Sensitivity Code Definition (MMA 1), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 1 and then press ENTER. A list of all the defined susceptibility codes appears. Looking Up Sensitivity Batteries (MMIQ 2) Description You can look up the susceptibility battery codes associated with susceptibility types, organism codes, and specimen types. Susceptibility battery associations are defined in Microbiology Sensitivity Battery Definition (MMA 2). For more information, see Chapter 25, Sensitivity Battery Definition (MMA 2), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 2 and then press ENTER. 3 At the SENSITIVITY TYPE prompt, do one of the following: • To view a list of all susceptibility battery codes and their definitions, press ENTER. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 237 • To view the definition for a specific item, enter the code for a susceptibility type, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Sensitivity Interpretations (MMIQ 3) Description You can review the definitions of zone sizes (for Kirby Bauer susceptibility testing), minimum inhibitory concentrations (MIC), and minimum bacteriocidal concentrations (MBC). Using this option, you can view lists of three levels of susceptibility interpretations: • All the ranges and interpretations defined for a specific susceptibility type, organism, and drug combination (level 1 interpretations). • The extended interpretations by body fluid and route defined for a specific susceptibility type, achievable level (in blood/urine), organism, and drug combination (level 2 interpretations). • The extended interpretations by body fluid defined for a specific susceptibility type, achievable level in blood/urine, organism, and drug combination (level 3 interpretations). The lists are sorted by susceptibility type, organism, and drug code. In addition, you can view a list of specimen group restrictions. Specimen groups allow you to report blood or urine interpretations for level 2 interpretations (extended interpretations by body fluid and route) or level 3 interpretations (NCCLS by body fluid only) by a specimen description group or by an individual specimen description code. Susceptibility interpretations are defined in Sensitivity Interpretation Definition (MMA 3). For more information, see Chapter 26, Sensitivity Interpretation Definition (MMA 3), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 3, and then press ENTER. The following menu appears. SUSCEPTIBILITY INTERPRETATION INQUIRY 1. 2. 3. 4. ? Susceptibility Interpretation Definition Susceptibility/Route/Body Fluid Interpretation Susceptibility/Body Fluid Interpretation Specimen Group Restrictions 3 At the ? prompt, type the number of the item you want to view. 4 If you type 1, 2, or 3, the SUSCEPTIBILITY METH prompt appears. At this prompt, do one of the following: Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 238 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) • To view a list of all susceptibility interpretation codes and their definitions, press ENTER. • To view the definition for a specific item, enter the code for a susceptibility method, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and then press ENTER. Looking Up MIC Exam Interpretive Values (MMIQ 4) Description Each drug that can be used in an MIC exam can have several sets of information defined to print on the patient cumulative report whenever MIC results are reported. You can look up the definitions of any drug that has achievable levels by body fluid and route defined. The interpretive values are defined in MIC Exam Interpretive Values Definition (MMA 4). For more information, see Chapter 28, MIC Exam Interpretive Values Definition (MMA 4), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 4, and then press ENTER. The following menu appears. MIC EXAM INTERPRETIVE VALUES INQUIRY 1. MIC Exam Interpretive Values 2. MIC Exam Interpretive Values By Route ? 3 At the ? prompt, type the number of the item you want to view. 4 At the DRUG prompt, do one of the following: • To view a list of interpretive values for all drugs, press ENTER. • To view the interpretive value for a specific drug, enter the code for the drug, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up MIC Exam Usual/Dosage Values (MMIQ 5) Description You can look up the usual MIC values for organism/drug combinations, as well as normal dosage amounts for specified drugs. These codes are defined in MIC Exam Usual/Dosage Values Definition (MMA 5). For more information, see Chapter 27, MIC Exam Usual/Dosage Values Definition (MMA 5), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 239 2 At the ? prompt, type 5, and then press ENTER. The following menu appears. MIC EXAM USUAL/DOSAGE VALUES INQUIRY 1. MIC Exam Usual Values 2. MIC Normal Dosage Levels ? 3 At the ? prompt, type the number of the item you want to view. 4 At the ORGANISM CODE prompt, do one of the following: • To view a list of values for all organisms, press ENTER. • To view the value for a specific organism, enter the code for the organism and then press ENTER. If you do not know the code of the organism whose definition you want to view, type two question marks, and press ENTER. Looking Up Workcards (MMIQ 6) Description You can look up the structure of any workcard that has been defined in Workcard Definition (MMA 6). For more information, see Chapter 29, Workcard Definition (MMA 6), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 6, and then press ENTER. 3 At the BATTERY CODE prompt, do one of the following: • To view a list of workcards for all battery codes, press ENTER. • To view workcards for a specific battery, enter the code for the battery, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Culture Keyboards (MMIQ 7) Description You can look up the layout of the keyboards used for culture result entry. You can also view the associations between culture keyboards and battery codes. Keyboards for culture entry are defined in Culture Keyboard Definition (MMA 7). For more information, see Chapter 22, Culture Keyboard Definition (MMA 7), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 240 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) 2 At the ? prompt, type 7 and then press ENTER. The following menu appears. CULTURE KEYBOARD INQUIRY 1. Culture Keyboard Definition 2. Battery/Keyboard Association ? 3 At the ? prompt, type the number of the item you want to view. • If you type 1, the CULTURE KEYBOARD prompt appears. Enter the code of the keyboard you want to view, or press ENTER to view all keyboards. The definitions of all culture result/modifier keys on the selected keyboard appear. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. • If you type 2, a list of the associations between batteries and culture keyboards appears. Looking Up Direct Exam Keyboards (MMIQ 8) Description You can look up the layout of the keyboards used for direct exam result entry. You can view the associations between batteries and direct exam keyboards, as well as a list of the organisms defined as positive results for each battery and specimen type. Keyboards for direct exams are defined in Direct Exam Keyboard Definition (MMA 8). For more information, see Chapter 21, Direct Exam Keyboard Definition (MMA 8), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 8, and then press ENTER. The following menu appears. DIRECT EXAM KEYBOARD INQUIRY 1. Direct Exam Keyboard Definition 2. Battery/Keyboard Association 3. Direct Exam Positive Result Definition ? 3 At the ? prompt, type the number of the item you want to view. • If you type 1, the DIRECT EXAM KEYBOARD prompt appears. Enter the code of the keyboard you want to view, or press ENTER to view all keyboards. The definitions of all direct exam result/modifier keys on the selected keyboard appear. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 241 If you do not know the code of the item whose definition you want to view, type two question marks, and then press ENTER. • If you type 2, a list of the associations between batteries and keyboard codes appears. • If you type 3, a list displays the organisms defined as positive results for each battery and specimen type. Looking Up Sensitivity Keyboards (MMIQ 9) Description You can look up the layout of the keyboards used for susceptibility results entry. Susceptibility keyboards are defined in Sensitivity Keyboard Definition (MMA 9). For more information, see Chapter 24, Sensitivity Keyboard Definition (MMA 9), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 9, and then press ENTER. 3 At the SENSITIVITY KEYBOARD prompt, do one of the following: • To view the definitions of all susceptibility keyboards, press ENTER. • To view the definition for a specific keyboard, enter the code for the keyboard, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Quality Assurance Definitions (MMIQ 10) Description You can look up the quality assurance (QA) values that have been associated with a battery. You can search by either of the following: • Organism ID QA codes, which are the quality assurance data required for the comparison of the direct exam results with the culture results. • Susceptibility QA codes, which are the expected susceptibility patterns for specific drugs by culture, specimen type, organism, and susceptibility type. QA codes are associated with batteries in Quality Assurance (MMA 10). For more information, see Chapter 30, Quality Assurance (MMA 10), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 10, and then press ENTER. The following menu appears. QUALITY ASSURANCE INQUIRY 1. Organism ID Quality Assurance 2. Susceptibility Quality Assurance ? Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 242 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) 3 At the ? prompt, type the number of the item you want to view. 4 At the BATTERY CODE prompt, do one of the following: • To view a list of the quality assurance values defined for all battery codes, press ENTER. • To view the quality assurance values defined for a particular battery, enter the code for the battery, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up No-Growth Worksheets (MMIQ 11) Description You can look up the definitions of no-growth worksheets, including the days on which the worksheets are updated and whether the result is automatically finalized. No-growth worksheets are defined in Identify No Growth Worksheets (MMA 11). For more information, see Chapter 32, Identify No Growth Culture Worksheets (MMA 11), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 11, and then press ENTER. 3 At the WORKSHEET CODE prompt, do one of the following: • To view a list of all no-growth worksheet definitions, press ENTER. • To view the definition for a specific worksheet, enter the code for the worksheet, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Online Filing Parameters for Organism IDs (MMIQ 12) Description You can look up the settings that determine whether organism IDs from online instruments are automatically filed into culture results. You can also look up the method/card type combinations for an online instrument’s biotype data or the method/card type definitions for manual biotype entry. Parameters for automatic filing are defined in On-Line Filing Parameters (MMA 12). For more information, see Chapter 33, Filing Parameters for Organism ID (MMA 12), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 243 2 At the ? prompt, type 12, and then press ENTER. The following menu appears. FILING PARAMETERS FOR ORGANISM ID SELECT OPTION 1. 2. On-Line Filing Parameters for Organism ID Inquiry Filing Parameters for Biotype Data Entry Inquiry ? 3 At the ? prompt, type the number of the item you want to view. • If you type 1, the DEVICE CODE prompt appears. • If you type 2, the METHOD CODE prompt appears. 4 At the DEVICE CODE or METHOD CODE prompt, do one of the following: • To view a list of filing parameters for all devices or methods, press ENTER. • To view the filing parameters for a specific device or method, enter the code for the device or method, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Online Filing Parameters for Sensitivities (MMIQ 13) Description You can review the settings that determine if a susceptibility for an organism will automatically file into the culture results. The parameters for online filing are defined in On-Line Filing Parameters for Sensitivities (MMA 13). For more information, see Chapter 34, On-Line Filing Parameters for Sensitivities (MMA 13), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 13, and then press ENTER. The following menu appears. ON-LINE FILING PARAMETERS FOR SENSITIVITIES - INQUIRY 1. Organisms To Be Excluded From On-Line Sensitivity Filing 2. Filing Parameters For On-Line Drug Sensitivities ? 3 At the ? prompt, type the number of the item you want to view. • If you type 1, a list displays the organism codes and descriptions that are excluded from online susceptibility filing. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 244 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) • If you type 2, the DEVICE CODE prompt appears. Do one of the following: • To view a list of filing parameters for all devices, press ENTER. • To view the filing parameters for a specific device, enter the code for the device, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Specimen Description Groups (MMIQ 14) Description You can look up the definitions of specimen description groups, such as wound cultures or urinary tract cultures. The groups are designated by numbers that determine the order in which the groups appear on internal microbiology reports. Note that these specimen group definitions are not the same as those defined for inquiry, which you can look up using IQ Specimen Group Inquiry (MMIQ 18). Specimen description groups are defined in Specimen Description Group Definition (MMA 14). For more information, see Chapter 31, Specimen Description Groups (MMA 14), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 14, and then press ENTER. 3 At the SPECIMEN GROUP prompt, do one of the following: • To view the definitions of all specimen groups, press ENTER. • To view the definition for a particular group, enter the code for the group, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Drug Reporting Classifications (MMIQ 15) Description You can look up the definitions of drug reporting classifications. Drug classifications allow the reporting of less toxic, less expensive drugs if they are susceptible, while suppressing more toxic, more expensive drugs. Drug classes are numbered from one to ten, with one being considered the highest class; a drug appears on reports only if the drugs in higher classes are resistant. Drug classifications are defined in Drug Reporting Classification (MMA 15). For more information, see Chapter 35, Drug Reporting Classification Definition (MMA 15), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 15, and then press ENTER. 3 At the ORGANISM prompt, do one of the following: • To view the drug classifications for all organisms, press ENTER. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 245 • To view the drug classification for a particular organisms, enter the code for the organism, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Looking Up Online Workcard Definitions (MMIQ 16) Description You can look up the definitions of workcards and worklabel battery and media associations and workup keyboard definitions that have been defined for use with paperless microbiology. Online workcards and workup keyboards are defined in Online Workcard Maintenance (MMA 16). For more information, see Chapter 36, On-Line Workcard Definition (MMA 16), in the Microbiology Maintenance User’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 16, and then press ENTER. The following menu appears. ONLINE WORKCARD INQUIRY 1. Media-Form Inquiry 2. Workload Group Inquiry 3. Workup Keyboard Inquiry ? 3 At the ? prompt, type the number of the item you want to view. 4 Do one of the following: If you typed … Do this … 1 The BATTERY prompt appears. Do one of the following: (Media-Form Inquiry) • To view a list of workcards for all battery codes, press ENTER. • To view workcards for a specific battery, enter the code for the battery, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. 2 The BATTERY prompt appears. Do one of the following: (Workload Group Inquiry) • To view, by battery, a list of all the biochemical workup group codes linked to an organism or organism group, press ENTER. • To view workup group codes for a specific battery, enter the code for the battery, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 246 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) If you typed … Do this … 3 The Workup Keyboard Inquiry menu appears. (Workup Keyboard Inquiry) WORKUP KEYBOARD INQUIRY 1. Culture Workup Keyboard Inquiry 2. Direct Exam Workup Keyboard Inquiry ? 1 At the ? prompt, type the number of the item you want to view. 2 At the WORKUP KEYBOARD prompt, enter the code of the keyboard you want to view, or press ENTER to view all keyboards. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. The definitions for the workup workload and workup result keys on the selected direct exam or culture keyboards appear. Looking Up Bill-Only Tests (MMIQ 17) Description You can look up the definitions of microbiology batteries that qualify for addition of bill-only tests. A bill-only test definition includes: • Whether entry of a microbiology bill-only test is mandatory. • The maximum number of bill-only tests that can be generated. • Whether you are prompted for entry of bill-only tests when the culture or direct exam is finaled or tech-finaled. If this part of the definition is set to N for no, you are prompted any time that results are filed. • The default bill-only microbiology test. This bill-only test is generated only when the culture is finaled through Automatic No-Growth Result Entry. Microbiology batteries are specified for addition of bill-only tests in Bill Only Test Definition (MMA 17). For more information, see Chapter 37, Bill-Only Test Definition (MMA 17), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 17, and then press ENTER. 3 At the BATTERY CODE prompt, do one of the following: • To view a list of all batteries defined for bill-only tests, press ENTER. • To view the bill-only test definition for a specific battery, enter the code for the battery, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 247 Looking Up Inquiry Specimen Groups (MMIQ 18) Description You can look up the definitions of the specimen groups used for the specimen menu display in Microbiology Inquiry and for the Significant Findings Report. Note that these inquiry group are not the same as those used for other internal microbiology reports, which you can look up using Specimen Description Group Inquiry (MMIQ 14). Inquiry specimen groups are defined in IQ Specimen Group Definition (MMA 18). For more information, see Chapter 38, IQ Specimen Description Groups (MMA 18), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 18, and then press ENTER. 3 At the SPECIMEN GROUP prompt, do one of the following: • To view the definitions of all Inquiry specimen groups, press ENTER. • To view the definition for a particular group, enter the code for the group, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks and press ENTER. Looking Up the Security Settings for Organism Codes (MMIQ 19) Description Sunquest Laboratory can restrict the entry of individual organisms based on a user’s security level. This is a safeguard so that a less experienced technologist cannot release an unusual organism identification or one that requires additional serologic verification, such as Shigella flexneri. You can look up the security settings required to enter organisms. Organism security settings are defined in Organism Code Security Definition (MMA 19). For more information, see Chapter 39, Organism Code Security Definition (MMA 19), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 19, and then press ENTER. 3 At the ORGANISM CODE prompt, do one of the following: • To view a list of security settings for all organisms, press ENTER. • To view the security settings for a specific organism, enter the code for the organism, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 248 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) Looking Up Logical Progressions (MMIQ 20) Description Sunquest Laboratory can prevent certain modifications to culture results from receiving a correction statement, on the grounds that it is a “logical” or “expected” modification made during the process of identifying a culture. This is done by defining a logical progression tree with up to six levels, starting with the most general identification and ending with the most specific results. Example The following diagram illustrates a logical progression tree with four levels. Notice how the organism identification becomes more specific at each level. Gram Neg. Rods Level 1 Level 2 Gram Neg. Rods non-enteric Gram Neg. Rods enteric Level 3 Klebsiella Level 4 Klebsiella pneumoniae Enterobacter A logical progression applies to one hospital ID. When you look up a logical progression, you indicate the hospital ID and then follow the progression level by level, starting with level one. You can look up logical progressions only for hospital IDs that you have security for. Logical progressions for culture results are defined in Logical Progression Definition (MMA 20). For more information, see Chapter 40, Logical Progression Definition (MMA 20), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 20, and then press ENTER. 3 At the HOSPITAL ID prompt, enter the ID of the hospital for which you want to look up logical progression definitions. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Inquiring on Microbiology Maintenance 249 To view the progression defined as the default logical progression, press ENTER. The default logical progression is used for all HIDs that do not otherwise have a logical progression defined. 4 At the ACCEPT, MODIFY, OR REJECT prompt, type A followed by ENTER. The LEVEL 1 prompt appears. 5 Do one of the following: To … Do this … View all logical progressions defined for the hospital. • View a particular logical progression. 1 Type the first-level organism identification code, and Press ENTER. then press ENTER. A prompt appears for the next level in the progression tree. 2 Do one of the following: • To view all remaining branches of the progression tree, press ENTER. • To follow a particular branch of the progression tree, type the code of the organism whose branch you want to follow, and then press ENTER. Repeat for each remaining level in the progression tree. If you do not know the code of the organism whose branch you want to follow, type two question marks, and then press ENTER. Looking Up Label Print/Setup Time Options (MMIQ 21) Label Print/Setup Time Options (MMA 21), which can be set differently for each HID, provides two prompts. The first prompt specifies batteries for which the system dynamically prints workcards or worklabels at order, receive, or setup time. The second prompt specifies batteries for which the system automatically results the receive time as the setup time when a specimen on one of those battery is received into the laboratory. For more information, see Chapter 41, Label Print/Setup Time Options (MMA 21), in the Microbiology Administrator’s Guide. Description Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 21, and then press ENTER. • If you have access to only one HID, the Label Print/Setup Time Options definitions for that HID appear. • If you have access to more than one HID, you are prompted to enter an HID. Do so, and then press ENTER. The Label Print/Setup Time Options definitions for that HID appear. Looking Up Other Testing Keyboards (MMIQ 22) Description You can look up the layout of the keyboards used for other-testing result entry. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 250 Chapter 12: Using Microbiology Maintenance Inquiry (MMIQ) Keyboards for other-testing result entry are defined in Other Testing Keyboard Definition (MMA 22). For more information, see Chapter 42, Other Testing Keyboard Definition (MMA 22), in the Microbiology Administrator’s Guide. Steps to Take In SmarTerm, with terminal-based Sunquest Laboratory running, 1 At the FUNCTION prompt, enter MMIQ. The SELECT OPTION menu appears. 2 At the ? prompt, type 22 and then press ENTER. 3 At the OTHER TESTING KEYBOARD <ALL>: prompt, do one of the following: • To view the definitions of all other testing keyboards, press ENTER. • To view the definition for a specific keyboard, enter the code for the keyboard, and then press ENTER. If you do not know the code of the item whose definition you want to view, type two question marks, and press ENTER. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview Reviewers can use Clinical Validation to perform a secondary review of microbiology results prior to releasing the results to Inquiry and patient reports. This section contains the following topics Getting to Know Clinical Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Starting Clinical Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254 Selecting Accessions from a Validation Queue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Reviewing Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Exchanging Notes about Clinical Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Viewing Clinical Validation Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294 Getting to Know Clinical Validation Clinical Validation allows reviewers to check microbiology results prior to releasing the results to Inquiry and patient reports. Reviewers and laboratory technologists can share information about patients and specimens via internal notes available in Microbiology Result Entry and Clinical Validation. For more information, see … About Validation Queues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252 About the Clinical Validation Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 About Rules for Clinical Validation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 About Internal Notes, Result Comments, and Accession Result Comments . . . . . . 254 About Clinical Validation Reviewers Some laboratories require a secondary check of microbiology results before they are released. This type of workflow requires reviewers with sufficient experience to assess whether results should be released or returned to the lab for additional work. For example, reviewers may be any of the following: • Pathologists • Laboratory supervisors Chapter 13 Reviewing and Validating Clinical Results 252 Chapter 13: Reviewing and Validating Clinical Results • Senior lab technologists Reviewers can use Clinical Validation to final results, redirect them to a different reviewer, or return them to the lab for additional work with the existing results either released or not released. Because reviewers are the only personnel who use Clinical Validation, the term you in Clinical Validation documentation refers to reviewers rather than bench technologists. About Validation Queues Microbiology and other testing accessions can be assigned to a validation queue to be reviewed in Clinical Validation. Only those accessions that have been assigned to a queue can be reviewed. If results for an accession have been previously reviewed and then new results are entered, only the new results are placed in the queue. Example Yesterday the direct exam of an accession was resulted, sent to a queue, reviewed, and released. Today the culture is resulted and assigned to a queue. Only the culture results can be reviewed in Clinical Validation, although yesterday’s direct exam results can be seen for reference. The system administrator defines the members of a queue in function MA 11. Typically, the members should include not only primary reviewers but also one or more backups, in case a reviewer is unavailable. Once accessions are assigned to a queue, any member of the queue can open Clinical Validation and review the results assigned to the queue. Accessions can be assigned either automatically or manually: • Automatic assignments can be done by rules that send results to a particular queue based on criteria defined for your site. For more information, see About Rules for Clinical Validation on page 253. • Automatic assignments can also be done by site parameter [Queue for Clinical Validation at Tech Final/Validation group to assign/Append Message]. For more information, see Chapter 7, Microbiology, in the Site Parameter Administrator’s Guide. • Manual assignments can be done in Microbiology Result Entry. For more information, see Manually Assigning Results to a Validation Queue on page 109. In addition, if you determine that an accession has been directed to the wrong queue or would best be reviewed by another reviewer, you can redirect an accession from within Clinical Validation. For more information, see Redirecting an Accession to a Different Validation Queue on page 271. Under some circumstances, you may want a person who is not part of a queue to review particular results. In this case, you can assign an accession to an individual tech code from within Clinical Validation. When that individual opens Clinical Validation, the accession appears in a queue named My Queue. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Getting to Know Clinical Validation 253 About the Clinical Validation Workflow The first step in the clinical validation process is to ensure that all results needing review get assigned to the appropriate queue. If the site has multiple queues, lab technologists should be trained on which queue results should be sent to. The next step is to open Clinical Validation and select the queue and accessions you want to review. For more information, see Selecting Accessions from a Validation Queue on page 255. After you have selected accessions, you review them. You can do any of the following: • • • • • • • • • • Approve some or all of the results. Final some or all of the accessions you selected. Return the results to the laboratory for further work. Redirect the accession to a different queue or individual. Enter internal notes that can be viewed by both you and laboratory technologists. For example, you can explain why an accession is being returned. Enter result comments that are appended to the current results. Enter accession result comments. Order additional tests. Open Microbiology Result Entry, Lab Inquiry, or Microbiology Inquiry. View the history of susceptibility results. For more information, see Reviewing Results on page 265. About Rules for Clinical Validation Rules can automatically assign results newly entered on an accession to a particular clinical validation queue. In addition, rules can determine whether results are released or placed into Hold. If your site uses rules to automatically send accessions to validation queues, your system manager assigns them to perform an action when you click Save in Microbiology Result Entry. However, if a user manually assigns an accession to a queue in Microbiology Result Entry and a rule qualifies the accession for a different queue, the manual assignment supersedes the rule’s assignment. Under some circumstances, a battery may meet the criteria of more than rule, and so the results may qualify for multiple queues or multiple actions. If this happens, you must select the correct queue or action. For more information, see Resolving Rule Conflicts for Validation Queues on page 110. Consult your system manager with any questions about the rules in your application or see the Rules Administrator’s Guide. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 254 Chapter 13: Reviewing and Validating Clinical Results About Internal Notes, Result Comments, and Accession Result Comments Clinical validation help laboratory technologists and clinical reviewers function as a team, even if they never work face-to-face. Lab technologists and reviewers can exchange information is several ways: • Internal notes • Result comments • Accession result comments Internal Notes Internal notes allow reviewers and lab technologists to write and view informal notes, facilitating a dialog between them and maintaining a record of patient and specimen level memoranda. Internal notes encourage communication about patients and specimens. They are not included on patient reports. Accession Result Comments Reviewers can create text comments that apply to the entire accession and are treated like results. This allows you to enter an interpretation that spans the batteries on the accession. These comments, known as accession result comments, can be viewed or edited from both Clinical Validation and Microbiology Result Entry. For more information, see Using Accession Result Comments in Clinical Validation on page 293. Result Comments You can add comments about a particular specimen or result. These comments are the same as result comments that you can enter in any Sunquest Laboratory resulting application. Unlike accession result comments, result comments are associated with the specimen or result, rather than with the accession as a whole. Starting Clinical Validation Description Use this procedure to start Clinical Validation. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Navigating the Sunquest Gateway in the Laboratory for Windows User’s Guide. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Accessions from a Validation Queue 255 2 In the Sunquest Gateway window, on the Lab tab or the All tab, double-click Clinical Validation. The Clinical Validation selection window opens. For information on using this window, see Selecting Accessions from a Validation Queue on page 255. Related Topics Reviewing Results on page 265 Selecting Accessions from a Validation Queue You may have many accessions assigned to the validation queues that you are a member of. Before you can review results, you must select the accessions or batteries that you want to work on. To help you focus on particular types of results that appear in your queue, you can filter results. Depending on your login security, you can delete or modify filters created by other users. For more information, see … About Accessions and Batteries in a Review Queue . . . . . . . . . . . . . . . . . . . . . . . . 256 Selecting Accessions to Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 Selecting a Date Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259 Selecting a Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 256 Chapter 13: Reviewing and Validating Clinical Results For more information, see … Creating and Editing Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260 Deleting a Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264 About Accessions and Batteries in a Review Queue If an accession contains multiple batteries with different order codes, each battery must be reviewed individually. Therefore, the batteries appear separately in your Accession list. When you review one of these batteries, any other batteries are shown for informational purposes. However, you cannot take any action on the other batteries until you review them. Example A physician has ordered both a wound culture and a urine culture on the same accession. When this accession is added to your queue, the batteries appear separately in your Accession list. Two batteries are on the same accession number. When you review one of these batteries, the other battery is shown in grey text. You cannot take action on the other battery at this time. You cannot review a grey battery. Other kinds of order codes on an accession, such as bill-only tests, may also be displayed in grey because they do not require review. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Accessions from a Validation Queue 257 Note Although the items in your queue may be either accessions or individual batteries, this documentation refers to them collectively as accessions. Selecting Accessions to Review Description If you are a member of more than one queue, the accessions assigned to all your queues appear on the Clinical Validation window by default. You can select a queue to work on, and select the items from the queue that you want to review. Steps to Take In the Clinical Validation selection window, 1 If more than one queue appears under Select items for review and you want to focus on one queue, in the Queue box, click the queue you want to view. The items in the queue appear in the Accession list. When you click a queue … … items in that queue appear in your Accession list. The accession list displays the following information about each item. This column … Displays … Accession The accession number and a check box that you can click to select the accession for review or redirecting. Patient Name The patient’s name. Patient ID The patient’s medical record number. CID The container ID for the accession. This column appears only if your site uses Specimen Management, Routing, and Tracking (SMART). Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 258 Chapter 13: Reviewing and Validating Clinical Results This column … Displays … Foreign CID The container ID, if assigned outside of Sunquest Laboratory. This column appears only if your site uses foreign CIDs in SMART. Order Code The order associated with the accession number. Notes The following codes, which indicate the type of internal notes present: Lock Status • P for patient-level notes. • S for specimen-level notes. • + for notes that have not been viewed by anyone other than the person who entered the note. The name of the person, if any, who has selected the accession from a validation queue. You cannot review an accession that is locked by another person. Notice that if an accession contains orders for two different kinds of cultures, such as urine and respiratory, the accession list shows the cultures on a two lines so they can be reviewed separately. Note To view accessions that may have been added, locked, or unlocked since you opened the queue, click Refresh. 2 If you have many accessions to review, it may be helpful to view only accessions resulted during a particular date range or that meet certain criteria, such as results for a particular ordering physician. Do any of the following: To … See … View accessions resulted during a specified date range Selecting a Date Range on page 259 Filter accession based on selected criteria Selecting a Filter on page 260 3 To select accessions to review, do one of the following: • To select all accessions in the list, click Select all. • To choose one or more accessions from the list, select the check boxes in front of the accessions you want to review. 4 To review the selected accessions, click Review. For information on reviewing results, see Reviewing Results on page 265. Related Topics Modifying Shift, Tech Code, and Lab Location on page 28 Redirecting an Accession to a Different Validation Queue on page 271 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Accessions from a Validation Queue 259 Selecting a Date Range Description You can select a date range that restricts the accession numbers that appear on the Clinical Validation selection window. For example, you view only the accessions that were resulted within the last week. To select a date range, you use options at the top of the Clinical Validation selection window. When you enter a date range … … the Apply button becomes available. Click to clear the date range. You Need to Know After you select a date range, you can continue selecting accessions as described in Selecting Accessions to Review on page 257. Steps to Take In the Clinical Validation selection window, 1 To select the beginning time, do the following: • In the first From box, enter the first day you want to search, or click to look up a date. • In the second box, enter the beginning time you want to search. 2 To select the ending time, do the following: • In the first To box, enter the last day you want to search, or click to look up a date. • In the second box, enter the end time you want to search. 3 Click Apply. The accession list displays only the accessions resulted in the selected time span. 4 To stop restricting accessions to the specified date range, click Clear Filter. Related Topics Selecting a Filter on page 260 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 260 Chapter 13: Reviewing and Validating Clinical Results Selecting a Filter Description You can filter the accessions that appear on your Clinical Validation window. To select and apply an existing filter, you use options at the top of the Clinical Validation selection window. Select and apply a filter. Clear the filter. View the filter’s criteria. For information about editing or creating a filter, see Creating and Editing Filters on page 260. You Need to Know After you select a filter or time span, you can continue selecting accessions as described in Selecting Accessions to Review on page 257. Steps to Take In the Clinical Validation selection window, 1 In the Filter name box, select an existing filter. The criteria that the filter uses are displayed under Filter criteria. 2 Click Apply. The Accession list displays only the accessions that meet the selected criteria. 3 To stop filtering the Accession list, click Clear Filter. Related Topics Selecting a Date Range on page 259 Creating and Editing Filters Description You can create a new filter or edit an existing filter that you created. Depending on your login security, you may also be able to modify filters created by other users. A filter can use any combination of the following criteria: • • • • • • • Accession locations Age HID Lab locations Order codes Ordering physicians Organisms UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Accessions from a Validation Queue • • • • • • • 261 Positive or negative organisms Priority codes Sex Species Specimen type User-defined fields Worksheets You Need to Know If an individual criterion allows multiple selections, the filter includes accessions that meet any of the selections. For example, if you select both WDC and RESP Order Codes, the filter selects either WDC or RESP orders. If you select more than one criteria, the filter includes only accessions that meet all the criteria. For example, if you set the Age criterion to 21 years and the Sex criterion to Female, the filter selects accessions only for patients who are twenty-one years old and female. Steps to Take In the Clinical Validation selection window, 1 Under Select items for review, do one of the following: To … Do this … Edit an existing filter, or create a new filter based on an existing filter 1 In the Filter name box, select an existing filter. 2 Click Edit. Create a new filter from scratch • Microbiology User’s Guide Sunquest Laboratory Click New. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 262 Chapter 13: Reviewing and Validating Clinical Results The Clinical Validation filter window opens. If you are editing an existing filter, its name appears in the Filter name box and the settings appear under Current filter settings. For an existing filter, the settings for each criterion are shown. 2 To name the filter, do one of the following: • In the Filter name box, enter the name for the filter. • If you are basing your filter on an existing filter, to save the filter under a different name, click Save As. 3 If necessary, in the Queue box, select the queue to associate the filter with. 4 In the Current filter settings list, click a criterion on which you want to filter. The options for the criterion appear in the pane to the right of Current filter settings. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Selecting Accessions from a Validation Queue 263 5 To change the options for the criterion, do one of the following: If you clicked … Do this … Accession Locations 1 To restrict the filter to certain options, in the Code box, enter Lab Locations Order Codes Organisms a code you want to include, or click 2 Click Add. The information about the code appears in the list. Only the codes in the list are included when you apply the filter. Ordering Physicians Priority Codes Specimen Types 3 Repeat steps 1 and 2 for each code you want to add. 4 To remove a code from the list, do one of the following: Worksheets Age to look up a code. • Click the code and then click Remove. • Click Remove All. 1 In the From box, enter the first age to include, followed by a unit (M for months, D for days, or Y for years). If you enter just a number, the system assumes that the unit is years. 2 In the To box, enter the ending age to include, followed by a unit (M for months, D for days, or Y for years). If you enter just a number, the system assumes the same unit. 3 Click Add. HIDs • To have the filter include only certain HIDs in the filter, select the check boxes for the HIDs you want to include. POS/NEG Organisms • To include both kinds of organisms, clear the check boxes. • To include just one type of organism, select one of the following: Sex Microbiology User’s Guide Sunquest Laboratory Positive Organisms • Negative Organisms • To have the filter display only certain of the genders or species defined for your site, select the check boxes you want to include. • To have the filter display only significant findings, select Limit to clinically significant organisms check box. • To not filter by significance, clear the Limit significant organisms check box. Species Significant Findings • to clinically UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 264 Chapter 13: Reviewing and Validating Clinical Results If you clicked … Do this … User Defined Fields 1 To select a field to include, in the Field box, enter the field, or click to look up a field. 2 To select a particular value for the field, in the Value box, enter the value. 3 Click Add. The information about the code appears in the list, as in the following example. 4 Repeat steps 1 through 3 for each user-defined field you want to add. 5 To remove a field from the list, do one of the following: • Click the field and then click Remove. • Click Remove All. 6 Repeat steps 4 through 5 for each criterion you want to add to the filter. 7 If you want to remove any options for the selected criterion, click the option and then click Remove. 8 To save the changes to the filter and return to the Clinical Validation selection window, click Save. Related Topics Deleting a Filter on page 264 Deleting a Filter Description If you created a filter, you can delete it at any time. Depending on your login security, you may also be able to delete filters created by other users. Steps to Take In the Clinical Validation selection window, 1 Under Select items for review, in the Filter name box, select the filter you want to delete. 2 Click Edit. The Clinical Validation filter window opens. 3 Click Delete. You are asked to confirm the deletion. Related Topics Creating and Editing Filters on page 260 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 265 Reviewing Results You can review the accessions you selected and perform a variety of tasks such as changing the review status to final, approved, returned, or redirected. Support options can help you make timely and accurate decisions. For more information, see … Understanding the Clinical Validation Review Window . . . . . . . . . . . . . . . . . . . . . . . 266 Moving from One Accession to Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 About Clinical Validation Review Statuses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Changing the Review Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Redirecting an Accession to a Different Validation Queue . . . . . . . . . . . . . . . . . . . . 271 Suppressing or Unsuppressing a Result . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 Reviewing Susceptibility Histories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274 Opening Other Sunquest Laboratory Applications . . . . . . . . . . . . . . . . . . . . . . . . . . 276 Adding New Tests to an Accession . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Entering Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278 Clearing All Changes to an Accession . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 Printing Clinical Validation Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282 Printing or Faxing Interim Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Exiting the Review Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 266 Chapter 13: Reviewing and Validating Clinical Results Understanding the Clinical Validation Review Window The Clinical Validation window displays patient and specimen headers, accession details, review options, options that support your review, and navigation and print options. Patient header Specimen header Accession details Review options Support options Navigation and print options The components of the window are explained below: • The patient header and specimen header are similar to the headers used in Microbiology Result Entry. For more information, see About the Patient and Specimen Headers on page 51. • The accession details list displays the results for the current accession in outline, or tree, format. Right clicking a result line displays a shortcut menu; the options available on the menu depend on the type of item selected. If an accession contains multiple batteries, each battery must be reviewed separately. The results for the battery not currently being reviewed are shown for informational purposes only; they appear in grey, indicating that you cannot change the review status of that battery. The specimen header displays information about the battery up for review, not the one displayed for informational purposes. For more information, see About Accessions and Batteries in a Review Queue on page 256. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 267 The following example shows an accession that contains both a respiratory culture and a fungus culture, with the respiratory culture being reviewed. The results in bold text can be reviewed. The culture in light text is for information only. • The four review options are the actions that you can take after reviewing the results: Final, Approve, Redirect, and Return. They are described in detail in About Clinical Validation Review Statuses on page 268. • The support options can be used to research and support your review of the accession. The options are: • Collapse All hides all but the main branch of the results tree. After you click Collapse All, the button changes to Expand All. You can also hide or expand individual branches by clicking the + or - boxes in front of the branches. • Notes lets you view or enter internal notes about the patient or specimen. For more information, see Creating and Editing Internal Notes on page 291. • Acc Result Cmt lets you view or enter comments entered about the accession. Accession result comments are treated like results. For more information, see Using Accession Result Comments in Clinical Validation on page 293. • Result Cmt lets you view or enter test-level comments about the results. For more information, see Entering Result Comments on page 278. • Go To opens other Sunquest Laboratory windows. You can order additional test for the accession, or go to Inquiry, Microbiology Inquiry, or Microbiology Result Entry. For information on opening Sunquest Laboratory windows, see Opening Other Sunquest Laboratory Applications on page 276. For information about add-on orders, see Adding New Tests to an Accession on page 277. • Suscept History displays a cumulative history view of susceptibilities for the patient over a date range you specify. For more information, see Reviewing Susceptibility Histories on page 274. • Clear removes changes you have made, including comments and suppressions or unsuppressions. The only exceptions are orders or internal notes that you added. • Navigation and print options let you move to the next or previous accession, print or fax results, save your changes to the accession, and exit either the review screen or Clinical Validation. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 268 Chapter 13: Reviewing and Validating Clinical Results Moving from One Accession to Another Description After you have selected accessions to review, you can move from one accession to another, in the order that the accessions appeared on the selection window. Before You Begin Select the accessions you want to review. For more information, see Selecting Accessions from a Validation Queue on page 255. Steps to Take In the Clinical Validation window, • Do one of the following: • To move to the next accession, click Next. • To move to the previous accession, click Previous. About Clinical Validation Review Statuses Description The most important part of Clinical Validation is the review status that you assign to an accession. When an accession is first opened in Clinical Validation, the results have no status assigned. After examining the results, you can assign any of four statuses, or clear all statuses. The four statuses are: • • • • Final Approve Redirect Return For information on changing the status of an accession, see Changing the Review Status on page 270. Final This status releases the accession to reports and Inquiry, and finals the results. When you click Final, all the results that were queued are marked with a green, underlined check mark. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 269 Approve This status releases the accession’s results to reports and Inquiry, but also sends them back to the lab technologists for further work such as completing an add-on test. When you click Approve, the results that were queued are marked with a yellow check mark. When a user opens an approved accession in Microbiology Result Entry, the Queue is shown as ‘Returned’. You can communicate the reason for returning the results by creating a note. For more information, see Creating and Editing Internal Notes on page 291. Redirect This status sends the accession to a different validation queue. When you click Redirect and select an alternate queue, all the results that were queued are marked with a red arrow. Return This status sends the accession back to the lab technologists for further work, such as completing an add-on test. The results are not released to Inquiry and reports. When you click Return, the results that were queued are marked with a red, circular arrow. When a user opens a returned accession in Microbiology Result Entry, the Queue is shown as ‘Returned’. You can communicate the reason for returning the results by creating a note. For more information, see Creating and Editing Internal Notes on page 291. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 270 Chapter 13: Reviewing and Validating Clinical Results Changing the Review Status Description You can assign one of four review statuses to results: Final, Approve, Redirect, or Return. For information about these statuses, see About Clinical Validation Review Statuses on page 268. Clicking one of the status buttons shown under All Status Update changes the status of all results in the accession. However, you can also change the status of individual results to either Approve or Return by right-clicking the result. When you change the status of results, the change is not applied until you save your work on the accession. Before You Begin Select an accession to review. For more information, see Selecting Accessions from a Validation Queue on page 255. Steps to Take In the Clinical Validation window, To change the status of all results • Under All Status Update, click the status you want to apply to the accession. Note For more information about redirecting results, see Redirecting an Accession to a Different Validation Queue on page 271. To remove the status from all results • Click Clear Actions. Note You can also remove the status from all results by clicking the Clear button. In addition to statuses, this button also removes any other unsaved changes you made to the accession. For more information, see Clearing All Changes to an Accession on page 281. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 271 To change the status of individual results 1 Right-click the result whose status you want to change. A shortcut menu appears. The only statuses available on the right-click menu are Approve and Return; the other statuses, Final and Redirect, apply only to the entire accession. Right-click to display the menu. 2 Click the status you want to apply to the result. To save the status changes • Click Save. If this is the final accession you selected to review, you are returned to the selection window. If more accessions remain to be reviewed, the next accession appears. Related Topics Entering Result Comments on page 278 Suppressing or Unsuppressing a Result on page 273 Redirecting an Accession to a Different Validation Queue Description If you determine that a battery has been assigned to the wrong review queue, you can redirect it to the proper queue or to a specific individual. You can do this either when you are selecting items in your queue or when you are reviewing results. Steps to Take To redirect accessions, To redirect an accession from the Clinical Validation selection window 1 Select the check boxes in front of the accessions you want to redirect. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 272 Chapter 13: Reviewing and Validating Clinical Results 2 Click Redirect. The Select Queue window opens. 3 In the Select Queue box, enter the tech code for the individual or for the validation queue you want to send the accession to, or click to look up a tech code. 4 Click Save. The selected accessions are moved to the queue you entered. To redirect an accession from the Clinical Validation review window 1 Open the accession you want to redirect. For more information, see Selecting Accessions from a Validation Queue on page 255. 2 Click Redirect. The Select Queue window opens. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 273 3 In the Select Queue box, enter the tech code for the individual or for the validation queue you want to send the accession to, or click to look up a tech code. Red arrows indicate that the results are ready to be redirected. When you click Redirect … … red arrows mark the results … … and the new queue is displayed. 4 Click Save. The accession is redirected to the selected queue. Suppressing or Unsuppressing a Result Description In the Clinical Validation window, you can suppress an individual result. If a result is already suppressed, you can unsuppress it. The following types of results can be suppressed or unsuppressed: • Drug tests • Organisms • Tests for direct exams, cultures, or other tests Note If HIDE is the only answer for a test, you cannot remove the suppression for the test. You can, however, open Microbiology Result Entry to unsuppress the result. For more information, see Opening Other Sunquest Laboratory Applications on page 276. Before You Begin Select an accession to review. For more information, see Selecting Accessions from a Validation Queue on page 255. Steps to Take In the Clinical Validation window, To suppress a result 1 Right-click the result. 2 From the shortcut menu, click Suppress. An English text code is appended to the result, as defined by parameter [English text code to suppress tests from printing on patient reports]. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 274 Chapter 13: Reviewing and Validating Clinical Results To unsuppress a result 1 Right-click a result that has your site’s English text code for suppression appended. 2 From the shortcut menu, click Unsuppress. The English text code is removed from the result. Reviewing Susceptibility Histories Description When reviewing an accession, it may be helpful to see previous results for the patient. Using the Susceptibility History option, you can view a cumulative history of susceptibilities for the patient for a date range that you specify. The susceptibilities are displayed in reverse chronological order. The accession number that you were reviewing is preceded by an asterisk (*), as in the following example. The current accession is indicated by an asterisk. Before You Begin Select an accession to review. For more information, see Selecting Accessions from a Validation Queue on page 255. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 275 Steps to Take In the Clinical Validation window, 1 Click Suscept History. The Susceptibility History window opens. Data does not appear until you have determined the time span to be covered. 2 To filter the susceptibility history by date, do one of the following: To filter by … Do this … The number of days prior to today, or to include all days 1 Under Restriction for susceptibility history date select, click Days prior to current date. The following options appear. 2 Do one of the following: • • Select the Include all accessions check box. In the No. of days prior box, enter the number of days, from 1 to 9999. For example, if you enter 1, susceptibilities for today and yesterday are selected. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 276 Chapter 13: Reviewing and Validating Clinical Results To filter by … Do this … A date range 1 Under Restriction for susceptibility history date select, click Date Range. The following options appear. 2 In the From box, enter the first day you want to search, or click to look up a day. 3 In the To box, enter the last day you want to search, or click to look up a day. 3 Click Get Results. The susceptibility results from the selected time span are displayed under Microbiology Results. Opening Other Sunquest Laboratory Applications Description While reviewing an accession in Clinical Validation, it may be helpful to view the data for the accession in other Sunquest Laboratory applications. Using the Go To option, you can quickly open the following applications without having to navigate to the Sunquest Gateway: • Laboratory Inquiry • Microbiology Inquiry • Microbiology Result Entry If you make changes to the accession before you open Microbiology Result Entry, any changes other than adding internal notes or add-on orders are cleared. You can also order additional tests for the accession. For information about add-on orders, see Adding New Tests to an Accession on page 277. Before You Begin Select an accession to review. For more information, see Selecting Accessions from a Validation Queue on page 255. Steps to Take In the Clinical Validation window, while reviewing an accession, 1 Click Go To. A shortcut menu appears. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 277 2 Click the application you want to open. The application opens, displaying data about the selected accession. Adding New Tests to an Accession Description If your review of results in Clinical Validation warrants it, you can add new microbiology or bill-only tests to a battery. If you enter a microbiology test, the test is added to the current accession unless site parameter [Allow multiple micro batteries per accession number] is set to N, in which case a new accession is created. If you enter a micro bill-only test, the test is added to the current accession regardless of this setting. Before You Begin Select an accession to review. For more information, see Selecting Accessions to Review on page 257. Steps to Take In the Clinical Validation window, 1 Click Go To. A shortcut menu appears. 2 Click Add-on Orders. The Add-On Orders window opens. 3 In the Order Code box, enter the test code you want to order, or click to look up a test code. 4 Click Add. The order appears in the Add-on Orders list. 5 If you want to remove orders from the list, do any of the following: To … Do this … Remove a selected order • In the Add-on Order list, click the order you want to remove, then click Remove. Remove all orders • Click Remove Microbiology User’s Guide Sunquest Laboratory All. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 278 Chapter 13: Reviewing and Validating Clinical Results 6 To place the new orders, click Save. The new orders are shown at the bottom right of the Clinical Validation window, below the support options. Add-on orders and the accession number are shown here. Entering Result Comments Description You can use the Result Comment window to enter comments about specific results at the test code level for direct exams or cultures, or at the observation-result level. The results you are commenting on determine the types of comments that you can enter and the format of the Result Comment window. Result comments that pertain to all the results for the test code can include only composed text. The Result Comment window appears as follows: UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 279 When you comment on culture or direct exam observations, the comment can include either comment codes or free text. For these types of results, the Result Comment window appears as follows: Enter comment codes here. Enter free text here. Comments are listed here. When you comment on results for susceptibilities or non-microbiology tests assigned to a microbiology battery, you can enter comment codes, free text, or composed text. For these types of results, the Result Comment window appears as follows: Enter comment codes or free text here. Enter composed text here. Before You Begin Select an accession to review. For more information, see Selecting Accessions from a Validation Queue on page 255. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 280 Chapter 13: Reviewing and Validating Clinical Results Steps to Take In the Clinical Validation window, To enter comment codes or free text 1 To select a result to comment on, do one of the following: • Click the result, then click Result Cmt. • Right-click the result. On the shortcut menu, click Add Comment. The Result Comment window opens. 2 Do any of the following: To enter … Comment codes Do this … 1 In the Comment box, enter the comment code or click to look up a code. 2 Click Add. The code and its translation are added to the list. Enter or look up a code. Free text Click to add the code to the list. 1 In the Free text box, enter up to 140 characters. 2 Click Add. The text, preceded by a semicolon, is added to the description column in the list. 3 You can edit or remove either comment codes or free text entered in this session. Do any of the following: To … Do this … Edit codes or free text 1 In the list, click the line you want to edit. 2 Click Edit. The code or text appears in the Comment or Free text boxes. 3 Edit the code or text, then click Add. Remove a single line of text • Click the line of text, then click Remove. Remove all comment codes or free text • Click Clear. 4 When you are finished entering result comments, click OK. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 281 To enter composed text 1 To select a result to comment on, do one of the following: • Click the result, then click Result Cmt. • Right-click the result. From the shortcut menu, click Add Comment. The Result Comment window opens. 2 Click anywhere in the Composed Text box. 3 Enter your comments or observations by doing any of the following: To … Do this … Translate a text code into text. Press Ctrl+T, type one or more text codes, and then press Ctrl+T. Enter multiple codes on one line. Press Ctrl+T, type the codes with a hyphen between each code, and then press Ctrl+T. Insert a page break. Type .TP or .tp to indicate a new page on a report. Note To remove all composed text, under Composed Text, click Clear. 4 When you are finished entering result comments, click OK. Related Topics About Composed Text on page 76 Using Accession Result Comments in Clinical Validation on page 293 Clearing All Changes to an Accession Description You can remove all unsaved changes you made to an accession, including: • Status changes • Internal notes • Accession result comments Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 282 Chapter 13: Reviewing and Validating Clinical Results • Result comments There are two ways to clear all changes, differing only in what happens after the changes are removed. In one method, the accession is redisplayed in the review window. In the other, you leave the review window and return to the selection window. Steps to Take In the Clinical Validation review window, • Do one of the following: • To remain in the review window after removing changes, click Clear. • To return to the selection window, click Cancel. Printing Clinical Validation Details Description You can print or preview the details of a Clinical Validation review. This includes the patient and specimen headers, as well as the information in the review pane. For example, if you have marked the accession as finaled, the details report displays the finaled symbol in front of the results. Before You Begin Select an accession to review. For more information, see Selecting Accessions to Review on page 257. Steps to Take In the Clinical Validation window, To preview the details report • Click Preview Detail. The Print Preview window opens, displaying the report. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results 283 To print the details report 1 Click Print Detail. The Print window opens. 2 Select a printer, then click Print. Printing or Faxing Interim Reports Description You can print or fax the results as an Interim Report to any device defined in Terminal Definition (MA 7). Unsaved changes to the accession do not appear on the report. The results are printed as an Interim Report by Accession Number for the accession displayed in Clinical Validation. For more information about Interim Reports by Accession Number, see the Laboratory Reports User’s Guide. When you fax a report, you can use the default phone number defined for the device or enter the phone number of another fax machine. You Need to Know To print an Interim Report of the current results, you need to select a print or fax device. The device must be defined in Terminal Definition (MA 7). The report is an Interim Report by Accession of the displayed accession numbers. Before You Begin Select the accession you want to print or fax. For more information, see Selecting Accessions to Review on page 257. Steps to Take In the Clinical Validation window, 1 Click Print/Fax Interims. 2 The Print/Fax Device Selection window opens. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 284 Chapter 13: Reviewing and Validating Clinical Results 3 Do any of the following: To … Do this … Print the report. 1 In the Device box, type a Sunquest Laboratory device code for the printer, or click to look up a code. Type the device code of the printer. 2 If your site has a linked, multiple-CPU system, in the CPU box, enter the CPU where the report is processed. Fax the report. 1 In the Device box, type a Sunquest Laboratory device code for the fax device, or click to look up a code. Type the fax device code and phone number where you want to fax the report. If a fax number is defined for the device in MA 7, the number appears automatically in the Select or enter a fax number box. If there is more than one number defined, you can select the appropriate number. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Reviewing Results To … Do this … Fax the report (continued) 2 If the Phone # box is empty, enter a fax number for the 285 destination fax. If you entered a fax number manually, the system verifies the number according to the settings of the following site parameters: • [Pattern match for phone number] • [Verify indicated fax number is defined in maintenance before faxing an interim report (Y/<N>)] The following may occur: • If the fax number passes both site parameter checks and matches one client or physician, the system displays the recipient’s name. View the client associated with this number. • If the fax number does not pass the pattern match, the system notifies you to enter a number in the correct format. • If the fax number does not match a number defined in client or physician maintenance, the system notifies you that there is no match. If you have appropriate security, you can override this warning and send the fax to the specified number. If you do so, the system logs a low priority message to track the override. • If the fax number passes both site parameter checks and matches more than one client or physician, a search button appears. Click to view clients and physicians that match this number. a) Click the search button to display the matches. b) View the client and physician matches, and then click OK. 3 If your site has a linked, multiple-CPU system, in the CPU box, enter the CPU where the report is processed. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 286 Chapter 13: Reviewing and Validating Clinical Results To … Do this … Schedule the report for a future date and time. 1 In the Date box, enter the date on which you want the report printed. To have the report printed n days from today, you can enter a date in the form T+n. If you do not enter a date, the report is printed when you click OK. Enter the date and time that you want the report to print. 2 In the Time box, enter the time at which you want the report printed. To have the report printed at the time n minutes from the current time, you can enter a time in the form +n. 4 In the Print/Fax Device Selection window, click OK. Interim reports for the accession numbers are printed, faxed, or scheduled for the date and time you entered. Exiting the Review Window Steps to Take In the Clinical Validation window, To exit the review window and return to the accession selection window • Click Cancel. To exit Clinical Validation • Click Exit. Exchanging Notes about Clinical Results Both reviewers and lab technologists can view and enter internal notes. These notes are designed to facilitate communication about specimens being reviewed in Clinical Validation, but they are available in some other applications, as well. For more information, see … About Internal Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Viewing Internal Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288 Creating and Editing Internal Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Exchanging Notes about Clinical Results 287 About Internal Notes You can think of internal notes as electronic sticky notes that are useful for Clinical Validation. Internal notes facilitate communication between lab technologists and reviewers. Because this is a two-way communication, internal notes can be viewed and entered in Microbiology Result Entry as well as in Clinical Validation. Example You assign a review status of Return to an accession, which sends the accession back to the lab technologist for additional work. To explain what work needs to be done, you create a note that is attached to the accession. Your login security determines your access to notes; for more information, see Setting Security for Clinical Validation on page 305. Depending on your security, you can do the following: • View notes • Create notes • Modify notes, view suppressed notes, and view previous versions of modified notes • Delete notes A suppressed note is hidden from users who do not have the login security to view them. You cannot modify a note that is suppressed, but you can unsuppress it, modify it, and then suppress it again. Types of Notes There are two types of notes: • Patient-related notes are available for all of the patient’s accessions. These notes can be viewed in Microbiology Result Entry, Microbiology Inquiry, Clinical Validation, Administrative Data Entry, Order Entry, Order Receipt Modification, and Inquiry. They form a permanent part of the patient’s record. • Specimen-related notes that are specific to a particular accession. They are available only in Microbiology Result Entry and Clinical Validation. They remain available for viewing in Inquiry until the accession is purged. The Notes button shows the type of internal notes that are present: • P for patient-level notes. • S for specimen-level notes. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 288 Chapter 13: Reviewing and Validating Clinical Results • + for notes that have not been viewed by anyone other than the person who entered the note. Example In Microbiology Result Entry, when you select an accession, the Notes button appears as follows: Indicators on the Notes button The indicators (P+S) show that the accession has both patient-level and specimenlevel notes, and that the patient-level notes have been read only by their creator. If indicators do not appear, there are no notes for the selected accession. Note and Reports As their name implies, internal notes cannot be viewed on patient reports. On reports intended for internal use, the presence of internal notes is indicated by an ‘N’ on the following reports. The notes themselves are not printed: • • • • Overdue test log Pending test log Microbiology culture review report Worksheets In the Clinical Validation Reports application, you can view a report of internal notes that have been entered. Viewing Internal Notes Description Depending on your login security, you can view internal notes in both Microbiology Result Entry and Clinical Validation. You can then sort the notes chronologically and filter them by type or department. If a note has been revised, you can view previous versions. For more information regarding notes, see About Internal Notes on page 287. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Exchanging Notes about Clinical Results 289 Steps to Take In Clinical Validation or Microbiology Result Entry, with an accession selected, 1 Click Notes. The Internal Notes window opens, with the selected patient’s name and patient ID shown. If notes exist for the patient, they appear in the Existing notes list. Patient information appears here. Existing notes appear here. Create or edit notes. Sort and filter notes. 2 To modify your view of existing notes, do any of the following: To … Do this … Change the order in which the notes appear • Microbiology User’s Guide Sunquest Laboratory Under Sorting, click either Newest entry first or Oldest entry first. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 290 Chapter 13: Reviewing and Validating Clinical Results To … Do this … Include or exclude types of notes 1 Under Filtering, select or clear the Show Suppressed, Specimen-level, or Patient-level check boxes. 2 Under Dept Filter, select or clear the check boxes in front of the codes of the departments whose notes you want to view. Note Department filters are available only for patient-level notes. 3 If a note has been revised, a notification is appended to it in the existing notes list. To review the earlier versions, click View History. When you click View History … … the View History window opens. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Exchanging Notes about Clinical Results 291 Creating and Editing Internal Notes Description Depending on your login security, you can add, edit, or delete internal notes in both Microbiology Result Entry and Clinical Validation. For more information, see About Internal Notes on page 287. Steps to Take In Clinical Validation or Microbiology Result Entry, with an accession selected, To create or edit a note 1 Click Notes. The Internal Notes window opens. If notes exist for the patient, they appear in the Existing notes list. Existing notes appear here. Microbiology User’s Guide Sunquest Laboratory Click to edit an existing note. Enter and add notes. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 292 Chapter 13: Reviewing and Validating Clinical Results 2 Do one of the following: To … Do this … Edit an existing note 1 Under Existing notes, click Edit Note beside the note you want to modify. The note is copied to the Add/modify note list. Click Edit Note Note To modify a suppressed note, you must first unsuppress it. 2 In the Add/modify note list, edit the note. Create a new note • In the Add/modify note list, enter the note. 3 To designate the note as either referring to the patient or to the specimen, under Level, click Patient or Specimen. 4 To specify a department associated with a patient-level note, in the Dept box, enter a department code defined in Laboratory Departments (function MA 5), or click to look up a code. 5 To define whether the note can be viewed or edited only by people with login security to view suppressed notes, do one of the following: To … Do this … Mark the note as suppressed 1 Select the Suppressed check box. 2 In the Suppress/Unsuppressed Reason box, enter the reason you are suppressing the note. Mark the note as not suppressed 1 Clear the Suppressed check box. 2 In the Suppress/Unsuppressed Reason box, enter the reason you are unsuppressing the note. 6 Do one of the following: • To save the new or modified note, click Save. The note is added to the Existing notes list. • To cancel the modifications, click Discard. To delete a note • To delete a note, click Delete Note beside the note you want to remove. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Using Accession Result Comments in Clinical Validation 293 Using Accession Result Comments in Clinical Validation You can create text comments that apply to an entire accession. These comments, known as accession result comments, can be viewed or edited from Clinical Validation as well as from the Direct Exam, Culture, and Other Tests tabs in Microbiology Result Entry. For more information, see … About Accession Result Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 Opening Accession Result Comments in Clinical Validation . . . . . . . . . . . . . . . . . . . 293 About Accession Result Comments You can enter a comment that covers all the batteries of an accession. You can enter accession result comments as any combination of the following: • Free text • Text codes • Composed text Accession result comments are treated like results. For example, entering an accession result comment qualifies a patient report to print. Also, if you change either the free text or text codes in a comment, a correction statement may be appended. However, if only the composed text is changed, no correction statement is added. Depending on site parameter settings, accession result comments can be viewed in Inquiry and patient reports. For information about the site parameters that affect accession result comments, see Accession Result Comment Site Parameters on page 311. Related Topics About Composed Text on page 76 Entering Accession Result Comments on page 113 Opening Accession Result Comments in Clinical Validation Description You can view or enter accession result comments while reviewing results in Clinical Validation. For information on accession result comments, see About Accession Result Comments on page 112. Before You Begin Select the accession you want to review. For more information, see Selecting Accessions to Review on page 257. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 294 Chapter 13: Reviewing and Validating Clinical Results Steps to Take In Clinical Validation, • Click Acc Result Cmt. The Accession Results Comments window opens. For information on entering comments, see Entering Accession Result Comments on page 113. Viewing Clinical Validation Reports You can view a log of activity in Clinical Validation. You can also view a list of all internal notes that have been created. For both kinds of reports, you can specify the time frame the report covers, and filter the information included in the report. For more information, see … Opening Clinical Validation Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294 Viewing the Clinical Validation Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Viewing the Internal Notes Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Opening Clinical Validation Reports Description Use this procedure to start Clinical Validation Reports. Steps to Take From your PC desktop, 1 Log on to Sunquest Laboratory. For more information, see Logging On to Sunquest Laboratory on page 22. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Clinical Validation Reports 295 2 In the Sunquest Gateway window, on the Lab tab or All tab, double-click Clinical Validation Reports. The Clinical Validation Reports window opens. 3 Under Reports, do one of the following: • To view a log of changes made in Clinical Validation, click Clinical Validation Log. For more information, see Viewing the Clinical Validation Log on page 295. • To view a list of all internal notes created in Clinical Validation and Microbiology Result Entry, click Internal Notes Report. For more information, see Viewing the Internal Notes Report on page 297 Viewing the Clinical Validation Log Description In the Clinical Validation Reports application, you can view a log of activity in the Clinical Validation application. The log tracks the following by date: • • • • Whether comments have been added to accessions Whether add-on tests have been ordered When reports have been printed Actions applied to accessions and batteries, such a finaling a result, approving it, sending it back to the bench, or deleting it from a queue You can specify the date range covered by the log, and filter the results by HID and reviewer. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 296 Chapter 13: Reviewing and Validating Clinical Results Before You Begin Open Clinical Validation Reports. For more information, see Opening Clinical Validation Reports on page 294. Steps to Take In the Clinical Validation Reports window, 1 Under Reports, click Clinical Validation Log. Options related to the log appear under Parameters. Select a date range. Create a filter 2 To restrict the report to a selected range, under Report Range, do the following: To select … Do this … The start of the date range 1 In the first of the two Date range boxes, enter the date you want the report to start, or click to look up a date. 2 In the second box, enter the starting time you want the report to cover. The end of the date range 1 In the first of the to boxes, enter the date you want the report to end, or click to look up a date. 2 In the second box, enter the end time you want the report to cover. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Clinical Validation Reports 297 3 To include only selected HIDs or reviewers, do any of the following: To … Do this … Filter by HID 1 Under Current filter settings, click Hospital ID. 2 Under Hospital ID, in the Code box, enter the code for a hospital you want to include in the report. The hospital’s code and description appear in the list. 3 Repeat step 2 for each hospital you wan to include. Filter by reviewer 1 Under Current filter settings, click Reviewer. 2 Under Reviewer, in the Code box, enter the tech code for a reviewer you want to include in the report. The reviewer’s tech code and description appear in the list. 3 Repeat step 2 for each reviewer you wan to include. Remove any or all HIDs or reviewers • To remove an individual HID or reviewer, click the code, then click Remove. • To removed all HIDs or reviewers, click Remove all. The selections you made appear under Current filter settings. Note If you want to remove the date range and filters, click Clear. 4 To view the report, do any of the following: • To view the report online, click Preview. • To print the report, click Print. Viewing the Internal Notes Report Description You can view a report that lists the internal notes created in Clinical Validation and Microbiology Result Entry. You can specify a date range and filter the report. Steps to Take Before You Begin Open Clinical Validation Reports. For more information, see Opening Clinical Validation Reports on page 294. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 298 Chapter 13: Reviewing and Validating Clinical Results Steps to Take In the Clinical Validation Reports window, 1 Under Reports, click Internal Notes Report. Options related to the report appear under Parameters. 2 To determine whether the report is restricted to a selected date range, under Report Range, do any of the following: To include … Do this … All available notes • Only the notes entered during a specific date range 1 Select the Include date range check box. Clear the Include date range check box. 2 In the Date range box, enter the date you want the report to start, or click to look up a date. 3 In the to box, enter the date you want the report to end, or click to look up a date. 3 To determine the type of notes included in the report, under Notes, do any of the following: • To include patient notes, select the Patient Notes check box. • To include specimen notes, select the Specimen Notes check box. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Viewing Clinical Validation Reports 299 4 To filter the results, do any of the following: To … Do this … Filter by Hospital ID 1 Under Filter by, click Hospital. If you have previously created any HID filters for the report, they are shown under both Current filter settings and in the Hospital ID list. 2 In the Code box, enter an HID, or click to look up an HID 3 Click Add. 4 Repeat steps 1 through 3 for each HID you want to include in the report. Filter by Patient ID 1 Under Filter by, click Patient. If you have previously created any patient filters for the report, they are shown under both Current filter settings and in the patients list. 2 In the Code box, enter a Patient ID, or click to look up a patient ID 3 Click Add. 4 Repeat steps 1 through 3 for each patient you want to include in the report. Remove all filters • Click Clear. 5 To view the report, do any of the following: • To view the report online, click Preview. • To print the report, click Print. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 300 Chapter 13: Reviewing and Validating Clinical Results UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview This appendix lists the site parameters and maintenance definitions that determine the ways in which you use the Microbiology applications. This section includes the following topics Setting Security for Microbiology Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Microbiology Setup Entry Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Microbiology Result Entry Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 Microbiology Tech Final Release Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Microbiology Automatic No-Growth Result Entry Settings . . . . . . . . . . . . . . . . . . . . 324 Microbiology Inquiry Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 Clinical Validation Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328 Setting Security for Microbiology Applications Your security settings determine whether or not you can access a microbiology application and add or modify data. Each application requires a specific security setup for each user. For more information, see … About Security for Microbiology Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Setting Security for Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Setting Security for Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302 Setting Security for Microbiology Tech Final Release . . . . . . . . . . . . . . . . . . . . . . . . 303 Setting Security for Microbiology Automatic No-Growth Result Entry . . . . . . . . . . . . 304 Setting Security for Microbiology Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 Setting Security for Clinical Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Appendix A Settings for Microbiology Applications 302 Appendix A: Settings for Microbiology Applications About Security for Microbiology Applications For information about Security Control, contact your system manager or see the System Operations Administrator’s Guide. For more information about setting up security to access microbiology applications, see Appendix A, Setting Security, in the Windows-Based Applications Installation Guide. Setting Security for Microbiology Setup Entry Security definitions set by the system manager enable you to access Microbiology Setup Entry. The following table lists the security settings required to perform tasks in Microbiology Setup Entry. This activity … Requires these security settings … Accessing Microbiology Setup Entry. • Association of a security level in Define Security Level. • Definition of system function MST in Define System Functions. • Association of a tech code with your password in Password Assignment. Accessing patient orders associated with HIDs. Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Setting Security for Microbiology Result Entry Security definitions set by the system manager enable you to access Microbiology Result Entry and to view the Direct Exam, Culture Entry, and Susceptibility tabs and the Online, Biotype, Misc. Updates, Billing, and Other Tests tabs. If you do not have the proper security level, then one or more of the tabs may not be available in Microbiology Result Entry. The following table lists the security settings required to perform tasks in Microbiology Result Entry. This activity … Requires these security settings … Accessing Microbiology Result Entry. • Association of a security level in Define Security Level. • Definition of system functions such as MCE, MCER, MDE, MDER, MSN, MSNR, DEH, and MID in Define System Functions. • Association of a tech code with your password in Password Assignment. Accessing patient orders associated with HIDs. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Microbiology User’s Guide Sunquest Laboratory Setting Security for Microbiology Applications 303 This activity … Requires these security settings … Accessing the Direct Exam, Culture Entry, Susceptibility, Online, Biotype, Misc. Updates, Billing, and Other Tests tabs in Microbiology Result Entry to do any of the following: Association of the appropriate security level with your password in Password Assignment, Security Levels. • Enter direct exam, culture, and other test observations and modify observations. • Place direct exam and culture observations on hold. • Accept results uploaded from an online instrument. • Enter biotype information. • Modify setup date or time. • Enter bill-only codes. • Enter susceptibility results and modify results. • Apply Tech Final or Final status. • Assign results to a validation queue. Using accession result comments to do any of the following: • View accession result comments. • Add or modify accession result comments. • Add, modify, or delete accession result comments. Association of the appropriate security level with your password in Password Assignment, Security Levels. Setting Security for Microbiology Tech Final Release Security definitions set by the system manager allow you to access Microbiology Tech Final Release and to view the accession numbers associated with a hospital or laboratory facility ID (HID). If you do not have the proper security levels for an HID, then the accession numbers associated with that HID do not appear. Example You want to view the batteries assigned to batch number 1 and batch number 2. Batch number 1 includes batteries from two hospitals: CZH and SCH. You have the proper security levels for hospital CZH but not for SCH. When you review batch number 1, you can view the accession numbers associated with CZH, but the accession numbers associated with SCH do not appear. The following table lists the security settings required to perform tasks in Microbiology Tech Final Release. This activity ... Requires these security settings … Accessing Microbiology Tech Final Release. • Association of a security level in Define System Functions. • Definition of system function MTF in Define System Functions. • Association of a tech code with your password in Password Assignment. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 304 Appendix A: Settings for Microbiology Applications This activity ... Requires these security settings … Viewing the batch or accession numbers associated with HIDs. Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Releasing batteries by batch. Setting of the appropriate security level in Password Assignment, Security Levels. Setting Security for Microbiology Automatic No-Growth Result Entry Security definitions set by the system manager enable you to access Microbiology Automatic No-Growth Result Entry. The following table lists the security settings required to perform tasks in Microbiology Automatic No-Growth Result Entry. This activity … Requires these security settings … Accessing Microbiology Automatic No-Growth Result Entry. • Association of a security level in Define Security Level. • Definition of system function MNG in Define System Functions. • Association of a tech code with your password in Password Assignment. Accessing patient orders associated with HIDs. Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Setting Security for Microbiology Inquiry Security definitions set by the system manager enable you to access Microbiology Inquiry. For more detailed information about security settings in Microbiology Inquiry, see Getting to Know Microbiology Inquiry on page 207. The following table lists the security settings required to perform tasks in Microbiology Inquiry. This activity … Requires these security settings … Accessing Microbiology Inquiry. • Association of a security level in Define Security Level. • Definition of system function MCI or MCIQ in Define System Functions. • Association of a tech code with your password in Password Assignment. • Association of a security level in Define Security Level. • Definition of system function MHST in Define System Functions. • Definition of system function MCI or MCIQ in Define System Functions. • Association of a tech code with your password in Password Assignment. Accessing Microbiology History. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Setup Entry Settings 305 This activity … Requires these security settings … Accessing patient orders associated with HIDs. Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Setting Security for Clinical Validation Security definitions set by the system manager allow you to access Clinical Validation to perform secondary reviews of microbiology results. The following table lists the security settings required to perform tasks in Clinical Validation. This activity ... Requires these security settings … Accessing Clinical Validation. • Association of a security level in Define Security Level. • Definition of system function ZCVR in Define System Functions. • Association of a tech code with your password in Password Assignment. Reviewing accessions associated with a particular validation queue. Association of your tech code with the clinical validation group tech code in Tech Code Definition. Association of HIDs with your password in Password Assignment, Hospital ID for Data Entry. Modifying or deleting clinical validation filters created by other users. Setting of the appropriate security level in Password Assignment, Security Levels. Viewing and printing the clinical validation log or internal notes report. Setting of the appropriate security level in Password Assignment, Security Levels. Accessing the Internal Notes window to do any of the following: Setting of the appropriate security level in Password Assignment, Security Levels. • View internal notes. • Create internal notes. • Modify notes, view suppressed notes, and view previous versions of modified notes. • Delete internal notes, modify notes, view suppressed notes, and view previous versions of modified notes. Microbiology Setup Entry Settings The following settings control the operation of Microbiology Setup Entry. For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Microbiology Setup Entry Maintenance Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 306 Appendix A: Settings for Microbiology Applications For more information, see … Microbiology Setup Entry Site Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 Microbiology Setup Entry Maintenance Settings The following maintenance definitions allow you to enter a setup date and time for a culture. This definition… Defined in… Does this… Label Print/Setup Time Options MMA 21 Specifies batteries by HID for which the system dynamically prints workcards or worklabels at order, receive, or setup time. Print Workcard/Label at Order, Receive, Setup Time Specifies batteries by HID for which the system automatically results the receive time as the setup time when a specimen on one of those batteries is received into the laboratory. Use Receive Date/time as Setup Date/time Result If this option is left blank, the system dynamically prints workcards or worklabels when the first result-at-request is filed— either after an order is placed or after a restricted order is released. Laboratory Location Codes, Micro Workcard/Setup Workcard Ptr MA 6:6 Defines a printer to be used to print labels at order or receive time. Report Definitions MA 22:6 Defines worklabels that may include the setup date and time. General Parameter Maintenance MIM 1:1 Specifies battery codes for which setup date/ time will be uploaded from an instrument. General MIM 1:2:10 Defines date formats for instrument setup date/time for the Vitek. Defines a printer to be used to print labels at setup time. Micro Work Labels Microbiology Setup Entry Site Parameters The following site parameters affect how you use Microbiology Setup Entry. This site parameter … Does this … [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] If this site parameter is set to Y, the system makes Microbiology Setup Entry available for entering the date and time that a specimen is inoculated onto a growth medium. For specimens that have a setup date and time, Microbiology Automatic No-Growth Result Entry calculates no-growth results based on that setup date and time instead of the received date. The hang time setting determines how many seconds the system waits before automatically saving the setup date and time in quick mode. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Setup Entry Settings 307 This site parameter … Does this … [Number of hours to allow for future setup time (<0>)] If you enter a number other than zero for this site parameter, you can enter a setup time for a specimen in the future in Microbiology Setup Entry or in Microbiology Result Entry. The future time can be any time up to the number of hours from the current system time defined for this site parameter, up to a maximum of 96 hours. If this site parameter is set to 0, the system does not accept a setup time in the future. [Allow multiple micro batteries per accession number] This option affects the definition of microbiology worksheets in MA 3. When this site parameter is enabled, the system allows multiple culture batteries per accession number. Because every culture battery shares the same test components, you must define separate worksheets for all culture batteries that can be ordered together on the same accession number. When this site parameter is disabled, the system allows only one culture battery per accession number. [Shift start times (1,2,3) (in minutes)] Defines the shift start time in minutes for shifts one, two, and three. [Date formats] Enables the definition of the following date formats: • Standard 1, mm/dd/yyyy • Standard 2, dd/mm/yyyy • Canadian 1, dd/MMM/yyyy • European 1, yyyy/mm/dd mm=numeric month (04) MMM=alphabetic month (APR) [Components in microbiology battery to append correction statement (SDES,SREQ/DE/CNT/CULT/SENS/ OTHER TESTS)] Controls the type of results that have correction statements appended to them when the results are modified. [Correction statement for modified results] When this site parameter is enabled, the system automatically appends this correction statement to a corrected result with the date and time of the original entry. [Confirm correction statement change] Controls whether the system prompts for confirmation when it appends a correction statement to a modified result. [Mandatory entry of specimen type code for SDES] Controls whether valid codes are mandatory, or whether the system only warns that a valid code should be used. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 308 Appendix A: Settings for Microbiology Applications This site parameter … Does this … [Append correction statement to • microbiology results in final status only] When this site parameter is set to Y, correction statements are appended to all modified results, both preliminary and final. • When this site parameter is set to N, correction statements are appended only to modified results that are in final status. Microbiology Result Entry Settings The following site parameter settings and maintenance definitions determine the ways in which you can use Microbiology Result Entry. The topics listed in the table apply only to Microbiology Result Entry. Any other general maintenance definitions or site parameter settings, such as test or battery maintenance definitions or date and time format site parameters, are not included. Microbiology Result Entry settings are listed alphabetically by topic. For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Bill-Only Tests Maintenance Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Biotype Data Maintenance Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Colony Count Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Composed Text Site Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310 Correction Statement Site Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310 Specimen Resulting Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Future Setup Time Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Accession Result Comment Site Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Keyboard Maintenance Settings for Cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Keyboard Maintenance Settings for Direct Exams . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 Keyboard Maintenance Settings for Susceptibilities. . . . . . . . . . . . . . . . . . . . . . . . . . 312 Other Testing Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 Online Instrument Result Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Paperless Microbiology Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316 Paperless Microbiology Audit Trail Report Settings . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Performing Lab Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 Print Order Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 Searching for a Record Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 Suppressing Results Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 309 For more information, see … Susceptibility Update Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Viewing Results Site Parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Workload Code Maintenance Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Worksheet Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Bill-Only Tests Maintenance Settings The following maintenance setting enables you to enter bill-only tests. This definition … Defined in … Does this … Bill-only tests MMA 17 Specifies if a microbiology battery qualifies for bill-only data. Specifies a maximum number of bill-only tests. Defines maintenance to allow addition of bill-only tests only when the battery is resulted with a final or tech final status. Biotype Data Maintenance Settings The following maintenance settings enable you to record biotype data for a culture test. This definition … Defined in … Does this … English text codes MA 4 Defines type M method codes. Microbiology Instrument Maintenance MIM Defines microbiology instruments and card types. Instrument Maintenance IXM Defines card definitions for instruments. Filing Parameters for Biotype Data Entry MMA 12:2 Defines the card types and organism IDs associated with a device. Colony Count Site Parameter The following site parameter specifies the test code used to identify a colony count. This site parameter … Does this … [Replacement code for colony count (CNT)] Determines the test code used to identify a colony count. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 310 Appendix A: Settings for Microbiology Applications Composed Text Site Parameters The following site parameters determine how composed text entered for direct exam, culture, and susceptibility observations appear on patient reports. This site parameter … Does this … [Micro battery composed text] Allows entry of composed text. [Micro cums battery composed text [Margin]] Determines how the composed text will be formatted on patient reports for microbiology batteries. [Maximum length for composed text] Determines how many characters are allowed for composed text. [Susceptibility comments] Allows entry of composed text comments for susceptibilities. [Micro cums susceptibility comments [text type, margin] (body/footer)] Determines how the composed text will be formatted on patient reports for susceptibilities. [Restrict text codes to match department of test code?] Determines which text codes can be entered. Correction Statement Site Parameters The following site parameters enable you to append correction statements to results. This site parameter … Does this … [Append correction statement to microbiology results in final status only] Applies a correction statement if a final result is modified. [Confirm correction statement change] Displays a prompt in Microbiology Result Entry to verify if a correction statement is applied to a modified result. Note Does not apply to tests defined in Other Testing Maintenance. [Correction statement for modified microbiology results] Specifies the text of the correction statement. The text of the correction statement consists of three parts and cannot exceed 384 characters. • If the correction statement exceeds 384 characters, a message appears, and the modified result is not filed. • If the text of the correction statement changes, the correction statement appears in its original form until a result is modified. [Components in microbiology battery to append correction statement (SDES,SREQ/DE/CNT/CULT/SENS/ OTHER TESTS)] Specifies the tests in a battery that receive a correction statement when modified, such as specimen description (SDES), special request (SREQ), direct exam (DE), culture (CULT), colony count (CNT), sensitivities (SENS), or other tests. [Logical progression on correction statements] Uses logical progression definition maintenance (MMA 20) to apply a correction statement to culture results. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 311 This site parameter … Does this … [Micro no-growth group/comment group] Defines no-growth codes for observations. Original result is a member of the no-growth group code that is defined in the first part of the site parameter [Should the no growth group code(s) prevent a correction statement?] Prevents a correction statement if the result on original result is a no-growth code. [Append correction statement for modified Accession Result Comments] Determines whether a correction statement is added when you modify accession result comments. Specimen Resulting Site Parameter The following site parameter determines if unreceived specimens can be resulted. This site parameter … Does this … [Disallow entering microbiology results on un-received specimens] Determines whether specimens must have a receive date and time, or where applicable when SMART is active, an accession number with a partial receipt indicator, before they can be resulted and filed in microbiology result entry. Future Setup Time Site Parameter This site parameter … Does this … [Number of hours to allow for future setup time (<0>)] If you enter a number other than zero for this site parameter, you can enter a setup time for a specimen in the future in Microbiology Setup Entry or in Microbiology Result Entry. The future time can be any time up to the number of hours from the current system time defined for this site parameter, up to a maximum of 96 hours. If this site parameter is set to 0, the system does not accept a setup time in the future. Accession Result Comment Site Parameters This site parameter … Does this … [Activate Accession Result Comments] Determines whether accession result comments are available in Sunquest Laboratory. [Append correction statement for modified Accession Result Comments] Determines whether a correction statement is added when you modify accession result comments. [Include Accession Result Comments on GUI IQ/Interim/Cum/CRP/RBR] Determines whether accession result comments are displayed in Inquiry (including Microbiology Inquiry) and patient reports. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 312 Appendix A: Settings for Microbiology Applications This site parameter … Does this … [Text to display as the label for Accession Result Comments] Determines the heading that appears in reports and Inquiry for accession result comments. Keyboard Maintenance Settings for Cultures The following maintenance settings enable you to enter observations from a customized culture entry keyboard. This definition … Defined in … Does this … Define customized keyboard for culture entry. MMA 7:1 Defines the culture keyboard, including the count indicator key, count terminator key, no-growth, Other, Final, Tech Final, and result modifier keys. Associate the culture keyboard with the culture battery. MMA 7:2 Associates the keyboard with the battery defined in MA 1 and determines the default culture keyboard for the battery. Define a culture workup keyboard. MMA 16:4:1 Defines the culture workup keyboard, which includes: • Result/Modifier keyboard • Workup Workload keyboard • Workup Results keyboard Keyboard Maintenance Settings for Direct Exams The following maintenance settings enable you to enter observations from a customized direct exam keyboard. This definition … Defined in … Does this … Define customized keyboard for direct exam. MMA 8:1 Defines the direct exam keyboard including Other, Final, Tech Final, and result modifier keys. Associate the direct exam keyboard with the direct exam battery. MMA 8:2 Associates the keyboard with the battery defined in MA 1 and determines the default direct exam keyboard for the battery. Define a customized direct exam workup keyboard. MMA 16:4:2 Defines the direct exam workup keyboard, which includes: • Result/Modifier keyboard • Workup Workload keyboard • Workup Results keyboard Keyboard Maintenance Settings for Susceptibilities The following maintenance and site parameter settings enable you to enter observations from a customized susceptibility keyboard. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 313 Maintenance Settings This definition … Defined in … Does this … Define a susceptibility keyboard MMA 9 Defines a susceptibility keyboard and associates result keys and drug keys with the keyboard. Define susceptibility codes MMA 1 Defines interpretive values, such as susceptible, resistant, and intermediate. Define susceptibility batteries MMA 2 Defines which drug susceptibility batteries are to be automatically requested during susceptibility entry. Susceptibility Interpretation Definition MMA 3 Defines standard interpretations for zone sizes for Kirby Bauer and MBC susceptibilities and expanded interpretive definitions for body fluid and route or body fluid only. MIC Exam Interpretive Values MMA 4 Defines two basic sets of information: one set to print on the patient cumulative report with user-defined microbiology cumulative forms and another set to specify similar data fields to be definable by route of administration within drug type. MIC Exam Usual/Dosage Values Definition MMA 5 Defines the usual MIC numeric result expected for a specified drug when tested against the specified organism and indicates the normal dosage amounts. Online susceptibility formats MIM 1:2 or 2:2 Defines an online format based on instrument settings: S - standard (Level 1 only), E - extended (Level 2 or 3), or D standard (Level 1) and extended (Level 2 or 3). Site Parameters This site parameter … Does this … [Extended MIC Interpretations] Determines whether MIC interpretations by body fluid and route or by body fluid only are applied during susceptibility entry and if extended interpretations appear during susceptibility entry, in Inquiry, and on patient reports. [Extended MIC Interpretations By Body Fluid Only - NCCLS] Determines whether Extended MIC interpretations by body fluid only are applied during susceptibility entry and if extended interpretations appear during susceptibility entry and on cumulative reports. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 314 Appendix A: Settings for Microbiology Applications Other Testing Settings The following maintenance and site parameter settings enable you to enter results for non-microbiology tests from an other-testing keyboard. Maintenance Settings This definition … Defined in … Does this … Define a battery for other testing MA 1 Defines whether a placeholder test is on the microbiology battery. Associate non-microbiology tests with a placeholder test Other Testing Maintenance Defines which non-microbiology tests are associated with a placeholder during other test result entry. Define an other testing keyboard MMA 22 Defines an other testing keyboard and associates test keys and result keys with the keyboard. Bill Only Test Definition MMA 17 Specifies if a microbiology battery qualifies for bill-only data. Specifies a maximum number of bill-only tests. Specifies maintenance to allow the addition of a bill-only test whenever the battery is updated or only when the battery is autofinaled. Site Parameters This site parameter … Does this … [Activate Accession Result Comments] Determines whether the Accession Result Comments button appears on the Other Tests tab. [Append correction statement to modified result] Determines whether a correction statement is appended to a changed other testing results. [Components in microbiology battery to append correction statement (SDES,SREQ/DE/CNT/CULT/ SENS/OTHER TESTS)] Controls the type of results that have correction statements appended to them when the results are modified. [Correction statement for modified microbiology results] Specifies the text of the correction statement. The text of the correction statement consists of three parts and cannot exceed 384 characters. [Micro battery composed text] UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems • If the correction statement exceeds 384 characters, a message appears, and the modified result is not filed. • If the text of the correction statement changes, the correction statement appears in its original form until a result is modified. Determines whether you can enter composed text as a result for other tests. Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 315 This site parameter … Does this … [Restrict text codes to match department of test code?] Determines whether you can result tests with English text codes associated with other lab departments. Online Instrument Result Settings The following maintenance and site parameter settings are used to receive results from online instruments and to specify when to delete online instrument data. Maintenance Settings This definition … Defined in … Does this … Instrument Maintenance IX Defines the microbiology instrument or device sending the results. Microbiology Instrument Maintenance MIM Defines microbiology instrument data such as battery and enumeration codes, susceptibility card definitions, and instrument control parameters. Online Filing Parameters for Organism ID MMA 12 Determines whether automatic filing of online organism identifications occurs if results pass all the defined quality assurance checks. Online Filing Parameters for Sensitivities MMA 13 Determines whether automatic filing of online susceptibilities occurs if results pass all the defined quality assurance checks. Card Definitions Allows for the use of combo cards so that online instruments report data on both the organism ID and the susceptibility. MIM 1:3, MIM 1:4 Vitek card definitions. MIM 2:3, MIM 2:4 Microscan card definitions. Automatic Direct Filing MIM 1:2:1 or MIM 2:2:1 Determines whether online instruments results are automatically filed to the patient record. Matching MO codes when Autofiling MIM 1:2 or 2.2 Determines whether the organism identification from the online instrument must match the ID in the culture when autofiling. Site Parameters This site parameter … Does this … [Delete on-line instrument data upon culture final] Controls whether the online instrument data remains in the hold file until the culture is finaled or if data is retained for 10 days after it is finaled. [Extended MIC interpretations] Determines whether extended MIC interpretations by body fluid and route (Type 2) and by body fluid only (Type 3) defined in MMA 3 appear on the Online and Susceptibility tabs. [Extended MIC interpretations by body fluid Only - NCCLS] Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 316 Appendix A: Settings for Microbiology Applications This site parameter … Does this … [Automatic susceptibility update/ suppression removal/rule execution] Determines whether the following actions occur when online data is accepted in Microbiology Result Entry or when an organism ID is released from the hold file: • When an organism ID with a filed susceptibility result is updated with an online organism ID, the system prompts for an automatic susceptibility update. • Drug suppression is automatically removed and reapplied according to the new drug battery/drug classification scheme referenced with an organism name change. • Rules are executed. If part 1, automatic susceptibility update, is set to N, the system ignores the other two parts of the parameter. For more information on how settings for this site parameter affect susceptibility updates, see About Automatic Susceptibility Updates on page 158. [Retain enumeration codes after organism code] Determines whether enumeration codes defined in MIM, such as FEW or MANY, appear before or after organism codes when preliminary identifications are replaced with online instrument data. Also determines which organism ID and enumeration codes to discard or retain if multiple codes were entered. Paperless Microbiology Settings The following maintenance and site parameter settings activate paperless microbiology and determine how workup data is entered and displayed. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 317 Maintenance Settings for Direct Exam Batteries This definition … Defined in … Does this … Define workup codes and a direct exam workup keyboard for direct exam batteries. MMA 8:1 Defines the direct exam keyboard, including Other, Final, Tech Final, and result modifier keys. Example Throat culture MMA 8:2 Associates the direct exam keyboard with the direct exam or culture battery. This setting determines the default direct exam keyboard for the battery. MMA 16:4:2 Defines the direct exam workup keyboard, which includes: battery (THRO) that contains a direct exam—a strep screen. Microbiology User’s Guide Sunquest Laboratory • Result/Modifier keyboard • Workup Workload keyboard • Workup Results keyboard MMA 16:4:2:1 (same as MMA 8:1) Defines the direct exam keyboard, including Other, Final, Tech Final, and result modifier keys. MMA 16:4:2:2 Assigns type MW workload codes to keys on the workup workload keyboard. MMA 16:4:2:3 Assigns type MA 4 codes (not type MW) to keys on the workup result keyboard. MMA 16:3 Links by battery the workup group code to an organism or organism group. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 318 Appendix A: Settings for Microbiology Applications Maintenance Settings for Culture Batteries This definition … Defined in … Does this … Define workup codes and culture workup keyboard for culture batteries. MMA 7:1 Defines the culture keyboard including the count indicator key, count terminator key, no-growth, Other, Final, Tech Final, and result modifier keys. MMA 7:2 Associates the keyboard with the battery defined in MA 1 and determines the default culture keyboard for the battery. MMA 16:4:1 Defines the culture workup keyboard, which includes: • Result/Modifier keyboard • Workup Workload keyboard • Workup Results keyboard MMA 16:4:1:1 Defines the culture keyboard (same as MMA 7:1) including the count indicator key, count terminator key, no-growth, Other, Final, Tech Final, and result modifier keys. MMA 16:4:1:2 Assigns type MW workload codes to keys on the workup workload keyboard. MMA 16:4:1:3 Assigns type MA 4 codes (not type MW) to keys on the workup result keyboard. MMA 16:3 Links by battery the workup group code to an organism or organism group. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 319 Maintenance Settings for Direct Exam and Culture Batteries This definition … Defined in … For batteries that include a direct exam in the culture battery, define workup codes and keyboards. Does this … Defines the culture or direct exam keyboard, including the count indicator key, count terminator key, no-growth, Other, Final, Tech Final, and result modifier keys. MMA 7:1 or MMA 16:4:1 Culture keyboard MMA 8:1 or MMA 16:4:2 Direct Exam keyboard MMA 7:2 Associates the keyboard with the battery defined in MA 1 and determines the default culture keyboard for the battery. MMA 8:2 Associates the direct exam keyboard with the direct exam or culture battery. This setting determines the default direct exam keyboard for the battery. MMA 16:3 Links by battery the workup group code to an organism or organism group. Site Parameters This site parameter … Does this … [Enable microbiology on-line workcard?] Activates paperless microbiology. [Display option for online workcard?] Activates online workcard. [Workup summary displays by number or media] Determines if workup results are sorted by workup number or sorted alphabetically by media. Note If the site parameter [Enable micro online workcard] is set to N, the system ignores any settings of Y for [Display option for online workcard?]. Paperless Microbiology Audit Trail Report Settings The following site parameters and maintenance settings are used for the Paperless Microbiology Audit Trail Report. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 320 Appendix A: Settings for Microbiology Applications Maintenance Settings This definition … Defined in … Does this … Audit Trail Sort Sequence MMA 16:2 Determines the sort order of audit trail data on the audit trail report. Define a device number for the audit trail report printer. MA 7 Assigns a device number to a printer and specifies if the printer generates the audit trail report on a scheduled basis (autosend) or dynamically (as data is filed). Define the audit trail report printer to a location. MA 6 Associates a lab location with the printer that generates the audit trail report. Site Parameters This site parameter … Does this … [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] If the site parameter is enabled, the setup time displays on the audit trail report. [Workup summary displays by number or media] Determines if workup data displays on the audit trail report by workup number or alphabetically by the media code. [Enable microbiology on-line workcard?] Activates paperless microbiology. Performing Lab Maintenance The following maintenance setting determines whether a performing lab code is added to a test result. This definition … Defined in … Does this … Performing Lab MA 34 Associates each lab location used for entering results to a performing lab. Determines if a performing lab code or text appears with the results on all Inquiry displays and on patient reports. Print Order Site Parameter The following site parameter enables you to change the order of observations so that they appear in a different sequence on reports. This site parameter … Does this … [Allow print order modification for microbiology observations] Allows you to change the order in which observations print on reports. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Result Entry Settings 321 Searching for a Record Site Parameter The following site parameter allows you to define a specific accession number format to validate accession numbers entered in Microbiology Result Entry. This site parameter … Does this … [Number of characters of last name for extra validation of accession number] Verifies that entry of accession numbers in microbiology data entry include the accession number and characters from a patient’s last name. Suppressing Results Settings The following maintenance and site parameter settings enable you to hide a result. Maintenance Settings This definition … Defined in … Does this … Define maintenance for a specific test to hide a result. MA 1 When you enter a result at order time, a flag is set to hide the observation. If you no longer want to hide an observation for a specific test, you can change the maintenance definition. The change does not affect results previously filed but allows display of results of the test after the definition was changed. Site Parameters This site parameter … Does this … [Allow individual observation hide] Allows you to hide an individual observation or to hide all observations. [English text code to suppress tests from printing on patient reports] Sets text code to HIDE or some other site-defined text code to indicate a hidden observation. Translation for HIDE or other text appears on reports. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 322 Appendix A: Settings for Microbiology Applications Susceptibility Update Site Parameter The following site parameter determines whether susceptibility results are automatically updated in Microbiology Result Entry. This site parameter … Does this … [Automatic susceptibility update/ suppression removal/rule execution] Automatically updates previously filed susceptibility results when a culture result is modified or when susceptibility results are uploaded from an online instrument. Verifies if susceptibility results qualify for update, removes and reapplies drug suppression based on drug classification definitions, and reapplies any rules assigned. Viewing Results Site Parameter The following site parameter specifies a time frame and sort order when viewing results in Microbiology Inquiry. This site parameter … Does this … [Previous culture display] Determines the time frame for viewing direct exam and culture data and the sort order of the data. Workload Code Maintenance Settings The following maintenance settings enable you to enter workload codes for direct exams and cultures. This definition … Defined in … Does this … English text codes MA 4 Defines text codes as type MW microbiology workload codes for the type of culture being performed. Worksheet Definitions MA 3 Defines a worksheet to be used for entering microbiology results for direct exam or culture. MA 3 Associates MW codes with Workload Type-n prompts for a specified worksheet. Worksheet Settings The following maintenance and site parameter settings enable you to record observations using worksheets. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Tech Final Release Settings 323 Maintenance Settings This definition … Defined in … Does this … Define worksheets MA 3 Assigns tests to a worksheet and sets the sort order for worksheets: accession number, receive date and time, or setup date and time. Site Parameters This site parameter … Does this … [Worksheet accession number entry] Activates worksheets for direct exam and culture. Microbiology Tech Final Release Settings The system manager defines security and sets site parameters to enable you to use Microbiology Tech Final Release. For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Assigning Multiple Batteries to an Accession Number Site Parameter . . . . . . . . . . . 324 Worksheet Selection Site Parameter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 324 Appendix A: Settings for Microbiology Applications Assigning Multiple Batteries to an Accession Number Site Parameter The following site parameter controls whether multiple batteries are assigned to an accession number. This site parameter … Does this … [Allow multiple micro batteries per accession number] Assigns multiple microbiology batteries to an accession number. In Microbiology Tech Final Release, this site parameter affects the following: • You can view batch data that includes multiple microbiology batteries associated with an accession number. • If multiple batteries are assigned a Tech Final status when the Culture Review Report generates, you can add more than one battery from the same accession number to the batch. Sunquest Laboratory checks if the accession number is already assigned to a batch and if the batteries associated with the batch are assigned a Tech Final status. The setting of this site parameter is disregarded for sequence worksheets. Only batteries in Tech Final status that are defined to the selected sequence worksheet can be viewed or added. Worksheet Selection Site Parameter The following site parameter controls which type of worksheet to use to update batteries. This site parameter … Does this … [Allow updates in Micro Tech Final using Sequence Worksheet Batch (SWB) / Culture Review Batch (<CRB>)/Both (B)] Specifies for each HID which worksheet mode to use to update batteries. Microbiology Automatic No-Growth Result Entry Settings The following settings determine the ways in which Microbiology Automatic NoGrowth Result Entry operates. For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Automatic No-Growth Result Entry Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 Automatic No-Growth Result Entry Site Parameters . . . . . . . . . . . . . . . . . . . . . . . . . 326 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Automatic No-Growth Result Entry Settings 325 Automatic No-Growth Result Entry Maintenance The following maintenance settings affect how you use Microbiology Automatic NoGrowth Result Entry. This definition … Defined in … Does this … Identify No-Growth Worksheets MMA 11 Defines a no-growth worksheet for a culture battery. Specifies the starting age at which the no-growth calculation begins for the culture battery. Sets Automatic No-Growth Result Entry to automatically final cultures that have reached a user-specified age and have no tests pending. Sets the schedule of days on which the culture battery is eligible for update by Automatic NoGrowth Result Entry. Appends one or more text codes to a worksheet. Defines the NO GROWTH update statement. Label Print/Setup Time Options MMA 21 Indicates which batteries by HID base their nogrowth calculations on the receive date and time rather than the setup date and time when no setup date and time has been manually entered. English Text Codes MA 4 Defines the codes for the hours or days that the system uses to report the no-growth update. This definition also defines comments that occur frequently, as well as special testing codes. Bill Only Test Definition MMA 17 Specifies if a microbiology battery qualifies for bill-only data. Specifies a maximum number of bill-only tests. Specifies maintenance to allow the addition of a bill-only test whenever the battery is updated or only when the battery is autofinaled. Performing Lab MA 34 Associates each lab location used for entering results to a performing lab. Determines if a performing lab code or text appears with the results on all Inquiry displays and on patient reports. Use Receive Date/ time as Setup Time Result Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 326 Appendix A: Settings for Microbiology Applications Automatic No-Growth Result Entry Site Parameters The following site parameters affect how you use Automatic No-Growth Result Entry. This site parameter ... Does this ... [Enable Setup Date/Time (Y/<N>)\MST Display Hang 1-999] When the first part of this site parameter is set to Y, the system calculates the no-growth results based on the setup date and time instead of the receive date. Note that the first part of this site parameter must be set to Y in order for the system to provide the option to filter no-growth cultures on a worksheet by the setup date and time. The hang time setting determines how many seconds the system waits before automatically saving the setup date and time in Microbiology Setup Entry quick mode. [Should the no growth group code(s) prevent a correction statement?] Prevents a correction statement if the result on the original result is a no-growth code. [Micro no-growth group/comment group] Prevents the reporting of translations of no-growth codes (for example, NG7) and comments (for example, normal throat flora) on internal microbiology reports. [Report no-growth cultures on culture review report] • Determines whether or not entries will qualify for the culture review report based on if they are defined as positive or negative in MA 4, regardless of whether they are defined to the nogrowth group in the Microbiology Maintenance setting [Micro no-growth group/comment group]. • If the first observation contains an entry defined to the no-growth group identified in the Microbiology Maintenance setting [Micro nogrowth group/comment group], that entry qualifies for the culture review report when this site parameter is set to Y. It does not qualify for the culture review report when this site parameter is set to N. [Should micro no-growth updates queue for autosend?] Determines what types of no-growth results qualify for autosend—all no-growth results or only those that have been autofinaled. [Print autosend reports at accession location instead of event location] Allows autosend reports for inpatients to print at either the accession location, the event location, or both locations. [Print autosends by physician] Determines whether or not autosend reports can be directed to a specific printer for a specific physician. [Prevent autosend if patient discharged] Determines whether or not autosend will occur if a patient has been discharged, and results are entered that would normally qualify for autosend. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Microbiology Inquiry Settings 327 Microbiology Inquiry Settings The following settings determine ways in which Microbiology Inquiry operates. For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Microbiology Inquiry Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 Microbiology Inquiry Site Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 Microbiology Inquiry Maintenance The following maintenance settings affect the operation of Microbiology Inquiry. This definition … Defined in … Does this … IQ Specimen Group Definition MMA 18 Defines the specimen groups used for the specimen menu display. Microbiology Inquiry Site Parameters The following site parameters affect how you use Microbiology Inquiry. This site parameter ... Does this ... [Default patient lookup method for microbiology functions] Determines the patient default lookup mode. [Default Patient Name Lookup mode (Alpha, Exact Alpha, Soundex)] Determines the patient name default lookup mode. [Microbiology inquiry sort display] Determines the sort order for the accession/battery list in Microbiology Inquiry. The site parameter controls the following fields: CDT, RDT, ACC, BAT, and SDS. The order of the field display dictates the sort order of the lists. [Microbiology inquiry culture result display]] Determines the display of culture and direct exam results. [Allow multiple micro batteries per accession number] Determines if a single accession number can have more than one culture battery associated with it. [Enable Setup Date/Time (Y/ <N>)\MST Display Hang 1999] Determines the activation of Microbiology Setup Entry. [Micro no-growth group/ comment group] Determines if the code and translation display or only the code displays. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 328 Appendix A: Settings for Microbiology Applications This site parameter ... Does this ... [Text to display for block report status level 1] Determines text for level 1 result inquiry blocking. This affects only users with MCI-level security. [Text to display for block report status level 2] Determines text for level 2 result inquiry blocking. This affects only users with MCI-level security. [Print characters for callback flag] Determines the visual indicator for the Callback flag. [“Pending” text to appear on interims and inquiry] Determines the pending result translation to display. [English text code to suppress tests from printing on patient reports] Sets text code to HIDE or some other site-defined text code to indicate a hidden observation. Translation for HIDE or other text appears on reports. [Enable order comment] Determines order comment display for the HID associated with the accession number. [Print ordering physician on workcard/header display] Determines whether the ordering and admitting physician appear on workcards and headers. [Enable specimen comment] Determines the specimen comment display for the HID associated with the accession number. [Prompt for diagnosis code in GUI order entry by patient type (IP\OP\ER\OS)] Enables the ordering diagnosis code in Order Entry for the HID associated with the accession number. [Append elapsed time to colony count and first culture result] If this site parameter is set to Y, the system appends the elapsed time from the collection time to either the colony count or first culture result. It documents when microbiology results are actually reported via a keyboard entry. If this site parameter is set to N, the system does not append the elapsed time from the collect ion time to either the colony count or first culture result. [Extended MIC interpretations] If this site parameter is set to 1, 2, or 3, the extended susceptibility interpretations display. If this site parameter is set to 0, the extended susceptibility interpretations do not display. [Block report levels enabled] Determines if block levels from Requisition Based Reporting (RBR) are activated. Clinical Validation Settings For more information about site parameter settings or maintenance definitions, see the Site Parameters Administrator’s Guide or the Microbiology Administrator’s Guide. For more information, see … Clinical Validation Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Clinical Validation Site Parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Clinical Validation Settings 329 Clinical Validation Maintenance The following maintenance settings affect the operation of Clinical Validation. This definition … Defined in … Does this … Tech Code Definition MA 11 Defines a group tech code as a validation queue. Clinical Validation Site Parameters The following site parameters affect how you use Clinical Validation. This site parameter … Does this … [Activate Clinical Validation] Determines if your site can access the Clinical Validation application. [Message to append to accepted results that still require clinical validation] Determines the text appended to results that have been resulted and assigned to a validation queue, but have not yet been finaled by a reviewer. [Security level to manually assign a battery to a Clinical Validation review queue in MRE/Security level to remove a battery from a previously assigned review queue] Determines the security level required to manually assign a battery to a Clinical Validation review queue. The parameter also determines the security level required to remove a battery from a review queue. [Queue for Clinical Validation at Tech Final/Validation group to assign/Append Message] Determines whether Sunquest Laboratory automatically assigns results to a review queue when a battery is tech finaled. It also determines the default Clinical Validation group tech code to assign the results to. The tech code entered must be a valid tech code or a group tech code designated as a Clinical Validation group. Determines whether a message is appended to results to alert users that the battery has been automatically assigned to a review queue. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 330 Appendix A: Settings for Microbiology Applications UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Overview This appendix lists the messages you may see in the Windows-based Microbiology applications. Each table includes messages for each application and identifies the situation that generated the error. Note This message reference does not provide a comprehensive list of the messages you may see in the Windows-based Microbiology applications. Messages you view on the screen may be worded differently but are comparable to the messages listed here. If you require further information about a message, contact Sunquest Information Systems. In the message text shown in this appendix, items that appear between brackets are variables. When the actual error message appears, the text and the brackets are replaced by the value corresponding to the text. Example The error message “<Number> line(s) added.” is shown in this appendix. On your PC, the system displays the message with the appropriate variable in place of <Number>, for example “3 line(s) added.” This section includes the following topics Messages for Microbiology Result Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332 Messages for Microbiology Automatic No-Growth Result Entry . . . . . . . . . . . . . . . . 339 Messages for Microbiology Setup Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 Messages for Microbiology Susceptibility Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 Messages for Microbiology Tech Final Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343 Messages for Microbiology Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Messages for Clinical Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Appendix B Message Reference 332 Appendix B: Message Reference Messages for Microbiology Result Entry The following informational messages may appear in Microbiology Result Entry. This message … Means this … <Number> line(s) added. You entered multiple lines of composed text. Battery already has <tech final><final> result. Do you want to delete? Yes/No You deleted an existing Tech Final or Final status. Click Yes if you want to delete the existing Tech Final or Final status. Click No to retain the Tech Final or Final status. Do not use Callback code as the only result. You entered only a callback code and no result. You need to enter a result, press the TAB key, and enter a Callback code. Do not embed HIDE in the observation. Your site’s site parameter settings do not allow you to append HIDE to individual observations. Enter HIDE as the last observation for the result. Change of specimen description may affect susceptibilities. You modified the specimen description, which can affect any previously filed susceptibility results. The colony count hold result has been accepted. You accepted all colony count hold results and released them from hold. A correction statement has been appended to the result. The system automatically applied a correction statement to the result. The culture print order must match the number of observations. You deleted a culture observation which was included in a previously modified print order and then tried to save the changes. The numbers in the print order box must match the reference numbers assigned to the culture observations. The direct exam hold result has been accepted. You accepted all direct exam results and released them from hold. The direct exam organism groups do not match the culture results. You entered culture results that do not match the organism code and quantification entered for the direct exam. Duplicate entry. Please enter a code that hasn’t previously been entered. You entered a duplicate code. Entry of a bill-only code is mandatory. You tried to exit the application without entering a bill-only code. Microbiology maintenance (MMA 17) determines if bill-only codes are mandatory. The entry has been removed. You deleted a direct exam, culture, or susceptibility result. The exam print order must match the number of observations. You deleted a direct exam observation that was included in a previously modified print order and then tried to save the changes. The numbers in the print order box must match the reference numbers assigned to the direct exam observations. Filed results may only be modified, not deleted. You can only modify previously filed media, description, or biochemical workup results. You cannot delete them. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Result Entry 333 This message … Means this … The ID hold result has been accepted. You accepted all organism identifications and released them from hold. Invalid entry. All results have not been entered. You tried to apply a Tech Final or Final status to a battery before completing one or more of the following tasks: • Releasing results from hold. • Entering a specimen description (SDES) or special request (SREQ). • Entering a result for direct exam batteries. • Entering a direct exam or culture result for culture batteries with a direct exam. Entering a result for colony count or organism ID for culture batteries with a colony count. Invalid entry. This worksheet is defined as a loadlist. You entered a worksheet code that is defined as a loadlist. Invalid entry. A no growth result must be the first observation. You entered a no growth result on an observation other than observation #1. No growth results are entered for observation #1. Invalid key. Not defined to the keyboard. You pressed a key that is not defined to the keyboard. May not hold results that have been previously filed. You selected an organism that has previously filed susceptibility results. You cannot place previously filed results on hold. Organism ID is in hold. Organism must be entered before accepting susceptibilities. You are trying to save a susceptibility result for an organism that is still on hold. Place the susceptibility result on hold before saving the susceptibility result. The new entry is not in the same organism group. Accept? Yes/No You modified an organism ID and it does not match maintenance definitions. Click Yes to accept the organism ID. Click No to reject the entry and return to the previous window. The no growth result is invalid. The hourly code is not available. You entered a no growth result that does not have a no-growth code defined for this calculated hour in English Text Definition (MA 4) or the site parameter [Micro No Growth Group/Comment Group]. The no growth result is invalid. The observation is less than 1 hour. You entered a no growth result less than one hour after setup time. The no growth result is invalid. Receive time is missing. You entered a no growth result for a culture that does not have a receive time. The no growth result is invalid. The setup time is missing. You entered a no growth result for a culture that does not have a setup time. There is no colony count data on hold to file. You released results from hold, such as direct exam, culture, and susceptibilities results, but there are no colony count results on hold. There is no direct exam data on hold to file. You released results from hold, such as culture, colony count, and susceptibilities results, but there are no direct exam results on hold. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 334 Appendix B: Message Reference This message … Means this … There is no ID data on hold to file. You released results from hold, such as direct exam, colony count, and susceptibilities results, but there are no organism ID results on hold. There is no susceptibility data on hold to file. You released results from hold, such as direct exam, culture, and colony count, but there are no susceptibility results on hold. No modifications allowed. You do not have the security level required to modify this result. Security levels are set in Control Security (SC) and the site parameter [Security levels keyboard modifications after final]. This applies to all results that can be modified using a keyboard, such as direct exam and culture. This is not a valid worksheet. You entered a worksheet name that is invalid. This is not an individual worksheet name. You entered a worksheet name that is invalid. This code has been previously ordered. You entered a bill-only code that has already been entered for this result. The replacement result is too long and cannot be filed. You entered a correction statement that contains more than 384 characters. The result has been previously filed. Your security does not allow deletion. You do not have the security level required to delete this result. Security levels are set in Control Security (SC). Select a keyboard to enter an observation. No default keyboard has been defined for this type of battery or for unassociated or “zero” batteries. You must select the keyboard you want to use for the battery. Your system manager can define a default keyboard in Culture Keyboard Definition (MMA 7). The susceptibility hold results have been accepted. You released from hold all susceptibility results for the selected accession number/microbiology battery. As each susceptibility result is released from hold, a message appears showing the organism number, number of susceptibilities performed on an organism, and the susceptibility panel type, such as MIC or KB. A message that includes (Rejected) indicates that a previous susceptibilty result was released and accepted and then a second one was entered and accepted for the selected accession number. This is an unauthorized organism code. You do not have the security level required to enter this organism code. Security levels are defined in Organism Code Security Definition (MMA 19). Do you want to update susceptibility results? Yes/No You have changed the organism ID for a result that has a filed susceptibility. You must indicate if you want the system to update the susceptibility result. This message appears when the site parameter [Automatic susceptibility update] is set to Y. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Result Entry 335 This message … Means this … #n.n Susceptibility has been previously accepted. Combine data to existing susceptibility? Yes/<No> You are trying to save online susceptibility results for a result that has previously filed susceptibility results. You must indicate if you want the current results to be combined with the previously saved results. The #n.n online organism ID has been accepted. The online susceptibility or organism IDs that you accepted have been filed. The new entry is not in the same organism group. Accept? Yes/No You are trying to save an organism result that is not in the same group (different MG code) as a previously saved result. Click Yes to save the new result or No to cancel the save. Rejected. The organism group is not the same. You replied No to the message “The new entry is not in the same organism group. Accept? Yes/No.” The new result is not saved. The organism group has been accepted. You replied Yes to the message “The new entry is not in the same organism group. Accept? Yes/No.” The new result is saved. Culture is not defined to this worksheet. Use Worksheet Direct Exam Mode. You are trying to open a direct exam worksheet while in culture mode. Select Worksheet Direct Exam Mode and then open the worksheet. Direct Exam test is not defined to this worksheet. Use Worksheet Culture Mode. You are trying to open a culture worksheet while in direct exam mode. Select Worksheet Culture Mode and then open the worksheet. No matches found for the selected criteria. There are no accession numbers assigned to the worksheet you requested. Rejected. The online ID matches the culture ID. You are trying to accept an online result that is the same as the culture identification already on file. You cannot apply HIDE to data on hold. You selected a direct exam or culture result already on hold and tried to apply a HIDE code to the result. This message also appears if you are placing on hold an organism that already has a HIDE code. Culture observations suppressed. Use test suppression. You are trying to apply a HIDE code to all observations. Instead, apply HIDE as the last observation for the result or to one, but not all, observations. This error applies when the site parameter [Allow Individual Observation Hide] is set to Y. CULT has not been ordered for this battery. You are trying to enter a culture observation for a battery that does not contain a culture test. Remove HIDE from observations before applying to the final observation. You are trying to apply a HIDE code as the last observation for a result, when HIDE has already been applied to one or more observations. You must remove individual HIDEs before entering HIDE as the last observation. This error applies when the site parameter [Allow Individual Observation Hide] is set to Y. Tech Final status has been removed. You deleted the Tech Final status for a battery. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 336 Appendix B: Message Reference This message … Means this … Final status has been removed. You deleted the Final status for a battery. Invalid card type for this method. You entered a card type that is not defined in Sunquest Instrument Manager for the selected method. Duplicate method and card type. You entered a method and card type that has already been entered for the selected organism. Invalid biotype number. Only alphanumeric characters are allowed. You entered an invalid biotype number. Use only alphanumeric characters. Are you sure you want to delete the selected biotype data? You selected a biotype record and then clicked Delete. Click Yes to delete or No to retain the biotype record. To exit the message, click Cancel. Invalid organism number. You entered an invalid organism (observation) number. Invalid method code. You entered an invalid method code. Designate another entry as primary before deleting current primary data. You are trying to delete a primary observation for an organism that has two or more remaining biotypes. You must designate a new primary observation before deleting the selected observation. Mandatory entries are missing. You are trying to save a record before completing all mandatory fields. Invalid organism code. You entered an invalid organism code. Code <Bill-only test code> has been previously credited. You are trying to enter a bill-only test code that has been previously entered on the selected battery and subsequently credited. Invalid input. Enter a bill-only test code defined for department MC. You are trying to enter a bill-only test code that is defined for a department other than microbiology. You must enter a bill-only test code defined in MA 1 for microbiology. This bill-only test code has been previously ordered on battery <battery code for which bill-only code has been filed>. You are trying to enter a bill-only test code that has previously been filed on another battery on the same accession. Note: The "\" has been replaced with a space. You cannot use a backslash character when inputting composed text. #n.n (Rejected) -No Organism Results Entered You are trying to accept an online susceptibility that has no observations associated with it. This bill-only code has previously been entered from a non-micro application. You are trying to enter a bill-only test code that has previously been filed on the selected battery via order entry or another non-Microbiology application. #<organism number n.n> is a duplicate entry. Please enter a code that hasn't previously been entered. You are trying to accept an online organism code that has already been filed under another observation number. Remove test suppression before adding observation. You cannot add an observation if the only entry for the previous observation is a HIDE code. Remove the HIDE code before adding another observation. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Result Entry 337 This message … Means this … You can only suppress test on the last observation. You can only enter a HIDE code as the last entry for an observation. You must remove test suppression on last observation before entering HIDE on this observation. You cannot apply a HIDE code to an individual observation if a HIDE code is already entered as the last observation. Remove the HIDE code from the last observation and then apply a HIDE code to the individual observation. Direct exam observations suppressed. Use test suppression. You can either apply a HIDE code to an individual direct exam observation or enter a HIDE code as the last direct exam observation. Overlay existing drugs? Yes/<No> You are trying to accept online susceptibility results. Click Yes to replace or No to retain previously filed susceptibility results. Culture status changed. Save has been canceled. You are trying to save a culture battery and a lock cannot be refreshed. The lock times out after ten minutes. Another user has accessed the culture battery or a lock table has been deleted. The #n.n online susceptibility has been accepted. You accepted an online susceptibility. Placing results into HOLD is not allowed. You do not have the security level required to place results on hold. Interpret online susceptibility according to: You changed an organism ID but have not yet saved. You accepted an online susceptibility associated with an online organism ID code that does not match the recently modified organism ID. --Observation ID <<current/filed organism ID code>> --Online organism ID = <<online organism ID code>> The #n.n online susceptibility has been rejected. You accepted an online susceptibility result for an observation that already has a previously filed susceptibility result. You rejected the option of combining the two susceptibility results. #n.n online susceptibility rejected because of pattern check failure. The system encountered a pattern check failure for online susceptibility results. #n.n rejected because of gap in organism numbers. You tried to view online data for an organism ID that does not have a corresponding observation number in Microbiology Result Entry. The setup date is greater than the number of hours allowed for a future setup date. You entered a date that exceeds the number of hours from the current system time specified in site parameter [Number of hours to allow for future setup time (<0>)]. The setup time is greater than the number of hours allowed for a future setup time. You entered a time that exceeds the number of hours from the current system time specified in site parameter [Number of hours to allow for future setup time (<0>)]. The setup time is later than the current date. The entry of a future setup time is not allowed. You entered a setup time in the future and site parameter [Number of hours to allow for future setup time (<0>)] is set to 0. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 338 Appendix B: Message Reference This message … Means this … A culture battery cannot contain both results and a future setup date and time. You are trying to save a future setup date and time along with results entered on a culture battery. Batch number is not defined for worksheet <worksheet code> You entered an unknown or invalid batch number. There is not a sequence batch number defined to this worksheet. You entered one of the following: • A sequence worksheet that does not have any active batches. • A group or special worksheet code instead of a sequence worksheet code. Caution: Online data is present. Before responding Yes to this message, review online data and accept results you want to file. Then delete the observation. System will redisplay this message. Respond Yes. System will renumber observations. You must delete online data results that are now mismatched with the renumbered observations. You are trying to delete an observation that has associated online results, and the deletion will result in the renumbering of observations. You should review and accept the online results before deleting the observation. Then, delete the observation and the associated online results so that the numbers of the remaining observations and online organism IDs are in sync. Invalid entry. Enter a tech code that is associated to the placeholder test defined on this keyboard. The test you attempted to add off the customized No keyboards are defined for the placeholder test in this battery. Define a keyboard in Other Testing Keyboard Definition maintenance before attempting to enter results for any Other Tests. The battery includes a placeholder test for other testing for which a customized keyboard has not been defined. Before proceeding, in Other Testing Keyboard Definition (MMA 22), define at least one keyboard. Invalid entry. Enter a valid MA4 text code. You entered a text code not defined in MA 4. Individual observation is suppressed. Remove suppression from the individual observation(s) and apply suppression to the final observation to suppress the test. Continue Yes/No You selected the Suppress test check box, but an individual observation is already suppressed. A result for test <<data>> has already been saved. Do you want to replace the saved result with this online result? Yes/ <No> You attempted to accept an online result for a nonmicrobiology test that has already been saved. The online result has been rejected and will be removed from the online data. You declined to replace an existing result with a new online result. Invalid results were received for: <<list instrument methods, cups and test codes that contained invalid results>> Invalid online results were reported for one or more Other Tests. Invalid entry. Please enter a valid result. You entered an invalid numeric result or a code that is not defined in MA 4. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems keyboard is either not defined in MA 1 or is not associated with the placeholder test in Other Testing Maintenance. • Yes removes the suppression from individual observations and suppresses the entire test. • No retains the individual observation suppression without suppressing the entire test. Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Automatic No-Growth Result Entry 339 This message … Means this … This result has failed QA checking for <<data>>. Please confirm acceptance of the result. Yes/No A result failed one or more of verify, technical, or delta QA checking. This result has failed the technical QA range. Please confirm acceptance of result. Yes/No A result has failed the technical range of QA checking. Patient has the following syndrome associated with test <test code>: <syndrome description>. You saved a test result that is associated with a previously created syndrome for the patient. Syndrome <syndrome code> CREATED for Patient # <patient ID>, Test: <test code>. You saved a test result that resulted in the creation of a syndrome index for the patient. Syndrome <syndrome code> REMOVED for Patient # <patient ID>. You deleted the test result that initiated the creation of a syndrome index for the patient or modified it so that it no longer qualifies for creation of a syndrome. Because no subsequent occurrences exit for the syndrome, the syndrome index is removed from the patient record. Battery <<battery code>> has been assigned to a Clinical Validation review queue and cannot be finaled. You tried to final the results for a battery, but it has already been sent to a validation queue and can be finaled only in Clinical Validation. Result(s) previously entered and assigned to the clinical validation review queue <group tech code> during this session have been removed. No results will be sent to the review queue. You removed all qualifying results that had been sent to a validation queue. Messages for Microbiology Automatic No-Growth Result Entry The following informational messages may appear in Microbiology Automatic NoGrowth Result Entry or in the low priority and high priority message logs. This message … Means this … Invalid worksheet code. You entered a worksheet code that is not a nogrowth worksheet defined in MAA 11. <Worksheet name> has never been processed. You entered a worksheet name in the available worksheets list that has not been previously processed. The last update was completed on <date> <time>. You entered a worksheet in the available worksheets list that has been previously processed. An auto no-growth update for this worksheet was started on <date> <time>. The worksheet is still processing. Do you want to override that update? Yes/No You entered a worksheet that is still being processed in another no-growth update. For instructions about responding to this message, see Troubleshooting Microbiology Automatic No-Growth Result Entry on page 203. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 340 Appendix B: Message Reference This message … Means this … An auto no-growth update is complete. Worksheet: <worksheet code(s)>. Number of cultures updated: #. Number of cultures finaled: #. This low priority message is logged when an automatic no-growth update has been completed for a worksheet. In addition to displaying the code of the updated worksheet, this message indicates the number of accession numbers that have been updated and the number of accession numbers that have been autofinaled. An auto no-growth update has been completed. This low priority message is logged after all of the worksheets in the selected worksheets list have been updated with no-growth results. An auto no-growth update has started. When you click Start Update, this message appears before the system displays the Sunquest Gateway. Check the low priority message log to monitor the status of the update. An Auto No-Growth Result Entry is currently being processed: Microbiology No-Growth Update User/Process Name: Lab Location: Time (sec) : You are trying to process a Microbiology Automatic No-Growth Result Entry when someone else is already running the job in a multiple CPU environment. Only one instance of the application can be run in that type of environment. No setup date was entered for <accession number>, <battery code>, Worksheet: <worksheet code(s)>. No auto no-growth update was posted. This low priority message is logged when an accession number associated with an HID that uses Microbiology Setup Entry does not have an associated setup date and time. There is a conflicting lock on <accession number>, <battery code>, Worksheet: <worksheet name>. No auto no-growth update was posted. This low priority message is logged when an accession number on a no-growth worksheet is locked due to conflicting processing. An auto no-growth update request was This message appears in the high priority message unsuccessful because of a lack of log when the no-growth update cannot be performed processor slots or system performance. due to inability to use the processor. An auto no-growth update request was unsuccessful. Try again later. This message appears in Microbiology Automatic No-Growth Result Entry when the system files the previous message in the high priority message log. This culture was not finaled because of pending tests on <accession number>, <battery code>, Worksheet: <worksheet code>. No auto no-growth update was posted. This low priority message is logged when the battery that is scheduled to be autofinaled cannot be autofinaled because of pending tests. Hospital access is not permitted for this user on <accession number>, <battery>, Worksheet: <worksheet code>. No auto no-growth update was posted. This low priority message is logged when Microbiology Automatic No-Growth Result Entry encounters an accession number associated with an HID to which you do not have security access. The end date is earlier than the start date. You entered an end date that is earlier than the start date when defining a no-growth worksheet filter. The end time is earlier than the start time. You entered an end time that is earlier than the start time when defining a no-growth worksheet filter. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Setup Entry 341 This message … Means this … The start date is later than the current date. You entered a start date that is later than the current date when defining a no-growth worksheet filter. The start time is later than the current time. You entered a start time that is later than the current time when defining a no-growth worksheet filter. The end date is later than the current date. You entered an end date that is later than the current date when defining a no-growth worksheet filter. The end time is later than the current time. You entered an end time that is later than the current time when defining a no-growth worksheet filter. The setup time is in the future on <accession number>, <battery code>, Worksheet: <worksheet code>. No auto no-growth update was posted. This low priority message is logged when Microbiology Automatic No-Growth Result Entry encounters an accession number that has a setup time in the future. Messages for Microbiology Setup Entry The following informational messages may appear in Microbiology Setup Entry as well as in the low priority and high priority message logs. This message … Means this … A change of specimen description may affect susceptibilities. You modified the SDES field, which can affect any previously filed susceptibility results. A correction statement has been appended to the result. This message appears when the system automatically applies a correction statement to the result. The receive date and time are missing. You entered an accession number that has no receive date and time. The replacement result is too long. Therefore, the most recent result has not been filed. You entered a correction statement that contains more than 384 characters. The setup date is prior to the collect date. You entered a setup date that is earlier than the collection date. The setup date is prior to the receive date. You entered a setup date that is earlier than the receive date. The setup time is prior to the collect time. You entered a setup time that is earlier than the collection time. The setup time is prior to the receive time. You entered a setup time that is earlier than the receive time. The first part of the site parameter [Enable Setup Date/Time\MST Display Hang 1-999] has not been set to Y for this hospital ID. You entered an accession number that is associated with an HID that does not use Microbiology Setup Entry. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 342 Appendix B: Message Reference This message … Means this … You must enter the setup date along with the setup time. You are trying to save a setup time without entering a setup date. You must enter both a setup date and time. You must enter a setup time along with the setup date. You are trying to save a setup date without entering a setup time. You must enter both a setup date and time. <styp code> <styp code translation> is not assigned to the current hospital ID. You entered an invalid type S code for the SDES. A type S code is mandatory. Re-enter a valid code. You entered an invalid type S code for the SDES and the site parameter [Mandatory entry of specimen type code for SDES] is set to Y. You must enter a valid S code. The setup date is greater than the number of hours allowed for a future setup date. You entered a date that exceeds the number of hours from the current system time specified in site parameter [Number of hours to allow for future setup time (<0>)]. The setup time is greater than the number of hours allowed for a future setup time. You entered a time that exceeds the number of hours from the current system time specified in site parameter [Number of hours to allow for future setup time (<0>)]. The setup time is later than the current date. The entry of a future setup time is not allowed. You entered a setup time in the future and site parameter [Number of hours to allow for future setup time (<0>)] is set to 0. Messages for Microbiology Susceptibility Entry The following informational messages may appear in Microbiology Susceptibility Entry as well as in low priority and high priority messages. This message … Means this … Drug classification has been applied. You applied drug reporting classification schemes to previously filed susceptibility results or results previously in the hold file. Drug classification has not been applied. You rejected drug reporting classification schemes for previously filed susceptibility results or results previously in the hold file. The text has been truncated because the line is too long. You entered composed text and the line is too long. No interpretation is currently available. Enter an interpretative code. You entered a KB result for which there is no corresponding interpretation to an antibiotic zone size. The suppression has been removed. This message appears when you remove a drug suppression. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Tech Final Release 343 This message … Means this … Do you want to update susceptibility results? Yes/No You are trying to apply drug reporting classification schemes to previously filed susceptibility results or results previously in the hold file. Confirm that you do not want to make an entry for this drug. You bypassed the entry of an antibiotic drug result. Append the correction statement? You modified a result and the site parameter [Confirm correction statement change] is set to Y. No interpretation is available. You entered a MIC result for which there is no corresponding interpretation to an antibiotic zone size. You must HOLD or FILE current data before saving. You are trying to save susceptibility results without first filing or placing the result on hold. You must file the result to invoke drug classification and rule execution. No interpretation available. Enter an interpretive code or delete the result. You are updating a susceptibility result and the system cannot find an interpretation defined for the method/organism/drug. Messages for Microbiology Tech Final Release The following informational messages may appear in Microbiology Tech Final Release. This message … Means this … The specified accession number is already on the batch. No modifications made to current batch. You are trying to either add an accession number that has already been added to the batch in its entirety or add a second battery to a batch that contains the same accession number in a previous battery. Please wait. Release-batch job started. This message appears when you release a batch. Tech Final Update: Batch <number of batch> STARTED. This low priority message is logged when the system initiates the start of the batch release process. Tech Final Update: Batch <number of batch> COMPLETED. Number of batteries updated: (<number of batteries updated>). This low priority message is logged when the system completes the batch release process. Hospital access is not permitted. You are trying to add an accession number to a batch that is associated with a HID for which you do not have security. Final Update: Batch <#> Accession <#> not released due to user having no security privileges for HID. This low priority message is logged when you do not have security for one or more accession numbers on a batch that was otherwise released by the system. Batch <#> Accession <#> not released due to accession being locked. This low priority message is logged when the system encounters an existing lock on an accession number during the release process. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 344 Appendix B: Message Reference This message … Means this … Tech Final Update: Worksheet <Worksheet Code> <number of batch> Update STARTED This low priority message is logged when the system initiates the batch release process for the selected sequence worksheet. Tech Final Update: Worksheet <Worksheet Code> <number of batch> Update COMPLETED. This low priority message is logged when the system completes the batch release process for the selected sequence worksheet. Number of batteries updated: (<number of batteries updated>). Tech Final Update: Worksheet <Worksheet Code> Batch <#> Accession <#> not released due to user having no security privileges for HID. This low priority message is logged when you do not have security for one or more accession numbers on a sequence worksheet batch that was otherwise released by the system. Worksheet <worksheet code> Batch <#> Accession <#> not released due to accession being locked. This low priority message is logged when the system encounters an existing lock on an accession number in a sequence worksheet during the batch release process. There are no batteries ready to be updated to a Final status. You selected a sequence worksheet batch that has no batteries in Tech Final status. Battery not defined to this worksheet You are trying to add an accession that has a battery that is not defined to the sequence worksheet. Accession number is not in Tech Final Status You are trying to add an accession that is not in Tech Final status. No microbiology batteries on this accession You are trying to add an accession that does not have microbiology batteries associated to it. Accession number not defined. You are trying to add an invalid accession number. Missing Required Parameter You clicked the Add or Remove button, but did not enter an accession number. This is not a valid batch number. You entered a batch number that is not valid for the worksheet, is no longer active, was deleted, or was purged during a background file cleanup job. The specified accession number has previously been assigned to batch <NN>. No modifications made to current batch. You are trying to add an accession number that is assigned to a batch on another sequence worksheet. The specified accession number has been previously finaled. No modifications made to current batch. You are trying to add an accession that has already been finaled. Deletion of final entry is not allowed. Please use batch deletion in Manual Worksheets. You are trying to delete the last batch from a sequence worksheet. Worksheet is locked. Please try again later. You are trying to select a batch on a sequence worksheet that is locked by another application. This message includes the worksheet name, tech code and tech name, and the lab location. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Microbiology Inquiry 345 Messages for Microbiology Inquiry The following informational messages may appear in Microbiology Inquiry. This message … Means this … No microbiology results were found. You are looking up an accession number for which a specimen description has not been entered. There are no orders or results for the specified conditions. You selected a specimen group(s), episode(s), events(s), day(s) or date range for which no orders or results have been entered. The accession number is not defined. Enter a new search value. You are searching for an accession number that has not been assigned to a patient. The accession number is invalid. Enter a new search value. You are searching for an accession number with an improper format but no invalid characters. No accessions were found. Enter a new search value. You are searching for a valid requisition number that has not yet been assigned to an accession. You do not have security access to this hospital. Enter a new accession number. You are searching for an accession number or container ID associated with a HID for which you do not have security access. No data was found. Enter a new search value. You are searching for an invalid container ID. There are no microbiology batteries on this accession number. Enter a new search value. You are searching for an accession number that has been credited or deleted. Messages for Clinical Validation The following informational messages may appear in Clinical Validation. This message … Means this … Invalid entry. The end date and time must be later then the start date and time. You tried to filter accessions using an end date that is earlier then the start date. Accession, Order code: <accession>, <order code> You selected an accession and order code combination that another person currently has open. Locked By: <user that has the accession, order code open in Clinical Validation> Invalid entry. Enter an active individual tech code or a group tech code You entered an invalid tech code when redirecting an accession to a new queue. Room numbers are not a valid entry. Enter a valid location code that is not a room number. While creating a filter, you entered a room number for the patient location variable. Invalid entry. Enter a valid MA 4 (Type P) Priority code. While creating a filter, the code you entered as a priority is not defined as a priority code. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 346 Appendix B: Message Reference This message … Means this … Invalid entry. Enter a valid MA 32 Sex code. While creating a filter, the code you entered as a sex is not defined as a sex code. Invalid entry. Enter a valid MA 4 (type S) Specimen type code. While creating a filter, the code you entered as a specimen is not defined as a specimen type code. Invalid entry. Enter a valid MA 4 Micro Organism Group (type MG) or Micro Organism (type MO) code. While creating a filter, the code you entered as an organism is not defined as an individual or a group microbiology organism code. Invalid entry. Enter a valid MA 31 Species code. While creating a filter, the code you entered as an species is not defined as a species code. Invalid entry. Enter a valid age in days, months or years. While creating a filter, the age you entered does not conform to any of the standard formats: nD, nM, nY, or n. Location is invalid. Enter a valid MA12 location code. While creating a filter, the code you entered as a location is not defined as a location code. Physician is invalid. Enter a valid MA13 physician code. While creating a filter, the code you entered as a physician is not defined as a physician code. HID is invalid. Enter a valid HID While creating a filter, the HID you entered is either not defined as a HID or you do not have access to the HID. Invalid entry. Enter a valid lab location code. While creating a filter, the code you entered as a lab location is not defined as a lab location code. Invalid entry. Enter a valid MA 4 (type MG) Micro Organism group code. While creating a filter, the code you entered as an micro-organism group is not defined as a microorganism group code. Invalid entry, worksheet code <<worksheet code >> is a special worksheet. Enter a valid individual or group worksheet code. While creating a filter, the code you entered as a worksheet code is defined as a special worksheet. Invalid entry. Enter a valid orderable test (non-bill only), battery or package code. While creating a filter, the code you entered as an order is non-orderable, invalid, or a bill-only order code. Invalid entry. Enter a valid individual or group worksheet code. While creating a filter, the code you entered as a worksheet variable is not defined as an individual or group worksheet code. Invalid entry. Enter a valid MA 16 User Defined Field. While creating a filter, the code you entered as a user-defined field is not defined in MA 16 as a userdefined field. Invalid entry. Chart location is not a valid entry for this field. Enter a valid patient location. While creating a filter, you entered a chart location for the patient location variable. The filter name exceeds the maximum number of characters. Enter a filter name between 1-25 characters. You entered a filter name that is too long. A filter name is required when saving a filter. Enter a filter name between 1-25 characters. You tried to save a filter without first entering a name for the filter. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Messages for Clinical Validation 347 This message … Means this … Added order code <<order code>> has been rejected. The order code is a duplicate order for this accession. You entered an add-on order that is already on the accession. Invalid entry. Enter a valid MA 1 test code defined in Other Testing Maintenance. You entered a test code that is not defined in Other Testing maintenance. Invalid entry. Enter an orderable order code for department MC. You entered an add-on order that is not an orderable microbiology department code. Changes entered in Clinical Validation will be cleared. Continue and discard changes Yes/No. You tried to go to Microbiology Result Entry without saving the changes you have made in Clinical Validation. A reason is required when suppressing or un-suppressing a note. Enter a reason. You tried to add or save a suppressed or unsuppressed note without adding an explanation reason for the action. Invalid entry. Enter a valid MA 5 Lab Department code. While creating a patient-level note, the code you entered as a lab department is not defined as a lab department code. Clinical Validation is not activated. Activate Clinical Validation to access the functionality. You tried to open the Clinical Validation folder, but the site parameter to activate the application is set to N or not set. Invalid entry. The note entered exceeds the maximum length. Enter the note as less than 9000 characters. You entered a note that is too long. Invalid entry. The reason entered exceeds the maximum length. Enter the reason for suppressing or unsuppressing the note as less than 255 characters. You entered a suppress/unsuppress reason that is too long. GM145 Invalid input. Enter a bill-only test code defined for department MC. You entered a non-microbiology bill-only test code. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 348 Appendix B: Message Reference UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory accession number A system-generated number that identifies an order or a group of orders for a patient. All specimens associated with an accession number have the same collection date and time. accession result comments Comment about results that are stored at the accession level from within Micro Result Entry or Clinical Validation. Accession result comments are treated like results. autofile The automatic filing of online instrument results to a patient record. B batch A group of batteries on a culture review or sequence worksheet that have received tech-final status and been assigned a batch number. If the batch is on a sequence worksheet, some batteries may not be in tech final status. batch mode Result entry mode used to review and assign final status to microbiology batteries assigned to a batch number within the last seven days that were previously in tech-final status. batch number A system-assigned number that identifies a group of batteries. battery A group of related tests, for example, the tests that are part of a microbiology culture. All microbiology tests are grouped in batteries. bill-only test A test code that generates a charge to a patient. biotype data Data that identifies microbiology organisms. This information may come from an instrument or may be entered manually. C Callback An application used to document and track the telephone calls that your lab makes to report test results and problem specimens. callback (CB) code When appended to a result or order, this type of text code creates a callback record in Callback. Type CB codes have call priorities defined to them for use with Callback and are defined in English Text Definition (MA4). Clinical Validation A Sunquest application that you use to perform a secondary review of microbiology results before they are finaled. colony count A test, usually assigned the code CNT, that can be included in microbiology batteries to record the quantity of colonies observed in a culture. Glossary A 350 Glossary composed text Text messages or comments entered via a text editor to accompany test results. On the Susceptibility tab in Microbiology Result Entry, a pound sign is entered to invoke the text editor. container ID A unique number assigned to a specimen container if your site uses the Specimen Management, Routing, and Tracking (SMART) application. This number is used by SMART and other applications to track specimens. correction statement A statement appended to a microbiology result to indicate that a change has been made. Correction statements appear as free text, and state the entire previous result and the date and time it was resulted. culture A test included in microbiology batteries to identify microorganisms and record observations. Samples of body specimens are inoculated onto different types of media and incubated in a controlled environment so that the growth of microorganisms can be observed, analyzed, and recorded. D default composed text A long text comment that is defined for a test in Laboratory Maintenance. Default composed text can be modified during result entry as necessary. demographic data Information describing the patient. Also known as patient demographics, or patient data, this information is relatively constant. direct exam A test included in microbiology batteries to identify microorganisms and record observations. Samples of body specimens are placed on slides and examined under a microscope so that the microorganism can be identified and recorded. document callback (CD) code When appended to a result, this type of text code creates a callback record in Callback and prompts the user to document the call as successful or unsuccessful in the resulting application. Type CD codes have call priorities defined to them for use with Callback and are defined in English Text Definition (MA4). E enumeration codes Codes, such as few or many, that describe the quantity of an organism observed when added to a result. episode An episode is a medical event, such as an emergency room visit, that requires one or more laboratory tests. The episode may have more than one event associated with it. Also, a patient can have more than one active episode, such as an emergency room episode and an inpatient episode. This helps to manage overlapping episodes of care. event Describes a type of service a patient has received during an episode. Information stored at the event level includes location, event type, event status, start or admit date, attending physician, and diagnosis. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Glossary 351 extra workload Work performed in the laboratory that needs to be recorded, but cannot be billed and does not produce revenue. Examples include repeat tests, survey samples, and lab housekeeping activities. F Final A result applied to a microbiology battery if all tests in the battery have results, pass internal review and are ready for release. free text Text messages or comments not defined in the system that you enter to accompany a test result. Free text entry can be invoked by entering a semicolon. In free text, do not use delimiters, such as vertical bar (|), backslash (\), number sign (#), exclamation point (!), semicolon (;), and hyphen (-). H hang time The number of seconds that must elapse before the system automatically saves the current date and time as the setup date and time when Microbiology Setup Entry is used in quick mode. HIDE A text code set by Sunquest for the site parameter [English text code to suppress tests from printing on patient reports]. When this code is entered as a result or part of a result, the result does not appear on patient reports and does not print in certain inquiry functions, based on security. Your site can request to use a different code. HMO ID A patient identifier that names a patient’s health maintenance organization. Also known as alternate patient ID 2, the name of this field can be customized by your hospital or laboratory facility. See also patient identifiers. hospital information system (HIS) A software system designed to manage data in a hospital. I internal notes Notes about a patient or specimen that are exchanged between a lab tech and reviewer through the Clinical Validation application. As the name implies, internal notes cannot be viewed on patient reports or any of the inquiry applications. After results are filed, internal notes are discarded. M MBC Abbreviation for Minimal Bactericidal Concentration. Minimal concentration of an antimicrobial agent (antibiotic) required to kill a microorganism. MIC Abbreviation for Minimal Inhibitory Concentration. Minimal concentration of an antimicrobial agent (antibiotic) required to inhibit growth of a microorganism. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 352 Glossary Microbiology Automatic No-Growth Result Entry A microbiology application that you use to add and update no-growth result statements for cultures assigned to a predefined worksheet. Microbiology Inquiry A microbiology application that provides summaries and detailed results for culture and direct exam orders. Microbiology Result Entry A microbiology application that you use to record observations, enter workup data, view previous results, access online and biotype data, and enter susceptibility results. Microbiology Setup Entry A microbiology application that you use to enter the date and time that you process or plate a specimen. When you do this, you can base the no-growth update on the setup date and time instead of the receive date, thus increasing the accuracy of results. Microbiology Tech Final Release A microbiology application that you use to release a batch of microbiology batteries from Tech Final status to Final status. MPI number A unique identifier for a patient. A master patient index number avoids the danger of individual patient data being kept under more than one identification number. A master patient index supports maintenance of a single index of all patients and allows messaging of patient information among facilities or information systems. N no-growth worksheet A culture battery worksheet that allows you to use Microbiology Automatic No-Growth Result Entry to update no-growth statements for many cultures at a time. non-device-type biotype A microbiology organism identification obtained from a manual method, such as an API strip that is read visually by a technician. nonpaperless microbiology Paper-based process used to accumulate workload for microbiology workups. notes See internal notes. O online results Results of tests performed by an online instrument and transmitted to Sunquest Laboratory. online workcard An online form available in Microbiology Result Entry for sites using paperless microbiology. You can use the online workcard to enter workup data, such as the number and type of media used to process a specimen and to record extra workload. Other key A key you can press to invoke manual text entry to enter free text or codes that are not predefined to keys on a customized keyboard. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Glossary 353 other tests Non-microbiology tests associated with a placeholder test. Using other testing, you can enter and report results for non-microbiology tests such as urine microscopy as part of a microbiology battery. P paperless microbiology A process that uses an online workcard to enter workup data for direct exam or culture tests online. patient ID A demographics field that identifies the patient record. It is assigned at patient check-in or transmitted over an interface from the hospital's information system. At your facility, this number may be known as the medical record number, patient number, or hospital number. patient identifiers Patients can be identified by fields defined by each site, such as alternate patient ID # 1 (usually social security number), alternate patient ID # 2 (usually HMO ID), alternate patient ID # 3 (usually Episode No.), and billing account number. Site parameters control the wording and appearance of these alternate patient identifiers. patient header Located in the upper portion of the window, this read-only text displays the name and other demographic information for the selected patient. percent probability The likelihood, expressed in percent, that an organism identification is accurate. placeholder test A test that is associated with non-microbiology tests such as those for urine microscopy. If a placeholder is part of a battery, the associated tests can be resulted as part of the microbiology battery. In Inquiry and reports, the results of these other tests appear along with the micro battery. Q quality assurance checking Quality assurance feature designed to detect problems and to display failures that alert you to the problems. quick mode A data entry mode in Microbiology Setup Entry in which the system automatically saves the current date and time as the setup date and time after a pre-set interval has elapsed. R requisition-based reports Requisition-based reports (RBRs) are an optional feature of the Sunquest Laboratory client database. RBRs are reports of laboratory test results presented in a compact format in which all results for a single requisition appear in a single report, even if multiple accession numbers are involved. RBRs are a convenient and efficient way of communicating laboratory test results to physicians and medical facilities. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 354 Glossary requisition numbers A number assigned to an accession number during Order Entry and with which multiple accession numbers can be associated. report status A test included in all microbiology batteries that records the status of the tests in a battery and whether they are completed and the battery has received final status. rules Defined by a system manager to minimize data entry and automate tasks. Assigned to perform an action when you enter or save results. S setup date and time The date and time that a microbiology specimen is plated or processed. It can be entered into the system using Microbiology Setup Entry or added or modified on the Misc. Updates tab in Microbiology Result Entry. sequence worksheet A dynamically or manually created list of accessions scanned in or entered from a keyboard in the order that the specimens appear in a specimen tray. You create the sequence worksheet in the Manual Worksheet (MWS) function and use it in Microbiology Result Entry and Microbiology Tech Final Release. single specimen mode A data-entry mode in Microbiology Setup Entry in which you can change the system-supplied current date and time to the date and time at which a specimen was actually plated or processed. This mode also allows you to add or modify the specimen’s Specimen Description (SDES) and/or Special Request (SREQ) result. SMART Specimen Management, Routing, and Tracking. SMART is an application that enables lab personnel to track specimens, route containers to processing locations, and locate specimens quickly. social security number A patient identifier showing the patient’s social security number or other outside identification number. The name and format of this field can be customized by your hospital or laboratory facility. See also patient identifiers. specimen description (SDES) A test included in all microbiology batteries to record a specimen type and description. SDES can be defined as a result at requisition test. special request (SREQ) A test included in all microbiology batteries to record any necessary special requests. SREQ can be defined as a result at requisition test. specimen mode Result entry mode used to enter results for an individual specimen. Selection options for specimens include accession number, patient ID, patient name, and social security number, among others. specimen header Part of the screen that displays information about the order and the specimen. Site parameters control which comments fields appear in the specimen header. UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Glossary 355 susceptibility A method that determines if an antibiotic is effective for treating an infection caused by a specific organism. Also known as drug sensitivity in some enterprises. T tech code A unique code that identifies a technologist who uses the Sunquest Laboratory system. It is associated with a password. Tech Final A preliminary result applied to microbiology batteries by a microbiology technologist. V validation queue A group of accessions awaiting review in Clinical Validation. Results that have been assigned to a validation queue are reviewed by a member of the queue before they are released to Inquiry and patient reports. W worksheet mode Result entry mode used to enter results for specific tests that qualify for the selected worksheet. workup data Data that specifies the number and type of media used to process a specimen, such as a tube, plate, or slide. If your site uses paperless microbiology, you can enter workup data in Microbiology Result Entry using an online workcard. Z ZZ battery A battery automatically added to a patient record whenever a susceptibility test is done on an organism. The battery includes a method code and organism test, as well as the individual drug codes that were resulted. The batteries are named ZZ (ZZ00, ZZ01, and so on) so that they print after any culture results during the printing of reports. Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 356 Glossary UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems Microbiology User’s Guide Sunquest Laboratory Index A B accession numbers adding and removing 190 adding new tests to 277 assigning multiple batteries to 324 filtering queries by 222 moving between, in Clinical Validation 268 reactivating 49 redirecting 271 releasing batteries when locked 184 returning in Clinical Validation 268, 270 selecting for Clinical Validation 257 site parameter for validation 321 accession result comments about 112, 293 defined 349 editing or deleting 114 entering 113 opening in Clinical Validation 293 in Microbiology Result Entry 112 site parameters for 311 Accession/Battery List viewing results from 225 window 223 approved status 268, 270 autofiling and correction statements 126 online results 124 organism identifications 124 susceptibility results 125 Automatic No-Growth Result Entry See Microbiology Automatic No-Growth Result Entry automatic susceptibility updates about 158 site parameter 322 batch numbers looking up 185 recycling 182 batches confirming changes to culture review batch 190 confirming changes to sequence worksheet batch 191 credited accession numbers 184 modifying 189 releasing 186 releasing sequence worksheet batteries 187 tech final status 181 batteries about 52 assigning multiple to an accession number 324 crediting 158 multiple per accession, reviewing in Clinical Validation 256 viewing a history of 230 bill-only tests entering 100 in Clinical Validation 256 looking up (MMIQ 17) 246 maintenance settings 309 biotype data deleting 92 entering 90 modifying 90 online results, replacing with 122 recording 89 settings for entering 312 viewing 72, 91, 154 viewing a summary of 94 358 Index C cautions deleting observations with online results 104, 105 deleting online instrument data 135 clear data 92 Clinical Validation and other applications 276 details, printing 282 faxing reports 283 getting to know 251 log 295 maintenance 329 manually assigning results to 109 messages 345 multiple batteries per accession 256 my queue 252 printing reports 283 reports 294 resolving rule conflicts 110 review statuses about 268 changing 270 rules 252, 253, 257 security for 305 selecting a date range for 259 selecting a filter 259 settings 328 site parameters for 329 starting 254 window 266 workflow 252 colony count entering 70 keys 24 site parameter 309 combining drug results 123 comments in Automatic No-Growth Result Entry 200 in Clinical Validation 278 in direct exam and culture observations 67 in specimen description and special request 99 in susceptibility results 142 in workups 83 site parameter settings 310 using composed text 75 using customized keyboards 20 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems composed text about 76 for direct exam or culture observations 75 for susceptibility results 148 in accession result comments 113 in result comments 278 modifying 76 site parameters 310 container IDs (CIDs) filtering queries by 222 looking up in Microbiology Setup Entry 38, 41 searching for 214 correction statements and modified drug results 158 applying 103 site parameters 306, 310 when autofiling 126 culture keyboards, looking up (MMIQ 7) 239 cultures entering observations 67 filtering in Automatic No-Growth Result Entry 196, 201 hiding observations on patient reports 80 modifying observations 101 placing observations on hold 77 recording observations 66 releasing results from hold 78 responding to QA failures 115 result entry 48 rules for, about 55 viewing a summary of observations 94 viewing recorded information about 72 customized keyboards about 20 selecting 25 using 20 D data locking 13 protecting 13 data entry cancelling 93 clearing entries 92 dialog boxes, using 15 direct exam entering observations 67 Microbiology User’s Guide Sunquest Laboratory Index direct exam (continued) hiding observations on patient reports 80 looking up keyboards (MMIQ 8) 240 modifying observations 101 placing observations on hold 77 recording observations 66 releasing results from hold 78 responding to QA failures 115 result entry 48 rules for, about 55 viewing a summary of observations 94 viewing results for a culture 72 drug classifications applying 154 looking up (MMIQ 15) 244 drug results automatic susceptibility updates 158 combining and overlaying 123 correction statements 158 crediting a battery 158 entering 142 entering additional codes based on rules 144 filing 156 hiding 153 modifying 160 not done code 158 placing on hold 149 saving 156 E enumeration codes, and online data 121 episodes, filtering queries by 217 events, filtering queries by 217 extra workload for nonpaperless orders 88 for paperless orders 83 F fax reports 283 filtering inquiry results about 216 by accession number 222 by container 222 by episodes or events 217 by specimen groups 218 filtering out suppressed results 220 for a selected requisition number 221 Microbiology User’s Guide Sunquest Laboratory 359 filtering inquiry results (continued) workflow 210 filters, Clinical Validation creating and editing 260 selecting 259 final key 23 final results, scheduling 195 final status about 173 and online data 177 and quality assurance checking 176 assigning to a battery 176, 177 assigning to a battery with tech final status 178 clearing in Microbiology Result Entry 92 deleting 179 in Clinical Validation 268, 270 free text for susceptibility results 143, 147 in direct exam and culture observations 67 using to enter observations 68 functions, Microbiology Maintenance Inquiry (MMIQ) 233 H help accessing 13 printing 14 using 14 hiding and automatic susceptibility updates 159 direct and culture observations on patient reports 80 drug results on patient reports 153 history, susceptibilities 274 hold placing direct exam and culture results on 77 placing drug results on 149 placing results into 169 releasing susceptibilities on 151 results, replacing with online 122 viewing results on 72, 154 I Inquiry See Microbiology Inquiry inquiry results, filtering See filtering inquiry results UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 360 Index inquiry specimen groups, looking up (MMIQ 18) 247 interim format switching to 227 viewing results in 226 internal notes about 287 creating 111, 291 defined 351 in Microbiology Inquiry 229 in Microbiology Result Entry 111 report 297 K keyboard commands, using common 16 keyboard methods, about 141 keyboard shortcuts 15 keyboards customized 20 for unassigned batteries 23 maintenance settings 312 selecting 25 selecting for other tests 166 selecting for susceptibilities 140 susceptibility 23 using to enter observations 68 keyboards, looking up culture keyboards 239 direct exam keyboards 240 other testing keyboards 249 sensitivity keyboards 241 keys colony count 24 final 23 no growth 24 other 27 tech final 23 Kirby Bauer results 147 L lab locations filtering validation queues by 260 modifying 28 label print/setup time options, looking up (MMIQ 21) 249 laboratory applications, opening 276 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems locks about 13 accession number 13 accession numbers and releasing batteries 184 in Clinical Validation 257 logical progressions, looking up (MMIQ 20) 248 M MBC results 147 MCI and MCIQ security 208 MIC exams looking up interpretive values (MMIQ 4) 238 looking up usual/dosage values (MMIQ 5) 238 MIC results 147 Microbiology Automatic No-Growth Result Entry adding a comment 200 entering worksheets 199 filtering cultures 201 getting to know 193 maintenance 325 messages 339 performing updates 202 settings 324 site parameters 326 starting 198 troubleshooting 203 using 194 workflow 197 microbiology history, viewing 230 Microbiology Inquiry and Clinical Validation 276 canceling a search 226 filtering results 210 getting to know 207 maintenance 327 messages 345 searching for results 210 selecting results to view 212 settings 327 site parameters 327 starting 209 viewing results 213 workflow 209 Microbiology User’s Guide Sunquest Laboratory Index Microbiology Maintenance Inquiry (MMIQ) getting to know 233 starting 234 microbiology maintenance, inquiring on 235 Microbiology Result Entry about 50 and other applications 52 cancelling data entry 93 clearing entries 92 entering direct exam and culture observations 66 getting to know 48 looking up batch numbers in batch mode 58 looking up sequence worksheet batch numbers 61 messages 332 settings 308 starting 55 using worksheets 63 Microbiology Setup Entry getting to know 33 maintenance 306 messages 341 printing in 31, 36 reasons for using 34 settings 36, 305 site parameters 306 starting 37 using quick mode 37 using single specimen mode 37 Microbiology Susceptibility Entry about 139 autofiling 125 automatic update site parameter 322 entering results 138 getting to know 137 messages 342 modifying results 157 responding to QA failures 156 rules for 139 Microbiology Tech Final Release about 181 getting to know 181 looking up batch numbers 185 messages 343 modifying a batch 189 releasing a culture review batch 186 releasing a sequence worksheet batch 187 security 181, 303 settings 323 Microbiology User’s Guide Sunquest Laboratory 361 Microbiology Tech Final Release (continued) windows 182 Microsoft Windows, using 15 MMIQ See Microbiology Maintenance Inquiry mouse, using 15 multiple sensitivity entry, site parameter 322 my queue 252 N navigation indicators, displaying 16 no-growth key 24 worksheets 195, 196, 198 no-growth updates based on the receive or setup time 195 performing 198 scheduling 195 no-growth worksheets automatically updating 193 filtering cultures on 196 looking up (MMIQ 11) 242 nonpaperless microbiology about 53 entering workload for 88 not done code, about 158 notes See internal notes O observations adding 101 changing the print order 74 deleting 104 deleting when online results exist 105 entering free text 68 entering off of the keyboard 68 modifying 101 placing into hold 77 recording 66 viewing 72 online filing parameters looking up for organism IDs, (MMIQ 12) 242 looking up for sensitivities (MMIQ 13) 243 online instruments about data from 119 settings 315 viewing results from 126 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 362 Index online results accepting 127, 128, 130, 133 and previously filed codes 120 and quality assurance checking 124 autofiling 124 deleting 135 getting to know 117 locating after filing 134 replacing hold results with 122 saving 135 selecting individual 129 viewing 72, 126, 154 online workcards looking up definitions (MMIQ 16) 245 searching for an order 62 online workup data, recording 82 orders accepting online results for 127 adding in Clinical Validation 277 adding workload codes to 82 printing labels upon receipt of 30 recording additional workload for 83, 88 recording workup data for 53 searching for 55 searching for by batch 58 searching for by direct exam or culture worksheet 59 searching for by sequence worksheet 60 searching for by specimen 56 selecting another 93 viewing patient and specimen information 51 organism identifications and enumeration codes 121 and susceptibility results 118 autofiling results 124 on hold and online data 122 replacing with online data 121 selecting a result 140 other key, using 27 other testing entering results for 166 looking up keyboards (MMIQ 22) 249 overview 163 placing results into hold 169 QA checking results entered manually 168 results sent from instrument 120 releasing results from hold 170 replacing hold results with online results 122 viewing a summary of results 94 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems overlaying drug results 123 P paperless microbiology about 53 audit trail report 53 entering workup data 82 settings 316 Paperless Microbiology Audit Trail report, printing 53 Patient Cumulative report, printing 106 patient header 51 Placing 77 print order changing 74 of observations 74 site parameter 320 printing automatic printing 31 detailed results 232 help 14 in Microbiology Setup Entry 31, 36, 44 Paperless Microbiology Audit Trail report 53 Patient Cumulative report 106 reprinting options 31, 44 Q QA checking for other tests results entered manually 168 results sent from instrument 120 QA failures responding to for direct exam and culture 115 responding to for susceptibilities 156 quality assurance and online results 124 looking up definitions (MMIQ 10) 241 responding to failures 115 responding to failures for susceptibilities 156 queries filtering results 216 modifying 230 searching for results 214 viewing detailed results 226 query filters, about 216 queues See validation queues quick mode, in Microbiology Setup Entry 37 Microbiology User’s Guide Sunquest Laboratory Index R report blocking 208 reports displaying setup time on 33 hiding drug results on 153 hiding results on 80 in Clinical Validation 294 including biotype data on 53 including specimen description and special request on 99 interim 283 internal notes 297 Paperless Microbiology Audit Trail 53 Patient Cumulative 106 printing or faxing 283 showing multiple text codes on one line 99 showing multiple text codes on single line on 40 viewing direct exam and culture results on 48 requisition-based reports filtering 221 report blocking 208 searching for 214 results applying tech final or final status 141 autofiling from online instruments 124 changing 101 entering for direct exam and culture 66 entering for susceptibilities 141 entering in composed text 148 entering using a worksheet 64 filtering in Microbiology Inquiry 216 for other tests entering 166 placing into hold 169 QA checking when manually entered 168 QA checking when sent from instrument 120 releasing from 170 hiding 80 Kirby Bauer method 147 MBC format 147 MIC format 147 placing on hold 77 printing 232 releasing from hold 78 saving 97, 172 searching for 214 Microbiology User’s Guide Sunquest Laboratory 363 results (continued) selecting for an organism 140 selecting to view 223 sent from online instruments 126 settings for viewing 321 settings to suppress 321 summary of 94 viewing for a culture 72 viewing from a query 226 viewing from the accession/battery list 225 viewing in Inquiry 105 viewing in interim format 226 viewing in table format 228 viewing susceptibility summaries 155 rules about 55 and automatic susceptibility updates 160 and Clinical Validation 253 for entering additional drug codes 144 for entering susceptibilities 139 resolving Clinical Validation conflicts for 110 S scheduling final results 195 no-growth updates 195 SDES and SREQ See specimen descriptions and special requests search mode, selecting 56 searches See queries searching for orders by batch 58 by direct exam or culture worksheet 59 by sequence worksheet 60 by specimen 56 security for microbiology applications 301 in Microbiology Inquiry 208 in Microbiology Tech Final Release 181 looking up settings for organism codes (MMIQ 19) 247 selecting accessions for 257 sensitivities looking up batteries (MMIQ 2) 236 looking up codes (MMIQ 1) 236 looking up interpretations (MMIQ 3) 237 looking up keyboards (MMIQ 9) 241 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems 364 Index setup date and time alternatives for entering 35 entering in quick mode 38 entering in single specimen mode 40 modifying 43, 97 shifts, modifying 28 shortcut keys and menus 15 significant findings, flagging 67 single specimen mode, in Microbiology Setup Entry 37 site parameters accession number validation 321 accession result comments 311 automatic susceptibility update 322 Clinical Validation 329 colony count 309 composed text 310 correction statements 310 Microbiology Automatic No-Growth Result Entry 326 Microbiology Inquiry 327 Microbiology Setup Entry 306 multiple sensitivity entry 322 print order 320 special requests, modifying 40, 99 specimen descriptions, modifying 40, 99 specimen groups filtering by 218 looking up (MMIQ 14) 244 specimen header 51 Sunquest Laboratory, opening 276 suppress results in Clinical Validation 273 in Microbiology Result Entry 80 settings for 321 susceptibilities about 139 autofiling 125 automatic update site parameter 322 automatically updating 158 entering 138 history for a patient 274 modifying 157 not done code 158 responding to QA failures 156 rules for entering 139 using alternate interpretive codes 146 viewing 72, 154 viewing a summary of results 155 susceptibility keyboards 23 UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems susceptibility results and applying tech final or final status 141 and online data 122 entering 141 entering in composed text 148 on hold and online data 122 releasing from hold 151 viewing a summary of 155 Syndrome Index 53, 102 T table format switching to 227 viewing results in 228 tech codes, modifying 28 tech final key 23 tech final status about 173 and quality assurance checking 174 assigning to a battery 174 deleting 176 tests, adding in Clinical Validation 277 text comments, entering 27, 142 time, specifying restrictions on 219 U underlining of keyboard commands 16 V validation queues about 252 assigning results to 252 defined 355 filtering 259, 260 manually assigning results to 109 redirecting to another 271 reviewing 270 selecting in Clinical Validation 257 W Windows, Microsoft using 15 workcards looking up (MMIQ 6) 239 printing at order or receive time 31 Microbiology User’s Guide Sunquest Laboratory Index 365 workcards (continued) printing at setup time 31 using reprinting options 31 using two printers 31 worklabels printing at order or receive time 31 printing at setup time 31 using reprinting options 31 using two printers 31 workload entering 54 for nonpaperless orders 88 settings for defining codes 312 worksheets filtering cultures on 196 in Automatic No-Growth Result Entry 198 in Microbiology Result Entry 63 settings for using 322 using 63 workups and paperless microbiology 82 entering data 83 modifying results 87 viewing results 86 Microbiology User’s Guide Sunquest Laboratory UD-1527/00-11-MC Proprietary/Confidential—Sunquest Information Systems
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