Resulting Microbiology Specimens in Expanse

The process for resulting Microbiology specimens is similar to the process in Client/Server, however there are a few key differences. The steps below will outline the new process and highlight some of the changes.

Resulting a Positive Culture 

1. In the Specimen Desktop, go to Enter Results and type in the specimen number. Your specimen will display with the Micro procedure that was ordered, which may or may not include a Gram Stain. Enter Setup Date/Time/User as needed.

2. 

Gram

Stain:

a. In the result box, type the letter “E” followed by the enter key, or click the Result button on the bottom of the screen. This will bring up the Gram Stain resulting page. From there, press F9 to do a lookup and select the appropriate response code(s). (Please note that the codes may differ from those in Client Server, therefore doing a lookup is recommended.)

b. Once the results have been entered, click “Save” or press the F12key to save the information on the Gram Stain page. Select a file status according to your site’s procedures.

3. Culture:

a. The culture resulting pages can also be accessed by highlighting the appropriate field and typing “E” or clicking Result on the bottom of the screen. This will bring up Day 1 of your culture.

b. A list of several prompts will appear. This list differs from procedure to procedure. Please note that these prompts are NOT mandatory and may not all apply to your site. Fields may be left blank if not appropriate for your site.

c. Culture results for all applicable media are documented for day 1here. The results are internal for all prompts **EXCEPT PROMPTS THAT HAVE FINALRESULT IN THE TITLE.**

d. These prompts may be resulted using pre-established answer codes, which can be accessed by doing an F9 lookup. Multiple codes may also be used  for one prompt by putting spaces between the answer codes. In the image above, for BACO2 (line 3) the result codes of BHC and C were entered which expanded to the result texts “Beta hemolytic colonies” and “Coliforms”. The user may also add punctuation in between codes to improve clarity. In this example, “&” was added by the user.

e. Results may also be entered as free text in the result boxes. In the image above, Thioglycolate Day 1 (line 10) has a result that was manually typed out by the user. The result text to the right is displayed exactly as the user typed in the result field. There is a character limit so use of brief or abbreviated results is recommended when resulting this way.

f. If additional prompts need to be added, this can be done by clicking the Edit button at the bottom of the screen and selecting Prompts from the list.

g. Another pop-up will appear where a list of prompts can be populated. An F9 lookup can be performed here to see available prompts. Once all desired prompts have been added, press F12 or click OK

h. The new prompt(s) will appear below the field that was highlighted when the user clicked edit. In this case, Reincubate was highlighted, therefore the new prompt Catalase was added below it.

i. Follow the same steps as above for subsequent days.

j. Once the organisms have been identified, they may be entered under the organism tab. Results populated here will display highlighted in red in the patient’s EMR.

k. Additional notes can be added to the comment tab if needed. Please note that anything written there will display on the final report unless the line starts with “@”

l. From here, antibiotic susceptibility information may be entered on the Susceptibility and Antibiotics tabs. ***For integrated testing purposes, these fields can be left blank as the Susceptibility Procedures are not fully built. ***

m. Additional notes can be added to the comment tab if needed. Please note that anything written there will display on the final report unless the line starts with “@” symbol.

n. Once the results have been entered, click “Save” or press the F12key to save the information on the culture procedure pages. Select a file status according to your site’s procedures.

Resulting a Negative Culture 

1. Follow steps 1, 2 and 3a-i listed in the section above.

2. Press F12 to save info and return to the main result screen.

3. In the result field for the procedure, perform an F9 lookup. Select the result code that is appropriate to your culture outcome.

a. Some of these result codes are Meditech defaults and others are custom created for culture type. It is recommended that the custom results are used rather than the Meditech defaults whenever possible as they are set up with a canned text that results out when selected.

b. These custom results can be easily identified by the status under the Prelim/Final column on the right. In the example below, the result code of NOMRSA is the only custom result for the MRSA procedure.

c. If the Text column is blank, this indicates that resulting with that code at the defined status will not populate the canned text. For example, NOMRSA must be resulted as Final (FV) to populate the canned text.

Resulting a Negative Culture with a Final Result Prompt 

The process for resulting a negative culture via a final result prompt is very similar. If the procedure being tested has a Final Result prompt available, it can be used. Please note that reporting via a Final Result prompt will display differently in EMR and will not be as prominent for the provider.

1. Select the day in which the Final Result prompt is located. It may not be on the actual last day of testing due to variation between site procedures.

2. Perform an F9 lookup to view available answer codes. Select the one appropriate to your culture outcome.

Please note that results in this field will appear on the External report and entering free text is not possible.

3. Press F12 or click save to return to the previous screen. From there, leave the result fields blank.

4. The result may now be verified according to your site’s procedures.