IMM: L24 Expanded Scope of Practice: Lab Test Ordering

Pharmacists are able to …, …, and … lab tests

order, receive, interpret

Requirements for ordering laboratory tests:

• The pharmacist must have:

  • … relationship with patient

  • … to order the correct test and interpret results

  • Patient …

  • … conflict of interest

  • Access to patient information to determine:

    • If a lab test is required

    • Which lab test to order

    • Interpretation of result in context of patient

    • Actions to be taken in response to results

  • Test ordering must be to provide services … pharmacist scope of practice

    • …, assessing and resolving drug therapy problems

    • … drug therapy

Professional, Competence, consent, No, within, Identifying, Monitoring

Determining if you should order a lab test:

• Step 1: Determine how the lab result will … your decision making

• Step 2: Review available … work to determine when the test was last ordered

• Step 3: Review previous labs to determine what other … have been done

• Step 4: Determine if the patient already has a … from another healthcare provider to order the required laboratory tests

change, blood, tests, requisition

What’s the problem with unnecessary tests?

• … to the patient and health system

  • Canada spends ~$… billion annually on lab tests

    • It is estimated that …% of lab tests in Canada are unnecessary

• … to patient

• May result in … treatment decisions

  • i.e. if a test is performed too early, a medication may be unnecessarily increased, decreased, stopped, or started

Costs, 6, 10, Inconvenience, inappropriate

Which tests can pharmacists order?

• … profile (CBC)

• … markers (B12, ferritin, iron, transferrin)

• …: Sodium, potassium, chloride, calcium, magnesium, phosphate

• … tests: Creatinine, GFR, urinalysis,

• … ratio, 24H CrCl

• … tests: INR, Albumin, Bilirubin, Alk Phos, ALT, AST, GGT, LDH, total protein

• … tests: A1c, fasting BG, random BG, TSH

• …: Lipid profile, CK

• … drug levels

• … screening

Hematology, Anemia, Electrolytes, Renal, Albumin/Creatinine, Liver, Endocrine, Cardiovascular, Therapeutic, Drug

Pharmacists can only order lab tests if they have the … of when these tests are required and … to interpret and respond to the findings

• Knowledge and competence may vary based on:

  • Population

  • Laboratory test

knowledge, competence

Stepwise approach to interpreting results:

• Step 1: Assess results for degree of … and determine if it is a …

  value

• Step 2: Identify all possible … to the result

• Step 3: Make … to respond to results

• Step 4: … plan with patient +/- other healthcare providers

abnormality, critical, contributors, plan, Communicate

Documentation:

• Upon ordering and interpreting laboratory test results, pharmacist must document in the clinical record:

  • … information

  • Informed …

  • Test ordered and … for ordering

  • … ordered

  • … received

  • … taken in response to received results

  • Healthcare … to whom the results were forwarded (if at all)

Client, consent, rationale, Date, Results, Actions, professional

Limits upon pharmacist lab test ordering:

• Pharmacists must only order labs that:

  • Within the pharmacist's … and … to order and interpret

• Pharmacists must not order lab tests for:

  • … or family members

  • Exception: Emergency situations and another practitioner is not available

• Note: Pharmacists are not required to order laboratory tests, however, if they chose not to order laboratory tests when the test would benefit the patient, they must … the patient to a practitioner willing and able to order the test

knowledge, competence, Themselves, refer