Hi Kristen,
We did develop a reflex order and it took several tries to get it just right. 
We have Meditech so unfortunately I am no help with EPIC.
I can however tell you a few barriers we had and still have.

1)      Originally the reflux is based on the initial order, so if the initial 
order is failed to be put in in a timely manner it can cause the 2nd to be 
delayed and fall out

2)      The reflux time is now based on the arrival time in an attempt to 
prevent errors so  it refluxes 4 hours from arrival no matter when the original 
was ordered

3)      There were no established critical values for Lactic so these had to be 
established

4)      The physician and nurse are unable to see when the next lactic will be 
drawn, it generates labs in the lab so if the lab tech doesn't get there in a 
timely fashion this can cause fall out

5)      This auto generates only from results greater than 2 so if there is 
suspicion/change in condition then it needs to be re-ordered

6)      Any level greater than 2 continues to reflux until the result is less 
than 2, this has gone on several days on some patients

Hope this helps!
Katie

From: Sepsisgroups [mailto:[email protected]] On 
Behalf Of Christiansen, Kristen
Sent: Wednesday, March 22, 2017 11:45 AM
To: [email protected]
Subject: [Sepsis Groups] Reflex lactate functionality in EMR

Hello -

For those facilities who have implemented a reflex repeat lactate order, I am 
wondering if you had any challenges with getting this to work in your EMR?  
Specifically, has anyone done this with EPIC?


Kristen Christiansen, RN BSN
Clinical Outcomes Coordinator
Patient Safety and Performance Excellence
(303) 651-5347
[email protected]<mailto:[email protected]>

[cid:[email protected]]

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