Purpose, Workflow, and Best Practices
Toxicology - Result Entry with RX Verification (consistency assessment)
Use the Toxicology Result Entry form when recording drug screen/confirmation results. It mirrors Clinical Result Entry but adds RX Verification: for each analyte, the LIS compares detected drugs to the patient’s reported medications and generates an interpretation of Consistent or Inconsistent.
What RX Verification does
- Compares each detected/not-detected analyte (and key metabolites) to the patient’s reported medication list
- Produces a per‑analyte interpretation and an overall case summary
- Supports screening and confirmation workflows (e.g., IA → LC/GC‑MS)
Interpretation rules (core logic)
Reported medication contains this drug/class:
- Drug detected → Consistent (reported medication detected)
- Drug not detected → Inconsistent (negative for reported medication)
No reported medication contains this drug/class:
- Drug detected → Inconsistent (positive for drug not reported)
No reported medication and drug not detected:
- Typically Consistent/Negative (no discrepancy)
Notes
- Mapping includes parent drugs and expected metabolites (e.g., oxycodone → oxycodone/oxymorphone).
- Configurable by your lab: cutoffs, cross‑reactivity, grouping by class, and exceptions.
What you can enter and manage
- Quantitative and qualitative results for each analyte/class
- Screen vs. confirm status (e.g., Presumptive Positive, Confirmed Positive)
- Validity/adulteration markers (creatinine, pH, oxidants, specific gravity)
- Reported medications (brand/generic), last dose time (if collected), and notes
- Result comments (report-visible) and internal notes (verification rationale)
- Status control: Preliminary, Final, Corrected
- Holds and routing: Hold Results until review; control distribution timing
RX Verification calculation
Add a concise comment for any Inconsistent finding (e.g., “Amphetamine not detected; patient reports Adderall. Collected >72 hrs post-dose may reduce detectability.”)
High‑speed, mass entry tools
- Set‑all/Fill‑down for negative panels across identical tests
- Quick‑picks for qualitative values (Negative/Positive, Detected/Not Detected)
- Barcode/ID scan to jump to an accession
- Batch comments for standardized interpretations
Tip: Avoid mass entry when performing corrections or when results drive RX Verification exceptions.
Grid capabilities
- Filters: date, client/site, test/panel, status
- Grouping: by client, test, status, RX interpretation (e.g., Inconsistent first)
- Column customization
- Keyboard workflow: Arrow up and down/Enter navigation; Shift + Enter to Save
Validation and safety checks
- Cutoff checks and auto‑flagging
- Specimen validity flags (dilute, adulterated, substituted) that may set “Unable to evaluate”
- Reflex rules: auto‑order confirmation on presumptive positives
Editing, corrections, and audit trail
- Edit freely before release; once released, corrections require documentation and issue a Corrected report
- Required reason for change, with user/time stamps
- Full audit: who entered, verified, released, corrected, distributed
Release and distribution
- Release options: per result, per order, or in batch
- Distribution: Report Rules (fax/portal/HL7/email) trigger on release; you can requeue failures
- Timing controls: hold until confirmations return; release addenda only
Special toxicology workflows
Manual result entry step-by-step
Step‑by‑step (example: batch negatives with RX Verification)
- Open Result Entry and load orders
- Results → Result Entry → Search → set filters (date/client/test/status) → Find → select orders → Done.
- Select tests to work on
- Highlight the order(s); choose the tox tests in the Tests grid.
- Enter results
- Record qualitative/quantitative outcomes.
- Enter or verify the patient’s reported medications (on the order form).
- Mass entry for negatives (optional)
- Select multiple rows of the same tox panel; apply Negative to all.
- Add comments (as needed)
- Use standard comments for common interferences, detection window context, or confirm status.
- Recalculate RX Verification (is automatic but could be manually triggered)
- Save to auto‑compute RX Verification (or click Recalculate if applicable).
- Review per‑analyte and overall interpretations; address any Inconsistent flags with notes or confirmatory actions.
- Save
- Click Save. Proceed to Review/Release per policy; hold until confirmations if needed.
Best practices
- Maintain accurate medication mapping: brand ↔ generic ↔ class ↔ metabolites
- Prioritize confirmation before finalizing RX interpretation; clearly label presumptive vs. confirmed
- Route “Inconsistent” cases to a senior reviewer; require a rationale note before release
- Use saved views to surface items needing attention (e.g., “Inconsistent — review needed”)
- Keep cutoff tables, cross‑reactivity notes, and detection window guidance current
Troubleshooting
- RX Verification not updating: Ensure medications are entered and Save (or click Recalculate)
- False “Inconsistent — negative for reported med”: Check detection window, cutoffs, matrix, and adherence to mapping (parent vs. metabolite)
- False “Inconsistent — positive not reported”: Confirm cross‑reactivity or metabolites from other reported meds; proceed to confirmation
- Review validity/adulteration markers; recollect if required
- Missing analytes in panel: Verify test setup and analyzer/interface mappings; confirm panel assignment
With RX Verification, the toxicology workflow not only captures analytical results but also evaluates consistency against reported therapy—helping clinicians interpret adherence, potential diversion, or undisclosed drug exposure accurately and efficiently.