So I get a call from the lab.....

CDEWannaBe · Nov 13, 2012

Had that happen to me once... I've had type 1 diabetes since age 4 and use an insulin pump and have reasonable blood sugars. But using insulin, highs and lows happen.

After a normal check up there was a major delay in the lab and it took over 2 hrs. to get blood drawn. It was over my lunch hour and I knew my blood sugar was dropping and had turned off my insulin pump an hour earlier to mitigate, but my glucose tablets were in the car and I was worried if I left I'd be put on the bottom of the list. After labs I went to my car, ate a few glucose tablets and waited until BS came up to 80, then went back to my busy day.

About 4 hours later I got a call from my doctor's office... my blood sugar was 55 and I needed to treat it STAT! The PA was so nice but was clueless my low BS from hours earlier was no longer a problem. She kept telling me I needed to treat it or she would call EMS. I finally told her I'd drink some juice and hung up...

sapphire18 · Nov 13, 2012

Imagine how the doctors feel, with tons more patients than us: "Hi Dr. Grumpy, sorry to wake you up, but Mr. Smith in bed 10 has a white count of 22. Yesterday? 25...28 the day before that... Yes, I know it's trending down but I still have to call you..."

We get audited and any critical values must be reported to the physician within an hour of receiving them...there are some guidelines in place where expected out-of-whack results don't need to be called in certain situations, thank god. But a lot of time you're still just bothering the MD because protocol says so, even if common sense says otherwise.

SwansonRN · Nov 13, 2012

Hate getting calls from the lab. Wish they'd call with good news for once. "That patient whose lytes you've been repleting all night has a potassium of 4.1 and and a mag of 2.0, well done :)"

Indy, LPN, LVN · Nov 13, 2012

What I love is that I can enter a comment when I request the lab in the computer. So for a PTT, I might write "heparin drip" and hope they read that. And I turn my drips OFF for about a minute or five then do my draws if it's a line, make sure there is a waste and all that jazz. And still get somebody incredibly excited on the phone an hour later. No I'm not gonna call the doc you goof. I'm gonna follow my orders, thanks.

Or the metabolic panel that I write "dialysis patient" on and I get all sorts of yammering chitchat over a potassium and a creatinine. Yeah. Look that's what dialysis is for, they will fix this crap in about two hours. The doc knows it's like that or there wouldn't be dialysis orders on the chart. I'm gonna stop writing comments, no one reads them.

blondy2061h, MSN, RN · Nov 13, 2012

Imagine how the doctors feel, with tons more patients than us: "Hi Dr. Grumpy, sorry to wake you up, but Mr. Smith in bed 10 has a white count of 22. Yesterday? 25...28 the day before that... Yes, I know it's trending down but I still have to call you..."
We get audited and any critical values must be reported to the physician within an hour of receiving them...there are some guidelines in place where expected out-of-whack results don't need to be called in certain situations, thank god. But a lot of time you're still just bothering the MD because protocol says so, even if common sense says otherwise.

You guys consider a white count in the 20s critical? Ours aren't critical until 100.

sapphire18 · Nov 13, 2012

Hate getting calls from the lab. Wish they'd call with good news for once. "That patient whose lytes you've been repleting all night has a potassium of 4.1 and and a mag of 2.0, well done :)"

Hahaha, that would be awesome!

sapphire18 · Nov 13, 2012

You guys consider a white count in the 20s critical? Ours aren't critical until 100.

Hey, I don't make the rules, I just work there! Lol. But yes...a white count above like 25 is a problem...have never seen one above maybe 40. Maximum.

martymoose, BSN, RN · Nov 13, 2012

i always chuckle at the " mr blabla has a panic level troponin of 0.29 . am i supposed to start running around screaming and panic- ing? lol

meandragonbrett · Nov 13, 2012

Ours aren't Critical Values they are "Panic Values" *eye roll*

Also, our lab notifies the ordering provider of these panic values not the bedside RN. Not sure how that goes over on the phone.

DSkelton711 · Nov 14, 2012

You guys consider a white count in the 20s critical? Ours aren't critical until 100.

Nobody called it critical, they were making a point about some orders. Your labs critical is 100? That seems excessive to me. If I'm hitting 40 someone better be letting someone know about it ASAP. :)

imintrouble, BSN, RN · Nov 14, 2012

I'm not sure why all the eye rolling over lab calling results. They have protocols just like us. I'll bet they hate to call the floor over a result that is trending down, just like we hate to call the MD for the same reason.

I've never had one to interpret results for me, but I don't think I'd ridicule them for it even if they did.

I wonder if the lab feels small when we make fun of them? I know I do, when I have to call a critical BUN and creatinine on a dialysis pt to a nephrologist. Then have him yell at me because "Don't you know they're on dialysis?"

We all just do what we have to do.

sapphire18 · Nov 14, 2012

I'm not sure why all the eye rolling over lab calling results. They have protocols just like us. I'll bet they hate to call the floor over a result that is trending down, just like we hate to call the MD for the same reason.
I've never had one to interpret results for me, but I don't think I'd ridicule them for it even if they did.
I wonder if the lab feels small when we make fun of them? I know I do, when I have to call a critical BUN and creatinine on a dialysis pt to a nephrologist. Then have him yell at me because "Don't you know they're on dialysis?"
We all just do what we have to do.

I don't mind getting the calls- I understand it's protocol and I am glad to be notified right away of any crazy results. It's the calling the MD part that I don't like, when I KNOW there is nothing to be done about it. I hate having to wake them up for these calls, I know how hard it can be for them to get sleep. It would make more sense to me if the lab could just call the MD themselves- take out the middle man- the nurse. I most likely can't do anything about it without an order anyways! Of course with the exception of PRN lytes or transfusions, which I am forever grateful for.

Seems like they should have some protocols in place where you work to not have to call certain expected critical labs on dialysis patients, too.