So I get a call from the lab..... - page 3

by mindlor | 10,613 Views | 40 Comments

Your pt has a critical high potassium of 4.8.....seriously? Then in the same sentence....your other pt is set for dialysis....tell the dialysis nurse to stop.....their creatinine is 4.1 and dialysis may not be... Read More


  1. 2
    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.
    Peepsaretasty and merlee like this.
  2. 5
    Quote from blondy2061h
    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.
    prinsessa, klone, nrsang97, and 2 others like this.
  3. 2
    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.
    laidback14 and Tina, RN like this.
  4. 2
    Quote from imintrouble
    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.
    blondy2061h and Hygiene Queen like this.
  5. 0
    Our lab faxes results to our office, but half the time they don't actually call us with the criticals. We have to wait for one of the secretaries to pick them up off the fax and call us. Good thing it usually is a critical low white count in a patient that's chronically critically low and not something that we have to actually DO something about.
  6. 4
    I think the initial eye-rolling is calling for a "critical potassium" that is perfectly within normal limits. Something's going on in that lab, whether it's an errant lab tech or a glitchy computer.
    nrsang97, Nascar nurse, morte, and 1 other like this.
  7. 1
    I work oncology so when we get new leukemias we see 100,000+, which is a definite problem. Even giving people growth factor shots to prepare them to collect for stem cell transplant we can see 40-60k. While 25 is definitely a problem, the point of calling critical results is notify you of an immediately life threatening situation.
    psu_213 likes this.
  8. 0
    Quote from DSkelton711
    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.
    The post was about a doctor being called with critical white counts. See my previous post about why our values may be different that for otherwise healthy patients.
  9. 2
    One of the things I really love about our unit is that virtually all the infants as under the care of one neonatology group and they have their own list of critical values. Lab may call for all kinds of "panic" values, but we just given our names and if the value is in our call guidelines then we will notify the MD/NNP. Of course any time the RN is concerned about the infant, they are welcome to share their concerns with the MD/NNP.

    To give an idea of how generous our call guidelines are, our K+ call guidelines are <2.5 or >6.5. Please understand that the vast majority of our blood work is from heelsticks and tends to be hemolysed. I do love it when I send down a heelstick chemistry that I know was difficult to obtain, wasn't sure if the lab would even be able to analyze it then get a call from the lab about the K+. "Your K+ is 8.2 and it's definitely not hemolysed!!" Yeah right, I drew it, I knew it had a good chance of being hemolyzed and the infant is completely asymptomatic (everyone is on a cardiac monitor), I seriously l doubt they would be asymptomatic with a K of >8.

    I don't blame the lab for covering themselves, I know they have standards they have to meet. I could say some pretty hideous things about lab, but I'm sure they could probably say the same things about NICU nurses. We are constantly at odds trying to make them understand how small an 800 gram infant is and what it's total blood volume is and the fact that we can't draw 3mls for a confirmatory whatever on this kid unless they want to send along a bag of PRBCs with the extra lab tubes.
    Luckyyou and merlee like this.
  10. 0
    My first job in a hospital period, was phlebotomy. I do love the lab, but I love for people to have common sense too. Some things we get, some things we need explained, some things we can compromise on. Most things I can handle with a sense of humor. Our policies state that we do one of two things with a critical lab: call it and chart that, or chart why it wasn't necessary to call. So there are a lot of times I don't have to call because things trend down or because there are orders on the chart to handle the result, like electrolyte imbalance or the heparin drip. But since people do the job, there are some who are cool with a quick phone call and some who want to get excited about it. Usually it's 5-6 am and I am kind of busy, less time for chitchat there. I just want to chart this mess and get my stuff done, or I really need to get off the phone and call a doc.


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