How do you monitor labs at your facility??

CapeCodMermaid, RN · Oct 21, 2005

We have a lab book on each unit which is divided by month and then by day. When the lab slip is filled out, it is filed under the day the lab is to be drawn, and we write the lab tests on a master sheet at the front of each month. The lab tech is supposed to initial each line when they draw the labs.

Then when the results come back, we either fax them or call them in to the docs. We write on the sheet when we do this and then again if we get a new order, we write "see new order" or "MD aware, no orders" and then file it in the patient's chart. We got cited one year at survey for a lab that wasn't reported to the MD in a timely manner, so we are ever vigilant about reporting them. Last year we finally convinced our medical director to use the Coumadin protocol. Really cuts down on calls to the docs. All the ortho's use it around here so it's pretty universal.

Nascar nurse, ASN, RN · Oct 22, 2005

Sorry to butt in, but CapeCod.. what exactly is your coumadin protocol? Can you spell this out. Thanks

CoffeeRTC, BSN, RN · Oct 22, 2005

I'm curious too about the Coumadin Protocol. Is it like a standing order? We're not allowed to have those.

We need a better system too,but this is working for us.

When we get the order, it goes into the appointment book. 11-7 checks it nightly and will fill out the req form, they will draw the lab in the am.

The lab faxes over the results a few hrs latter on 7-3. That nurse should fax results to the doc asap. I used to put a call in to the doc's office to let them know about the labs being faxed. We also write..faxed to doc date and time on it. we used to have a stamper for this.

Wait a few hrs or so for the doc to call back. If they haven't called back by the end of office hrs....I make a few calls.

After speaking with doc, we note that we got orders or not on the lab. Also should be placed on report and of course a nurses note.

When I worked days I would always try to take care of the labs before the end of the shift. If I knew they were done, I always keep and eye on the fax machine too. Sometimes the doc with fax orders back on the labs we have faxed to them.

Nurse_Pauline · Oct 22, 2005

Id be intrested in hearing how the Coumadin protocol works too. We use coumadin flow sheets and that helps us manage the inrs.

hipab4hands · Oct 22, 2005

I am a manager of a unit that i just took over and i need a method for following up and making sure the md's are notified about the labs etc. In our facility, our PT/INR's have to be called to the MD they cannot be faxed. we have a lab stamp we put on the labs once the labs are either faxed to the md or called to the md. but i am finding 1st of all labs not being completed when they should and my biggest issue is whether the physician knows about the labs. I have a MD Fax book but it isn't effective and I need a good method but who will follow up to make sure the labs are done!! HELP thanks in advance :)

Our patient's have a case manager that is supposed to monitor the labs, notify MD's and contact pt.s' when thier coumadin needs to be adjusted. It's not a perfect system and sometimes patients fall through the cracks, but all in all it works.

CapeCodMermaid, RN · Oct 22, 2005

The Coumadin Protocol we use is pretty simple. The paper is set up like a flow sheet with the protocol at the top and the spaces for the information at the bottom. Since it's Saturday and I'm at home I don't have one in front of me, but basically...

You start with an INR, we usually start with the last known one from the hospital and the dose of Coumadin they were on there.

If the next INR is between 2-3, the dose stays the same and we draw again the next lab day. If the dose is 3, decrease by a mg, and redraw. If > 4, hold for one day, decrease by a mg....etc etc. It's all spelled out on the paper. Two nurses have to check the numbers and sign off. If the dose stays the same for 2 draws then we go to weekly. I'd be happy to fax all y'all a copy if you send me your fax numbers. And, believe me, it's much simpler to use than to read about!

Chel · Oct 23, 2005

Our lab draws are done twice a week, unless it's stat. The lab book is broke down by month, with a register for the name, test, date to be drawn, and which doc ordered it. The lab tech initials when the lab is drawn. Critical values are called to us as soon as the lab runs the test, and we page the doc. Non-critical results are usually faxed to us starting around four or five pm. I page the doctor for some labs (pt/inr, dig levels, anything that's really out of whack) and get new orders. I write on the faxed copy what the new order is, the date and time received, and my initials. The rest I fax to the offices and note the date and time on those as well. They get clipped together and passed to dayturn, so they can note the new orders when they call the doc the next day. The order is written on the copy, and it goes in a binder for "white labs". When the signed copies get bacl the midnight nurse highlights the test in the register and files it in the pt chart.

Daytonite, BSN, RN · Oct 23, 2005

We kept a log of all lab tests that were ordered. Everytime an order for a lab was taken off a chart a requisition was filled out and it was also logged. This log was kept in a slim 3-ring notebook at the desk. The lab reqs that needed drawing were placed in the very front. When a lab was drawn the phlebotomist was supposed to leave a copy of the requisition in there for us so we would know it was drawn. The log had columns to check off that a lab had been drawn, the lab results received and the doctor notified. It was the night shift nurses' job to check this notebook daily and look for the fax'd lab reports on what had been drawn that day and make sure it was noted on the TARs which is where we also listed them. The night nurse was also able to call the lab during the night (lab was open all night) to check on labwork that looked like it might not have been drawn. We would often just fax the lab results we got over the fax from the lab to the doctor's office and then mark the date, time and signature of the nurse faxing it and then file it in the patient's chart.

angel0672 · Nov 15, 2005

Could you please send me a copy of this protocol.

Thank you.

anniev · Mar 22, 2006

Our Medical director gives a list of lab values that he wants called on or faxed during office hours on.Usually call if inr 3 if a Dr other then Medical Director, sometimes gives us their values if not we go by Medical directors orders.of coorifice during off shifts labs come in you would page DR. With our regular lab days we try to get them faxed for review during office hours ,this is written on corner of lab with time date and initialed, Dr paged NON 3-21-06 0900 tlc. Dr faxed 3-21-06 0900 tlc or WNL 3-21-06 tlc (this is placed on chart ,not faxed) all of these are filed on chart and Dr signs off on next rounds which most of our residents have our Medical director and he is there q week and his CNP comes in q week and also does rounds. Other residents that do not use Medical director their Dr's come in monthly to sign off orders and do rounds .They also use same and sign all labs on review. This seems to be pretty black and white . some times this is even written on tar so when you sign for lab you are aware that if a certain level comes in that Dr wants to be paged or just faxed..Weights are the same it will be written notify Dr if + or - 3# so when you write in weight if it is up or down you know when to call.

punkinjones · Mar 24, 2006

I would be interested in seeing the protocol. My fax number is 919-231-6045. Attention:Ellen would be fine.

Thanks