Bilirubin level: What would you do?

  1. I'm fairly new to taking care of babies, so sometimes I'm still not sure of myself. I took care of a baby last night, it was his last night with us, so I was getting his PKU screen and did a bili because he was a little jaundiced. The results came back at 14.2, but at the time of the test the baby was 62 hours old (c-section mom, staying 3 days). According to our chart in the nursery that's still in the "watch infant, repeat if necessary stage". And I also drew the lab around midnight, so it was 1:30am when I got the results. I decided that there was no need to notifiy the MD at the time of the day with those results. When I gave report in the morning, the nurse I gave report to said things that made me really doubt this decision to not report it. Would you have called the MD for this? I've been poking around tonight online to try to find more references regarding phototherapy and bili levels, and the only thing I've found states that for an infant 49-72 hours, start phototherapy at 15 and above. So I feel like I made the right choice to not call, but I'm still doubtful. Help?
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  2. 13 Comments

  3. by   prmenrs
    I would not have called a doc @ 1:30 w/that result unless the baby was symptomatic-lethargy, poor feeding. In that case, I would have had an RN from the NICU check the baby--it might have to go to NICU, anyway.

    That is not a critical level @ that age, which you discovered when you checked--good work!! You could have pointed out that you checked [whatever] resource, indicating you didn't just blow it off.
  4. by   lovemyjob
    Would anything different be done if you notified the Dr? Not likely. The doc may want a followup in the AM, but he/she can write for that when he comes in. You followed your hospital protocol for starting/not starting Bili lights.

    I think you made a sound nursing judgement, IMO. It is important to stand by your decision. Use your best judgement and stand by it. If someone doesnt agree, it doesnt matter. They werent there, it wasnt their call. It was you and the info you had at that time and you made a decision based on that. It is so easy to let others make you doubt yourself. If you had doone something wrong, that would be a different story. But you didnt, so...
  5. by   rnin02
    Thank you both! I had felt confident of my decision, but this one nurse has a way of making you feel stupid and incompetent, I absolutely hate giving her report. She had me doubting myself, and I needed some reassurance. Thanks so much!
  6. by   ABQLNDRN
    I agree with the previous replies. You made the right choice. Sounds like the other nurse may be somewhat insecure in her own decision-making abilities. You followed protocol and refrained from calling the doc about something that was not life-threatening.
  7. by   wooh
    I recently came off nights. I'm having to adjust to calling the MD more often. There are things that I will call now during the day, I'd have never called during the night. Some things the MD needs to know, but the on-call MD doesn't need to be bothered with. Some dayshift nurses don't know the difference. You did good!!
  8. by   SmilingBluEyes
    Oh my it's so tough to make these calls on the night shift. But I agree with the others, you handled it the way I would have. Always, too, bounce these things off w/your coworkers. Sometimes, this helps, and you all come to a consensus as to the right action to take. This is especially critical on nightshift where so little support and resources are at hand. I think you did well.
  9. by   ElvishDNP
    I wouldn't have called it unless there were other reasons to do so, as prmenrs said. 14.2 total is high but not critical at >48hrs as long as kiddo's output & behavior are appropriate. Would I make sure the doc knew about it? Yes. Would I call him/her @0130 to do so? Nah.
  10. by   JaneyW
    Remeber, too, that there will always be someone who thinks you didn't do what you should have. On some units, it is the same person everytime. Other units have people who have their "areas" where it is their way or the highway. You will become thicker skinned and more sure of yourself, but the comments will still bother you. You made the right call.
  11. by   ElvishDNP
    Sometimes I think (please correct me if I'm wrong, dayshifters) that it feels like to some folks that it's something else to worry with when your day is already going to be crazy. Like I said, not everyone, but I feel that those who complain, that's what I understand their gripe to be.

    The same way I'm not going to call an MD about an H/H of 10/30 at 0430 if they had a c/s the day before. I'll place it in a conspicuous spot and/or catch them as they start rounds if they get there before I leave. But I'm not going to call someone about a nonurgent result if it's the middle of the night.

    If you do that long enough, docs will eventually realize that when you DO call it's something worth calling about and they will take you seriously. Most will, anyway. Good job.
  12. by   33-weeker
    One thing you could do to avoid that scenario entirely is to wait until later in the am to draw the lab. We usually draw our labs at night between 4-5 am, that way by the time the results come back, it's not a horrible hour to call if we need to. Sometimes as a nurse, you have to think about the position you put yourself in by doing things at certain times, etc., before you do them. If you can wait and do something with better timing for all involved, without going against policy or harming the pt., then do it.

    I do agree with the others that I would not have called that result at 1:30am.
  13. by   rnin02
    Quote from 33-weeker
    One thing you could do to avoid that scenario entirely is to wait until later in the am to draw the lab. We usually draw our labs at night between 4-5 am, that way by the time the results come back, it's not a horrible hour to call if we need to. Sometimes as a nurse, you have to think about the position you put yourself in by doing things at certain times, etc., before you do them. If you can wait and do something with better timing for all involved, without going against policy or harming the pt., then do it.

    I do agree with the others that I would not have called that result at 1:30am.
    Normally I draw my labs starting at about 5 on, that night seemed a little chaotic and I was afraid if I didn't do it when I had the baby for assessment I wouldn't have time to do it later. Thanks for all the advice!
  14. by   33-weeker
    If you are unsure about borderline results, you can always call it just before going off shift, also. (I've even waited until giving report and offered to my replacement, "would you like me to call this to the doc before I leave?") This way you make sure the doc gets notified at a nicer hour and don't leave it for days (unless they agree it can wait) - goodness knows the first few hours of their shift is usually organized chaos!

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