Abnormal blood results

Silverdragon102, BSN · Jun 30, 2006

Yesterday i alerted the junior medical staff regarding one of my patient's abnormal blood results and ask him to discuss the case with the anaesthetist. I told him that from my past exprience with this sort of things the anaesthetist would like to be informed, but he told that it was not necessary.
This morning pts op was cancelled as she was not fit for the surgery due to the fact her blood results were abnormal and the anaesthetist was not happy.
I informed the consultant in charge and told him that my concerns were raised regarding abnormal results to junior dr but no actions were taken.
The consultant then rang the junior medical staff who now denies that he was alerted in first place.
My argument is that the patient is admitted to the ward, it is medical staff's responsiblities to ensure that the patients are medically fit for the surgery.
I have informed my manager and asked me to complete an incident form.
What do you think?

You did what you had to do and that was discuss concerns with medical staff, the main thing is documentation and that name of medical staff informed was also recorded. I would wonder what was the medical staff doing the day before if not checking that patients are medically fit for the op. Sometimes I would bypass HO and go straight to SHO especially if knowing the results may delay the op as it may have been able to be sorted the day before enabling the op to go ahead as planned. Medical staff can deny and there isn't a lot you can say unless someone else witnessed your conversation with dr concerned.

paris2 · Jun 30, 2006

Thanks

Ok medical staff can deny and there isn't a lot i can say unless someone else witnessed my conversation with dr but my argument is that it is the dr's responsiblities to ensure pts are medically fit for surgery. Why nurses have constantly chasing drs around to ask them to do their job.

cariad · Jul 1, 2006

documentation is the name of the game....as thay say over here, if you didnt write it then you didnt do it !

you could have made a care plan for the abnormal results and documented that you had made the doctor aware, and then when he denied it, you woul be able to produce what you had written with the dat and time by the side of it.

even if something serious was to happen and you were to end up in court then the same applies. everything should be documented.

mabel u.k · Jul 1, 2006

In my role I am attached to a surgical team and work side by side with the junior docs, I am not condoning what this doc has done if you told him the results then he should have acted on them. Yes it is the doctors responsibility to make sure patients are fit for theatre ( and in our case the nurse practitioners) but sometimes the workload these young docs can have is horrendous. I love working alongside my docs and one of the comments was why are nurses always chasing docs, sometimes despite the best intentions if you have really unwell patients the routine stuff gets put on the back burner until you have time, not an excuse but it is reality. At times like these I rely on collaborative working with the ward nurses to keep me informed of the patients who are not unwell - I don't see that as them chasing me or m tema but working collaboratively in the patients best interest. For example, 0ne of our surgical teams yesterday had 45 patients on thier list and things like that may well have been on the list to deal with but didn't get around to it. there was no SHO for the team as she was on nights and the reg was in theatre.

We do pre-operative assessments 1 - 2 weeks before to make sure that this sort of thing doesn't happen.

You need to document communications with docs in the notes especially if it is something as important as that, it covers yourself. Do you have an on call SHO that you could contact if the patients own team don't act on informations that is a system that I have used in the past.

Cancellation of surgery on the day of the operation is extremely distressing for the patient which is why pre-op assessments are so vital in elective surgery. It is realy unfortunate your house officer didn't have the balls to stand up and say I am really sorry I was too busy to chase this up and accept responsibility. Despite that he/she is responsible for check results of tests that he ordered so even though he / she has denied you informing him of the results it was his responsibility anyway so you cannot be held responsible.

There are some really good junior docs out there but unfortunatey as with everything there are some really poor ones too. SOrry yours couldn't have been a little more honest

madwife2002, BSN, RN · Jul 1, 2006

You know in my old hospital, pre op bloods are always done the day before I too think 1-2 weeks is much better it gives more time to cancel ops.

Here in the US is is the nurses responsibilty to look at blood results, as well as the drs-and obviously inform the Dr just in case they missed them. So after hand over or before if you have time, you check you pts lab results. Works well

paris2 · Jul 9, 2006

An update on the incident i had with an abnormal blood results where a junior dr was alerted about and took no action.

Well the dr involved was reprimanded by a consultant and also the letter has gone to all junior drs reminding them to that they must check that all patients are medically fit for the surgery and take appropriate action if required.

Although i know it is a team approach between nurses and drs to ensure patients are adequately prepared for surgery (as we do most of the time), it is drs's responsiblity to ensure that pts are medically fit for surgery (although i know nurses are very proactive in this area then drs anyway).

The area of practice i work in is where pts surgery can take place within a day or two (most of them are urgencies) and therefore promt action must be taken.