Being notified of elevated troponin....

[Blondie Nurse]

I'm not a CCU nurse, but i work on a Tele floor that is transitioning to a PCU....(pulmonary and cardiac).....

My concern is that we brag about being a Level III CP center and have all these algorthyms...yet our lab does not have the ability to be warned of Critical Values of elevated troponins! Currently they can get "panic values" for K+ below 2.8 and the lab will notify the nurse of this value so that it may be dealt with in a faster time. But when we have an elevated troponin and need to be alerted, we simply have to be vigilant about checking our labs when they come up. This is the first hospital that i've worked in that doesn't notify the nurse of even a slightly elevated troponin. The other day the floor was going crazy w/ admits and a troponin was elevated to 16.....lab did not call the floor to notify the nurse of the elevated troponin and when the nurse was finally able to check her labs in the computer, she ofcourse had a "oh crap" moment when she saw the labs.......

I've worked in many hospitals as an agency nurse or as a staff nurse, this is the first that doesn't have a "critical value" limit set on troponins. Many of our obs patients are CP workups...

Anyone have articles or suggestions on how i should approach this topic and present my case to the Housewide Practice Council (a group of ppl that meet monthly to discuss hospital wide needs and processes....each floor/dept has a representative)...I want to work on getting this changed for faster response to our MI's....but not sure how to approach it...

thanks :)

Brandi

[getoverit, BSN, RN, EMT-P]

Wow. Yeah, your lab needs some policy change.

There are plenty of articles about early detection and intervention on MIs. If you google it, you'll get about a million hits.

I'd just present it as "time is muscle", there shouldn't be anyone on your Practice Council who doesn't understand that. The pathology department (or whoever sets parameters for abnormal lab values) can just make a policy that troponin above xx will have a lab personnel call and speak with the patient's nurse directly to inform them. That's what we do for every critical lab value, I get calls from the lab all the time.

Not informing of something that significant identifies a serious need for change. In fact, some of the lab techs decided that they weren't going to be bothered by calling the nurse....so we got the policy changed...now they have to call the doctor.

[armyicurn]

Is that so called lab certified? I know there is a commission that oversees all labs...sort of like the joint commission. The name escapes me at the moment

[rn-jane]

Would talk with the cardiologist or whoever is your chief medical officer about the problem. Maybe if they holler enough the lab manager will sit up and understand why its so important. Don't direct it to the techs or lab people you need to talk with the boss.

[GreentigerRN]

You should have access to a database of journal articles that will prove the necessity of rapid notification of elevated trops. We have issues as well, the lab will notify the nurse if the first trop is >0.1 but >0.5 is considered critical. So if the first trop in the ER is >0.1 we don't get a call on the floor if the second trop is 10. Can I get a WHAT?

[Patchouli]

same problem at my hospital. as a matter of fact, the same thing happened to me with a patient. busy as heck, lab late putting in values when checked. then sometime later put in cardiac enzymes. by the time i checked them it was later, and of course, troponins were elevated!

[Sugah Britches]

Timely reporting of critical labs and tests is a Joint Commission requirement for the National Patient Safety Goals... sounds like someone needs to evaluate and rewrite a P&P...