Excuse Me??

[mattcastens]

OK, who's heard of this one.

I was taking care of a woman s/p ORIF of the hip. In ICU for cardiac monitoring (needs a new pacer generator). Hgb post-op = 9, which is down from 13 two days ago.

The lab calls me and says that "Her Hgb is down significantly -- what did she have done?"

I responded, "What's the value?"

"I can't tell you that until you tell me what she had done."

EXCUSE ME???

This is an agency assignment. I've worked in several hospitals and never had lab refuse to give me a value; nor have I ever had them inquire as to my patient's condition. Aparently, this is fairly common at this hospital.

I was not in a happy place (and in a bit of a hurry) so I simply told him and got the result.

Thoughts?

[WriteStuff]

Gross negligence if you ask me!!

I would have asked to speak to the Lab Supervisor on duty at the time and request that the Lab's Policy that drives this kind of response, be read to me over the phone!

[TracyB,RN, RN]

Sounds like a nosy lab tech. I bet the pt was a neighbor or someone he knew. How did you not jump through the phone?!?!?

[fiestynurse]

I have never had a lab person ask me about a patient's diagnosis when giving me a critical lab value. They report the value to me and ask me my name to cover their butts and thats that.

[mattcastens]

Well, I'm glad I'm not alone in my anger. Next time I'll remind them that if they want to know more about my patient, they can go to school to become a nurse or doctor.

Here's another one:

I was recovering a post-CAB & sternectomy with an open chest.(the guy was in bad shape). One of his grafts blew and he started painting the ceiling. We called OR and the surgeon (of course), but in the meantime we were pouring in the crystaloids and had the Level I infuser to push the blood products. (For those who don't know, it is an infuser that warms the fluid and has such high pressure that you can infuse a liter of fluid in just about one minute.) We sent down for STAT O-Negative blood (many pints worth) and got a call from the blood bank:

"We can only send you one unit of blood per IV access."

My charge's response: "Send up the damn blood -- we can transfuse it faster than you can get it up here."

"I'm sorry, that's not our policy."

We ended up having the largest nurse we could find (a man about 6'2") to run down to the lab and litterally rip the blood out of the tech's hands.

What were they thinking??? do they not know the meaning of STAT? Do they not know that in a CVICU when we ask for blood, we need blood?? We are a Level I trauma center ... Do they talk that way to the ED when they have a multi-trauma??

We talked to the surgeon about the problem and he went to spank some bare lab-supervisor bottom. We still have the occasional problem, but they've gotten better.

BTW, they guy totally survived and came to visit us in the unit a couple of months later.

[wrkoutgirl]

Originally posted by mattcastens

Well, I'm glad I'm not alone in my anger. Next time I'll remind them that if they want to know more about my patient, they can go to school to become a nurse or doctor.

Here's another one:

I was recovering a post-CAB & sternectomy with an open chest.(the guy was in bad shape). One of his grafts blew and he started painting the ceiling. We called OR and the surgeon (of course), but in the meantime we were pouring in the crystaloids and had the Level I infuser to push the blood products. (For those who don't know, it is an infuser that warms the fluid and has such high pressure that you can infuse a liter of fluid in just about one minute.) We sent down for STAT O-Negative blood (many pints worth) and got a call from the blood bank:

"We can only send you one unit of blood per IV access."

My charge's response: "Send up the damn blood -- we can transfuse it faster than you can get it up here."

"I'm sorry, that's not our policy."

hi mattcastens! This is so interesting! Could you explain a little more about that infuser? I've only been a nurse for a few months, but I always thought that when you infuse fluids too fast the pt could go on shock from bp increasing so fast. How is this prevented when you give blood so fast? What kind of unit do you work at? Sounds like a great place for learning and becomint very experienced. I work in a cardiac unit with CHF pts. Some pts' hearts have an ejection fraction is reduced to 15% or so. They are on heavy continuous drips (literally life sustaining) and waiting for a heart. I have not seen one yet but sometimes we get pts on the LVAD. I will have an in-service on this device this week. I am excited.

About the situation with the lab we get a little attitude from them when they come to the unit, as if they are doing us a favor and they hate life. Unfortunately, we also get this from the nurses assistants to the point that some of us do things our selves to avoid their answer as I am busy now, well, you can do it too. I know we could but this is when we are so busy and we are just asking for little things from them. They disappear from the unit constantly, do no answer call bells, and ignore our paging. It is hard to work when you don't get teamwork and there is so much politics. Isn't it? :o monica

[Huganurse]

If the lab is billing the insurance for the lab services, then they need the diagnosis to bill the payor source. Maybe that is why the lab person needed to know. That lab person may not be allowed to run tests without the diagnosis. Perhaps they ran it without and was nervous about it afterward since they are responsible for obtaining all the information. Sometimes I have seen that it is not in the main database like it is supposed to be or the system is not accessable at the time.

I am beginning to see a pattern on these boards of nursing issues that are related to the payor sources and reimbursement. Maybe if the hospitals and outside services educated the nurses on the big picture there would be less resentment between departments. ???? Just a thought.

[RNKitty]

Nice point of view Huganurse. One I definitely hadn't thought about.

[armyrn]

I worked as a lab tech while going through nursing school so I have a little perspective on this. Huganurse is right that if lab is responsible for the patient/insurance being billed for labs, then lab tech need the diagnosis to be on the lab slip. I speak from experience that LOTS of nurses forget to write this or don't think it's important or any of the lab's business. Sometimes we would just "make them up" based on other information, but we were told we couldn't do that anymore and we would have access to a computer system so we could easily check patient diagnoses. this would take about a month and in the meantime we would be fired if we "made up" any more diagnoses. We had to use all kinds of tricks to get the diagnosis from the nurses. That said, it was TOTALLY out of line for the technician to refuse to release lab values.

[P_RN, ADN, RN]

Is there some kind of a Reader's Digest cheat sheet that all these folks get their scripts from?

The SAME thing started at our hospital about 3 years ago.

Oh but *FIRST* you would answer the phone and they would say "Please spell your name...." yeah like I would tell them 'til I found out why. Not "hello/kiss my ____ but SPELL YOUR NAME...."

SECOND, it would be "This is the lab, we have an H&H on _____"

It is significantly CHANGED...(not LOW/not HIGH but CHANGED) "

THIRD......."have they had surgery or something?"

I think there must be a conspiracy of lab techs vs. nurses out there.......this way they cover themselves CALLING....

to WHOM....

give VALUE and

document that the nurse understood it was CHANGED!

We had finally convinced them that they shouldn't be giving labs to just anyone, because sometimes the teenage volunteers would answer the phone.....so this is how they got back at us.

Capice?

[psnurse]

Matt, in response to your question about the lab and the ED.... YES!!! Getting O neg in the ED is a pain too. There is a form that has to be signed before the blood is released by the doctor no less, stating that he realizes the blood we are about to give has not been cross matched. Then a nurse has to pick it up and go through this whole drawn out procedure to actually obtain the blood. And the lab will only release 2 units at a time. So someone has to be the designated blood runner on those occassions.

They also inquire about patients' conditions when reporting critical results. It is maddening!!

[P_RN, ADN, RN]

Speaking of designated blood runners......

I have wondered has anyone but me had experience with the blood bank sending blood through the pneumatic tube system????

They had started that right before I left. You would fill out a request slip and tube it to them. They in turn would issue the blood and ship it back by way of the tube. When the blood arrived, you would sign the slip and tube it back.....I guess it saved steps but it always bothered me that the tube system was used......

Well, also we did send specimens to the lab in the tube too. Red carriers were used.....but STILL!

[BackInSchool]

Just where were you working that sent blood through the tubes?

I'm very curious because I too am a USC grad and have never heard of that here in Columbia, SC. Surely the facility would be infamous.