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?

[mattcastens]

Originally posted by 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.

I live in the Twin Cities working both staff at one hospital and agency at a couple of others. We have always sent blood through the tube system and have never had any problems. I don't quite understand what the big deal is. Could someone please explain?

[BackInSchool]

Well, being the pessimist that I always am, I can think of a number of bad scenarios. Where I used to work the tube system became jammed about once a week and would be unusable for hours. Also, anyone could pick up whatever was sent on the other end. The third thing that bothers me about tubes is that things don't always go where they were supposed to. People sent things to the wrong floor or unit or the gremlins in the system did. The last thing that bothers me may be really farfetched, but can you imagine the cleanup if blood or specimens "leaked" while in the tube system?

My facility may have been extremely anal, but our blood procedures were quite involved and very similar to the narcotics procedures. First, only licensed personnel could transport blood. We were required to show our employee picture I.D., sign for blood, and carry it back to the unit in a locked case. The "seal" on the case had to be broken in front of another licensed personnel who went through the rest of the process with you.

I guess that I really believe in that old motto "better safe than sorry" and kinda freaked when I heard of a facility that would send blood through the tubes. It may be SOP but I think it's SNAFU

[P_RN, ADN, RN]

BackInSchool where do you work? The PRMH used the tube system for that . Unless they've come to their senses I assume they still do. You at USC?

[mattcastens]

Originally posted by BackInSchool

Well, being the pessimist that I always am, I can think of a number of bad scenarios. Where I used to work the tube system became jammed about once a week and would be unusable for hours. Also, anyone could pick up whatever was sent on the other end. The third thing that bothers me about tubes is that things don't always go where they were supposed to. People sent things to the wrong floor or unit or the gremlins in the system did. The last thing that bothers me may be really farfetched, but can you imagine the cleanup if blood or specimens "leaked" while in the tube system?

>SNIP

I guess that I really believe in that old motto "better safe than sorry" and kinda freaked when I heard of a facility that would send blood through the tubes. It may be SOP but I think it's SNAFU

Interesting. As I said, we've never had any problems. I guess my theory is that until you do, go with what is most efficient.

[LaurieCRNP2002, MSN, RN, APRN]

I also work at a facility where we use the pneumatic tube system to send blood to the patient care units. The unit of blood usually comes in two plastic bags. We have not had any problems that I am aware of (thankfully). I can understand Backinschool, who expressed a variety of concerns, all of them valid. Especially about the blood leaking. Anyway, that's my $.02 worth :)

Laurie

[hogan4736, BSN, RN]

maybe he was ensuring that you weren't housekeeping...

just playing devils' advocate

[mustangsheba]

This has never happened to me, but I can tell you that holding back lab values unless you provide a diagnosis is not acceptable practice. Unless the lab needs the diagnosis for billing, they have no reason to have this information. In my geographical area, there are signs at every nurses' station stating that unless you are caring for a particular patient, it is a breach of confidentiality to access their information. I assume that goes for all hospital personnel, not just nurses who might actually have a use for it.

[Sleepyeyes]

by mattcastens....he started painting the ceiling

Matt, does that mean what I think it means??? --as in bright red arterial-colored "paint"?

[RNinICU]

In our hospital, it's not the lab so much as the pharmacy that gives us this kind of problem. Many times we have had patients crashing and called down to have them send a stat drip. Most of the pharmacists know we will send the order down as soon as we have a minute to spare, but there are a few who will not send the med until we fax them a written order. This of course takes precious minutes that the patient may not have. We keep some premixed drips on stock, but there are a some, like neo and Levophed that have to be mixed by the pharmacy. Our cardiac surgeon likes to use epical for his patients with low BP, and one pharmacist just has a fit every time we ask for it. We have gone to the head of the pharmacy about this, but he supports these obstinate people, and says they need to cover their practice. Our cardiac surgeon has even spoken to him, but it has done little to change the situation.l

[shay]

Oh, do NOT get me started on the *@#!! LAB!!! Never had one demand a dx for a result, but I guarantee if they had tried that crap w/me, a very nasty, very looooooooooong incident report would have been filed, and my very strong nm would have marched herself down there to rip somebody a new one.

Ugh. I also have the problem w/STUPID lab techs not knowing the meaning of stat. Idiots. My only prayer is that one fine day, these buttheaded lab techs will be pts themselves, in desperate need of the lab's services for some reason or another, and THEY will fall victim to their own practices!! AAAAAAAAARRGGHHH!

I have only had experience with ONE hospital that had a good lab.........ONE. It was at a very large teaching hospital, and I guess these lab techs knew that the pts here were friggin' sick and most likely DYING, so they didn't mess with you...if you said STAT, it meant STAT. If you needed blood, they didn't fiddle fart around with you over how much you could take at a time.

ALL THE OTHER LABS I HAVE DEALT WITH ARE SLOW, BACKWARD, AND SUCK BIG TIME.

[mattcastens]

Originally posted by Sleepyeyes

Matt, does that mean what I think it means??? --as in bright red arterial-colored "paint"?

Yup. That's what it means.

[BadBird, BSN, RN]

I have had the lab ask if the patient had surgery because the count was down but no specifics, sounds like a nosy person to me. Definately write a statement of concern .