Getting all necessary information for doctor notification

[sweetjen2006]

I always hear the horror stories regarding not having all necessary information when calling doctors on needs. I want feedback on various scenarios regarding what information I would need.

Example: calling about a calcium that is critical in labs

Doctors usually want to know about the current albumin level and creatinine level

[icuRNmaggie, BSN, RN]

The serum calcium is not considered reliable if the albumin is low (pseudohypocalcemia.) You may see orders for an ionized (free) calcium which measures the amount of calcium not attached to blood proteins. It is not uncommon to see a low calcium in fluid overload and chronic illness such as CKD and liver disease. A low calcium would also be expected in a pt receiving multiple transfusions, as there is no calcium in banked blood. Try to relate the critical value to the patient, especially if the pt had parathyroid surgery or has a critical illness.

Assuming your pt is monitored, report any ectopy, know the mag level or ask for one, and assess the pt for muscle weakness, spasms and twitching.

In some facilities, not enough attention is paid to the role of calcium in cardiac function.

Good question.

[Dranger]

Eh in the ICU per protocol we order all electrolyte and kidney function labs. I can order ionized calcium if the albumin and total (not free) calcium are amok and order IV or PO lytes as necessary unless the creatinine is remarkably elevated.

Using SBAR format and having the labs/I/Os/vitals screens up can help a lot. Just think through the situation before you call. With hospitalists it's not usually a problem but when you call a specialist at 3am you better know what you are talking about.

[sweetjen2006]

Thank you! Very helpful