does your lab call elevated cardiac enzymes to the floor?

Published

Specializes in cardiovascular surgical stepdown.

If you have a pt who's cardiac enzymes come back elevated/positive, does your lab call the floor to inform that pt's RN? Where I work, any critical lab values are called to the floor and lab documents who they spoke to about the results. I have always wondered why cardiac enzymes don't get called - so had our charge nurse ask. This is the response from our lab "We only call critical values. Our policy on critical values is approved annually by the medical staff and there has been no interest to date to include cardiac enzymes. Our current policy does not include cardiac enzymes, which is similar to the policies at most labs. Our lab computer system is set up to print abnormal results on the floors which has been our way to communicate these results." So since they say it is the policy at most other labs, just wondered what you all have to say about that...Thanks!

Up Vote Up Vote ×

Nope. If it's not a critical lo/hi, the lab does not call. It's our responsibility to stay on top of checking our labs.

Up Vote Up Vote ×
Specializes in Cardiac Telemetry/PCU, SNF.
Nope. If it's not a critical lo/hi, the lab does not call. It's our responsibility to stay on top of checking our labs.

Yep, that's us too. If a patient is having Q6 enzymes, I'll try to set an alarm on my PDA - doesn't always seem to work out right though.

Now if we could only get our lab to post those results in an expedient manner...

Cheers,

Tom

Up Vote Up Vote ×

Cardiac enzymes that are even slightly elevated have always been called to the floor, no matter which floor at every hospital I've worked in. And they always must be called to a licensed nurse. Your hospital's policy sounds scary to me.

Up Vote Up Vote ×
Specializes in Telemetry, LTC, Psych.

Our lab calls all critical labs to the RN.

Up Vote Up Vote ×
Specializes in Cardiac Telemetry/PCU, SNF.
Cardiac enzymes that are even slightly elevated have always been called to the floor, no matter which floor at every hospital I've worked in. And they always must be called to a licensed nurse. Your hospital's policy sounds scary to me.

I would think that some context would have to be used in order to not inundate the floor RN with information. For example: patient is admitted to the floor with rule-out ACS, negative EKG changes, enzymes normal. Troponin 0.02 pg/ml, but has a history and was in rapid a-fib with RVR (now converted). Patient is in a tele bed, getting q6 hour enzymes. Now should the enzymes bump to 0.03, why should the lab need to call that to the nurse? Especially if there are not corresponding chest pain or other cardiac symptoms? This wouldn't be a critical value. Important to know, yes. But not something that warrants an immediate call to the floor RN.

Granted if the Troponin takes a major jump, say from 0.04 to 1.0, you better believe we'll get a call and we'll be on the horn to the MD. But 9 of 10 times when someone is admitted and getting serial enzymes, you're going to expect a possible elevation in enzymes, comes with the territory.

But that's just my take on it...:twocents:

Cheers,

Tom

Up Vote Up Vote ×
Specializes in Utilization Management.

I wish ours would call an abnormal trop to us. As it is they call only critical highs. That can get pretty annoying when the trops are still high but trending down. Yet we never get that call that they're trending up....KWIM?

Anyhow, I tend to keep an eye on the labs anyway because the ER unit secretary doesn't always put all 3 trops in and then we're scrambling to get a stat set when they finally deliver the patient to the floor.

Up Vote Up Vote ×
Specializes in Case Manager, Home Health.
Cardiac enzymes that are even slightly elevated have always been called to the floor, no matter which floor at every hospital I've worked in. And they always must be called to a licensed nurse. Your hospital's policy sounds scary to me.

Same at our hospital. All critical labs, which include cardiac enzymes, are called to the floor from our lab. We then have 15 minutes to report these to the MD following that pt (I know, we don't always call, it depends if it's the second/third and if it's trending up or down and what the pt's condition is and what the last set of orders were, etc...oh, yeah, and if it's 3:00 am or not...)

How in the world can a busy RN just keep poking into the computer system just to see if the labs have been drawn and when they are completed? This is a design for desaster in my opinion.

Up Vote Up Vote ×

Although I am new to nursing (just graduated and passed my boards) and have not experienced the nursing end of things, I have been a lab tech for 11 years and have worked in a number of labs. I have never worked in a lab that has established critical values for ck/ckmb results, only troponins. The pathologists decide critical values, techs generally don't have any input. While it might be nice to get a call from the lab regarding high ckmb results, the lab is busy running tests and calling an array of other critical labs. If lab people spent all their time on the phone, they would not get any testing done. The lab feels that nursing should be watching their labs on on their critical patients.

Up Vote Up Vote ×
Specializes in Cardiothoracic Transplant Telemetry.
I would think that some context would have to be used in order to not inundate the floor RN with information. For example: patient is admitted to the floor with rule-out ACS, negative EKG changes, enzymes normal. Troponin 0.02 pg/ml, but has a history and was in rapid a-fib with RVR (now converted). Patient is in a tele bed, getting q6 hour enzymes. Now should the enzymes bump to 0.03, why should the lab need to call that to the nurse? Especially if there are not corresponding chest pain or other cardiac symptoms? This wouldn't be a critical value. Important to know, yes. But not something that warrants an immediate call to the floor RN.

Granted if the Troponin takes a major jump, say from 0.04 to 1.0, you better believe we'll get a call and we'll be on the horn to the MD. But 9 of 10 times when someone is admitted and getting serial enzymes, you're going to expect a possible elevation in enzymes, comes with the territory.

But that's just my take on it...:twocents:

Cheers,

Tom

We don't get a call no matter what the numbers are for enzymes. It doesn't matter if they go from .03-.04 or .03-30, the lab doesn't let us know. I have tried to get them to call enzymes by going through our manager, but no luck yet. Another problem is that I swear that the lab is asleep at night. I am so tired of having to call to get results on enzymes that were drawn 2-3 hours ago..... sigh....

Up Vote Up Vote ×
Specializes in Med-Surg.

Only criticals are called, hi/lo's. I'm sure this complies with Joint Commission requirements.

Up Vote Up Vote ×
Specializes in Cardiac Telemetry/PCU, SNF.

OK, after I posted I had a case that trumped previous experience. Lab did call with a major bump, from 0.0 to 0.28, more than anything though, they were making sure the sample was OK, not that it was high. So I guess there is exception to every rule.

Oh yeah, trops topped out around 2.2, guy went to the lab with a 90% occlusion of his RCA, but with the exception of the first episode of chest pain, pain free.

Cheers,

Tom

Up Vote Up Vote ×
+ Join the Discussion