Lab communication break down

[PeepnBiscuitsRN]

First of all, as the RN, I will willingly shoulder the blame for whatever could have happened and what did happen. I am not looking to really place blame on anyone anyway. I just think that a little courtesy and communication would have helped.

At my facility, if a patient is having having Heparin run as an IV drip, we draw their HEPUF every 6 hours. Once their HEPUF is therapeutic x 2, it's checked daily in the am. So I came on shift with the understanding that one of my patients had had a therapeutic HEPUF x 2, so I went ahead and put in for the next level to be drawn with the am labs.

The lab staff usually hits our floor between 0530 and 0615. Generally am lab values are about 85-95% complete (resulted) by change of shift. So I generally expect to look in a patient's chart around 0700-0715 and see the am levels there for me to report off to the day shift. Occasionally, if the lab happens to be on our floor for something else, or a patient has a stat lab and it's after 0430 they will draw am labs. Generally the lab tech informs me of this- "hey can we draw the am labs for the guy in 85xx while were here?"

"Sure, knock yourself out." (Unless it's something really specific like a fasting lipid panel and they've not been NPO for the specified amount of time).

So Friday morning I see the lab carts roll onto our floor at about 0550-0600. I've been sitting next to my patient with the Hep drip's room for the last 2-3 hours (*doing my hourly rounding, of course!*) I saw NOBODY go in to draw his HEPUF during that time. Around the time the lab carts showed up, we got busy, so I was off to help another nurse out. I figured it was business as usual. So imagine my horror when I was reporting off to the day nurse and we looked to see what his HEPUF was and it was resulted at 0556, and the rate needed dialing back and it was almost an hour and a half later! (not dramatically dialed back, but still!) Now, in the 5am hour I was parked outside that guy's room, and I didn't see one person go in! Nobody told me "hey I'm drawing Mr. Q's HEPUF now, is that ok?"

I'm embarrassed because something real bad could have resulted from me not knowing that lab had been drawn early. Again, I am responsible for checking for new lab values, I understand, but is it not reasonable to expect that the lab staff drawing would TELL me that they were drawing early? So I don't expect that it would be drawn when the rest of the lab crew arrived an hour or so later?

[KelRN215, BSN, RN]

If it's a daily am lab and not time-specific, I would not necessarily expect the phlebotomist to ask me/tell me prior to drawing labs. Our labs are usually drawn right around change of shift as we do not have 24/7 phlebotomy coverage and phlebotomy arrives around 7. If the slip are in the "phlebotomy draw box", the phlebotomist will assume he/she is to draw the labs. If a parent questions it, they will ask me. If the lab slip is missing from the box, I assume that the phlebotomist has taken it and is drawing the labs. I almost never get told that they've been done, I usually have to ask the patient/parent themselves "did the phlebotomist come in?" Because in many of these cases, the labs are drug levels and the drug cannot be given until the level is drawn so I want to know that they've been drawn, but rarely does the phlebotomist tell me.

If your lab values are significantly off, would your lab not call you to report the result? Our lab does call with "panic" values/values that need to be acted on immediately.

[BluegrassRN]

Maybe I'm missing something, but I don't see the big deal at all. Are you upset because it was drawn a bit early (and if it's a daily lab, I don't consider that early), or were you upset because it was out of the parameters and no one called you? Since it wasn't a critical change, I don't see why they would call you. You were the one who knew you had a pt on a drip that would be possibly need to be titrated, you are the one responsible for looking for the results. I'm not sure where the miscommunication with lab lies at all in this scenario.

Seems like there is nothing to be upset about.

[Perpetual Student]

If 0556 was the time it was drawn I wouldn't sweat it. By the time it was processed and input into the system it likely would've been around 0630. No reasonable person would be expecting you to hover at the computer immediately prior to shift change--you'd obvously be rounding on your patients and getting ready to report off.

Ideally, the lab would call with abnormal values that require intervention. But it apparently wasn't a critical value and in the end what needed to be done got done. It's not like several hours passed or anything.