zofran 5,059 Views
Joined: May 6, '09;
Posts: 105 (66% Liked)
; Likes: 369
I am a med lab scientist, and if I come across a value that is incompatible with life I get it recollected to verify and don't report the first result. I let the nurse know what is going on so he/she is in the loop and is prepared for the call if the result verifies as being critical.
Also, when a lab scientist calls a critical result even if the patient is improving, it is because they are mandated to do so by the rules or their lab/hospital. The hospital where I work demanded this because a doctor was not notified by the nurse of a critical result and the doctor himself didn't notice the critical until the THIRD time it was reported! I know that a CO2 that is high on a COPD patient is expected and we all roll our eyes at having to call the seventeenth such result, but it's something we grit our teeth and bear along with other insults to our intelligence. I have heard people say we in the lab are not being paid to think, even though we were extensively trained to think (bachelors degree) and are QA specialists.
The lab scientist is supposed to check the validity of results and supposed to do look-backs constantly (at least I do) to see what a patient has been running before reporting. The belief that a lab scientist is a brainless button masher is no more true than the belief that a nurse is a butt wiper. It's insulting, arrogant and ignorant to think like that about any profession.
Get to know your good lab scientists and be nice to them; they can be your best resource and actually help make a nurse's job easier if they will let us. That's what we're here to do. That's what I want to do.
The nurse should know not to start the dose when they do not knowing the trough level! If it is important enough to order the test, it is important enough to check the value. If it was not important it would not be done. The Lab person should not have to check to see that the nurse is doing their job correctly, as the vancomycin should not be infusing before the trough results are known.
As for the results being recorded all I can say is **** in, **** out. The lab can only report out the results on the specimen they were given, they cant make results up and they can't disregard a potentially critical value. The lab tech does not want to stop and call you the result and have you get upset with them, it is more work for them (most of the time they know you screwed up the collection, but without proof they can only report what they have, as you may given the wrong dose or double dosed the patient, or in this case already started the med) they don't have this information they are not on the floor with the patient.
I dont have any issues with the lab...but dont get me started on the pharmacy. Pharmacists--love em, always answering my questions. Getting my antiseizure med six hours late after three med requests and three phone calls--dont love so much.
I don't mean to pick apart a vent, so I apologize for that, but I do have a couple of questions (maybe they'll help in the future?).
I know you may not know the answers to some of these, but...why was the trough drawn THAT long after the med went up? If it were, say, 10 minutes, I can understand that, since there is a 30 minute window for meds, and a 2000 dose can go up at 1930, for example. Where I work, troughs are scheduled (I believe) 15 minutes before the dose is scheduled to be given, so using that scenario (again, just an example):
Vanco is scheduled for 2000
Trough is ordered for 1945
Nurse hangs med at 1930
Trough drawn 15 minutes in to med infusion
The nurse SHOULD be aware of when the trough is scheduled for. It's common knowledge that troughs are drawn on that med in general, usually on the 3rd or 4th dose, and every x number of doses afterwards. I don't know how every facility provides the nurse with their info for the shift, but where I work, on our profiles, there is a heading for lab work, so it would not be hard to find. IMO, if someone is on Vanco, you make it a point to find out when the next trough is due, to know if it coincides with the dose you have to give. Conversely, our lab staff will usually give us a heads up when they're going to be drawing a trough, since they know a med might go up a little sooner than the scheduled time. In your scenario, it's the 40 minute window that really stumps me. Either the trough was drawn very late, or the med was hung really early. Or whoever scheduled it in the first place made an error (or, someone rescheduled the administration time, without changing the corrseponding lab draw times).
Anyway. Sorry to overanalyze (I tend to do that). Regardless of the situation, that nurse's reaction wasn't appropriate, and you should not have been asked to remove the value from the computer (I can't believe anyone would ask that about ANY lab value!). Even if they think a result is erroneous, it is what it is, and then steps need to be taken to fix it...whether it's, inform the doc and schedule another trough with the next dose, in a case like this, or whatever. No nurse, I don't think, can have the authority to say to remove a lab result...which, I take it, would be basically "discarding" it, and making it like it never existed. Not ok.
If someone from the lab comes and draws the trough, that person wouldn't necessarily know that Vancomycin was running. It's not up to them to know what meds are up.
Just have to say -- who draws a vanco trough when the med is running??
Think of it as job security.
All the technological advancements, all the miracles of modern medicine, all the scientific innovation. And ultimately we can't save people from themselves.
The pt will stop having BMs when a stool sample is ordered!
In my research on graduate nurses I came across this cutsie poem, thought I'd share the laugh!
is this a joke? i will be getting the same thing i get for the rest of the year~ nothing other than my usual paycheck.
OMG Why is that a harmless question posted can irate so many people? Did I ever say anything about isolating this pt? You don't even know about this pt's coughing spells. Please think about why you guys assumed that I wanted to isolate this pt. Why did you assume that this pt had no problem covering mouth? People just love to pounce on others in the same industry because it gives them a false sense of pride. Nurses are one of the worst I realize. BTW, many of you so knowledgeable about MRSA yet none of you ever quoted what CDC said. Hmmm. So, I guess those of you, who were quick to criticize me, know more than the CDC and the MD who ordered the culture?
I am not irated (sic), lol. I am amused. You are being awfully (over) reactionary about this and no one understands why.
Manufactured drama, or a complete lack of understanding of MRSA, or both.
On the plus side, you can find tons of information on the internet; on the negative side, a lot of it is crap.
The "article" you cite is from a company called MRSAid, which sells an unproven "cure" for MRSA colonization. Given their vested interest in encouraging the development of an extreme form of MRSA Common Wisdom, I'd hardly consider them a reliable source.
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