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RNs giving patient lab results.

Nurses   (4,704 Views 90 Comments)
by Dperez201 Dperez201 (New Member) New Member

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Patient discharged after being hospitalized in ICU for sepsis.  Patient calls RN to find out results of urine and blood cultures.  RN sends the physician an email requesting the he contact the patient to provide the results.  The physician said that I should have given the patient the results myself.  Has anything changed?  I thought RNs can only give results after the doctor has reviewed them?  Please help.

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

504 Posts; 3,751 Profile Views

This tends to vary with practice. I prefer for MD’s to do it, but the reality in the ICU is that patients don’t want to wait the 12 plus hours it often take, and in many cases I have to implement orders based upon lab results (example new antibiotics for a positive blood culture, or a blood transfusion for a low H&H). My line in the sand is something like cancer or HIV.

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3,079 Posts; 44,672 Profile Views

I'm very confused. The patient is discharged home and calls you at work, at the hospital, for lab results from when he was septic in the ICU?  

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PeakRN specializes in Adult and pediatric emergency and critical care.

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This is very facility and even unit dependent. At my old system anyone outside of medical staff (Docs, APRNs, PAs...) were prohibited from giving 'diagnostic results' to patients whether it was labs, imaging results, or whatever else. Nurses and techs got put on action plans for things like telling families that their kid had a broken arm because they were putting on a splint the physician ordered, but hadn't come in the room and actually told the family about the fracture.

In my current hospital policies change a bit by care area, however in the ED we (the charge nurses) review all of the cultures and of they were appropriately treated and if they are positive and require treatment then we consult our doc. On the unit we are trending and interpreting gasses, interpreting TEGs, reviewing hemograms, and all kinds of other labs as we are making changes to the vent, ecmo circuit, ordering blood product, and so on all through the shift (of course based on standing orders from the docs). If I called a doc with every lab change or patient question their is no way they could see all of their patients, let alone probably get out of the room.

If someone who was discharged called I would just check that they didn't have some critical result someone tried to call them with (prompting the family to come back in), but otherwise I would emphasize that we call them for any critical results and that they should reach out to medical records or the online patient portal to see their results.

Edited by PeakRN

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3,079 Posts; 44,672 Profile Views

Your reply is makes sense, but is confusing at the same time 😁. Maybe you or your "boss" should discuss, review, the policies with that doctor, maybe he is confused also.

The "old system" was a little over the top. You couldn't tell parents their child's arm was broken!

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

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There is an old school preference some Docs have to be the gatekeeper of information, although that also directly contradicts my requirement to ensure the patient is kept up to date with their medical information and educated in a timely manner.  I'm willing to give some leeway to Docs when appropriate, but generally they can't negate my professional responsibilities to the patient.

The circumstances certainly come into play, in critical care almost all information about the patient's condition and changes to their condition come from the nurse, it would be wildly inappropriate for me not to share this information as it becomes available.  In the outpatient setting with less time sensitive information, deferring to the doc might be more reasonable.

Edited by MunoRN

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AgentBeast has 6 years experience as a BSN, RN and specializes in Cardiology and ER Nursing.

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Better question is why was a presumed septic patient discharged from an ICU without the blood cultures and urine cultures being resulted?

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Jory has 10 years experience as a MSN, APRN, CNM.

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We have a very strict policy on this at our hospital. 

Nurses don't give out lab results, period.  Just because a physician has reviewed them doesn't mean the RN should interpret them.  

We do have two exceptions:  Bilirubin results (normal only) and blood culture results, but only if clear. 

It just opens up a can of worms.  Something as simple as bilirubin levels coming down/up leads to, "Is my baby going home?  Are they going to start/top the bili lights? It's going up is my baby going to have brain damage?"  Goes on and on. 

Clinics can sometimes work a little differently.  Our nurses can only repeat the labs result (some patients don't have access to their patient portal and will be told to come in if there is going to be an intervention.  But they can't state what is causing an abnormal lab result, etc.

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Jory has 10 years experience as a MSN, APRN, CNM.

1,302 Posts; 11,768 Profile Views

11 hours ago, MunoRN said:

There is an old school preference some Docs have to be the gatekeeper of information, although that also directly contradicts my requirement to ensure the patient is kept up to date with their medical information and educated in a timely manner.  I'm willing to give some leeway to Docs when appropriate, but generally they can't negate my professional responsibilities to the patient.

The circumstances certainly come into play, in critical care almost all information about the patient's condition and changes to their condition come from the nurse, it would be wildly inappropriate for me not to share this information as it becomes available.  In the outpatient setting with less time sensitive information, deferring to the doc might be more reasonable.

I have a real-life example for you:

Patient admitted to the hospital and has a TSH level of 31.  They ask for results and you give it to them.  They ask why is it so high?  What is your answer.  

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3,079 Posts; 44,672 Profile Views

So you wouldn't tell a patient who's been IDDM for many years their Ac 1 level?

How about a patient with a low H & H, the doctor has discussed all the treatments and options, told the patient they'd get 3 units of RBC's and have the H & H rechecked. You'd just hang a 4th unit and not tell the patient what the H & H was?

 

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beekindRN is a ASN, RN and specializes in ICU.

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7 minutes ago, brownbook said:

So you wouldn't tell a patient who's been IDDM for many years their Ac 1 level?

How about a patient with a low H & H, the doctor has discussed all the treatments and options, told the patient they'd get 3 units of RBC's and have the H & H rechecked. You'd just hang a 4th unit and not tell the patient what the H & H was?

 

Yes! Or when I tell them their potassium was low and here's a big horse pill, we'll recheck your lab in a couple hours, etc.

It's my understanding that we can disclose some labs/results (ie. Calcium is low, Hgb finally came up, your WBC is decreasing -- abx seem to be working ) while the patient is a patient. Once they go home, everything goes through medical records.

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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In the ICU the reality is that you often have to discuss lab results with patients (or their proxies) because lab results often involve emergent treatment considerations and the residents are spread throughout the hospital and are often not able to be there for hours.  Before we were a teaching facility there literally were no doctors at nights in the ICU which meant we had to seek all orders by telephone and implement those orders (obviously patients want explanation as to why they are going for CT's, or getting electrolytes replaced or will be taking GoLYTELY all night even though they are pooping bloody diarrhea).  Now I have had friends (travel nurses) who worked at Hopkins and they said it was "a different world" you couldn't turn around without hitting a resident (they/ the residents were even putting foley's and IV's in for them, they actually told me that they worked so much less that they felt like they were stealing from the hospital).  

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