RN's vs LAB

[chaosRN, ASN, RN]

I had a patient the other day - CABG x 3 but had to go back to the OR for a bleed. Upon returning to the unit, the pt was still bleeding some. The MD wanted to give some platelets and draw some bleeding studies. The pts platelet count was within normal limits, but he wanted the platelets anyway. OK, no problem.........I get a phone call from the lab - not the blood bank - the lab - asking me "why do you want to give platelets? The platelet count is within normal limits. Does the doctor know what the count is?" I said yes he knows and that I need them. She proceeded to ask me why - over & over - "Why would you give plts if the count is normal" Keep in mind, this conversation is pulling me away from pt care - fresh post op - on levophed - kind-of sick (coworker watching pt while I was on the phone!!). We kept going back & forth :argue: - After I quickly and as nice as I possibly could at the moment - told her this was a very sick pt - I hung up on her. I had a coworker call the blood bank and got my plts up.

One more situation - when we draw aptts - the lab calls and gives us the out of range result, but always asks if they are on heparin? Do they have to document this somewhere? Why do they ask?

Shouldn't they just give us the out of range levels and be done? We as nurses will call the MD with the abnormals if appropriate.

Has anyone else had the lab question them like this?

[TazziRN, RN]

Yes, if the pt is being anti-coag'd they need to note that on their end.

As for the lab asking about the platelets, I don't blame you for hanging up. I think I would have asked, "Are you refusing to give me the platelets?" If the answer was No, then I would have asked, "Then can we talk about this some other time when I don't have a critical pt?"

[Indy, LPN, LVN]

I don't usually have that kind of problem with lab. I have it with pharmacy sometimes. If they can't get me a NOW drug that I don't happen to have on floor stock in a reasonable amount of time then I call and ask them to call the physician and explain to the MD why they can't send me the patient's meds.

It floors them for me to state "the half life of X infusion is X... if you go over this amount of time and I have to restart the infusion because of it, I will personally call the doctor at 3 am and let him/her know."

But boy oh boy does it work. Now in an emergency once I did get my dopamine before I had even written the order down. So there are some really good people in pharmacy. I don't enjoy having to pull out the attitude - I have enough attitude to spare- but it's effective when I do.

[clee1]

This just floors me!

Why is it that "support" departments (lab, pharmacy, radiology) never seem to know that the PURPOSE of their work is patient care; and that patient care is NOT an INTERRUPTION of their work???

Seems to me that there is way too much questioning, documenting, and butt-covering going on here, and not near enough concern with the most important aspect of the job: the needs of the patient.

[Aneroo, LPN]

I have the same problem with radiology.

"We need a urine pregnancy test done also (for an ultrasound), in case the beta hcg is too low."

Ummmm- if the beta is too low, then the urine sure as heck isn't going to show anything.

That night, the docs called and informed them they needed to do those ultrasounds.

[Tweety, BSN, RN]

I've had nuclear medicine more than once grill as to why I needed to do a lung scan. "Is the patient short of breath"...."does the doctor suspect a p.e., wouldn't a CT Scan be better", "can it wait until Monday?", "do you really need it?".

I always invite them to call the doctor and ask them the questions yourself.

That's what you should have said....."you call the doctor and ask her/him why she/he is transfusing with a normal platelette level and see what they say and then let me know." click

[perfectbluebuildings, BSN, RN]

We most often seem to have the issues with the pharmacy- most are really nice but then some nights they just get, well, hateful- "Well we're SHOWING that we sent that drug up already and you should have it... are you SURE you looked every place you could??" I don't know what happens to meds, I mean it's not like we'd take home IV claforan or something, and I know the pharmacy people are just doing their jobs too... but it gets irritating when they practically refuse to send something up and act like we're idiots or thieves for not having the meds we need. Or say "that should have been done on day shift!!" even though i can't do anything about THAT fact at that point, and whether that was a pharmacy day shift job or nursing day shift job or whatever, who knows?

Whew ok, venting over.

[perfectbluebuildings, BSN, RN]

OK one more thing... Why can't pharmacists deal directly with doctors regarding medication orders that they want clarified, e.g. what strength or some random thing about a med... I mean they have doctorates of pharmacy it seems like they should have that authority, and they can do it like from a doctor's office right? but in the hospital we're always the go-betweens... there must be a reason for that what is it?

[chaosRN, ASN, RN]

I always invite them to call the doctor and ask them the questions yourself.

That's what you should have said....."you call the doctor and ask her/him why she/he is transfusing with a normal platelette level and see what they say and then let me know." click

I will remember that for next time they question me or another nurse!! :monkeydance: Heck, I'll even provide the phone number!!!

[elthia]

We most often seem to have the issues with the pharmacy- most are really nice but then some nights they just get, well, hateful- "Well we're SHOWING that we sent that drug up already and you should have it... are you SURE you looked every place you could??" I don't know what happens to meds, I mean it's not like we'd take home IV claforan or something, and I know the pharmacy people are just doing their jobs too... but it gets irritating when they practically refuse to send something up and act like we're idiots or thieves for not having the meds we need. Or say "that should have been done on day shift!!" even though i can't do anything about THAT fact at that point, and whether that was a pharmacy day shift job or nursing day shift job or whatever, who knows?

Whew ok, venting over.

I had that problem with a pharmacy tech when I worked oncology..."why do you need all those large volume IVF NOW." Well, because I REFUSE to give this pt cisplatin which is nephro toxic until I have his pre and post hydration bags on hand. Never could get the darn tech to realize that ALL 4 or so liters would be in the pt in about 12 hours, so no, they are not going to expire. I just never was comfortable with the thought of having to wait for each bag as it was needed, not with the way that pharmacy worked.

[Loribabble]

Our lab is ok... rarely have issues with them...

Pharmacy is great (slow at times, but good) - they will call the Dr to get the med clarified, changed etc - oftentimes before nursing knows there is even a problem.

My biggest issue is medical stores... I love working with people from other countries etc and learning their cultures but I get soooo aggravated when all he** is breaking loose and I need something yesterday and because of the language barrier they have NO idea what it is I need... after explaining in excruciating detail they will act like they do and send you something completely off the wall. You call the lead tech and they yell at you saying you need to call the floor tech - already did that! There are also a couple that no matter what it is you need - they are conveniently "out". We had a WONDERFUL tech but they moved her to cover a larger floor - very frustrating!

[rnsrgr8t]

When I used to be a Pediatric Oncology nurse, we had a protocol that all children admitted with fever and neutropenia had to have their cultures drawn, IV access obtained and antibiotics infusing within an hour of them walking in the door. We had regular monitoring of this and could get into a lot of trouble if we were not on to pof things. I had this one pharmacist in the middle of the night who was dragging his feet getting my antibiotics ready. It was part of the protocol that they were supposed to stop everything and make these up. I had to call several times, pitch a fit, run over to pharmacy it was a mess. Then, he looked at me dumbfounded when I also asked for the Tylenol to be filled then as well. "you want the Tylenol too?". Well, his admittting diagnosis was FEVER and neutropenia... nah we'll just let the child suffer with a 104 fever. Unbelievable!