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Who is responsible for lab results?

Posted

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

I'm wondering, when doctors order labs, is it their responsibility to follow up on them, or is it nurses' responsibility to read the labs and notify doctors of abnormalities? I thought it would be the doctors since they order them and are supposed to interpret them and treat them, but I've noticed if I don't notify I usually don't get orders or the orders are delayed. I get that we have fewer patients to keep track of than the doctors, but it scares me that if I get really busy and don't see an abnormal lab for a while, the doctor won't see it either. What is everyone's experience with this? Thanks

In my experience, it is primarily the responsibility of the person who ordered the test.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

It's the responsibility of the nurse to notify the ordering entity. The ordering entity will follow up with any new orders needed. 

Ioreth, ADN, RN

Specializes in Ortho-Neuro. Has 2 years experience.

This will likely vary by facility, however in mine:

If there are protocols based on labs, then it is the responsibility of the nurse to make sure the corresponding lab is ordered, read the result, and act on replacement protocol based on the results.

If a critical result is discovered by lab, then they notify the nurse who then notifies the physician. It is then up to the physician whether or not to act upon the critical lab. 

Other labs may be monitored according to unit protocols, such as whether to place a patient on neutropenic precautions.

All other labs it is the responsibility of the physician to monitor the labs. Although not required, the RN watches these too and will alert the physician of anything particularly worrying, but the RN may not act independently upon these labs. Generally if something is a little high or low, we will not bother mentioning it, but if something is particularly high or low, such as H&H or creatinine, then we will bring it up so that it can be acted upon earlier.

Don't get too worried about a few labs being out of whack. People are in the hospital for a reason, and their labs will generally match what is wrong with them. If they just had surgery, their H&H will be low and WBC will be up. I've learned to recognize what is normal for the patient's condition, what needs to be acted on immediately even if it isn't a critical lab, and what can wait until the physician or PA makes rounds. 

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

Critical labs are called to us by the lab and then we have 15 minutes to call the doctor that ordered it.

Other than that it's collaborative.   We get a notification on our charting system when labs have been resulted and we probably get the results before the doctor.  So really there isn't an excuse for us not notifying the MD for things that might need intervention.  But as stated above we need to recognize what's important and what can wait.

That doesn't relieve them of responsibility for checking their own lab results that they ordered.  

Do what's best for the patient.

Edited by Tweety

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Thanks all! I try to stay on top of my labs and notify asap if I see something abnormal. I never have a problem with notifying, I've just been worried about some abnormal labs a pt of mine had at 0200 on nights that I saw when I got there at 0700 (blood sugar 63, lactic 9, pH low, etc). Labs were signed off by night MD that pt was put on D5LR and labs chronically abnormal due to stage 4 gastric cancer.

I made another post about it, but pt coded later and I was left wondering if I should have discussed the labs with day MD before she went for a procedure, or at least re-checked blood sugar or something. I think she was just really sick, but I keep thinking about it. ahh being a nurse is so stressful. This happened 10 weeks ago and still bugging me. I hate to feel like I missed anything. 

Been there,done that, ASN, RN

Has 33 years experience.

1 hour ago, LibraNurse27 said:

Thanks all! I try to stay on top of my labs and notify asap if I see something abnormal. I never have a problem with notifying, I've just been worried about some abnormal labs a pt of mine had at 0200 on nights that I saw when I got there at 0700 (blood sugar 63, lactic 9, pH low, etc). Labs were signed off by night MD that pt was put on D5LR and labs chronically abnormal due to stage 4 gastric cancer.

I made another post about it, but pt coded later and I was left wondering if I should have discussed the labs with day MD before she went for a procedure, or at least re-checked blood sugar or something. I think she was just really sick, but I keep thinking about it. ahh being a nurse is so stressful. This happened 10 weeks ago and still bugging me. I hate to feel like I missed anything. 

No Libra, you didn't miss anything. That was not a code, that was the time the patient died.  Many patients will pass  around the the time you  cared for them. It was just their time to  go. You must stop beating yourself up when a patient passes. 

Peace to you.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

3 hours ago, LibraNurse27 said:

Thanks all! I try to stay on top of my labs and notify asap if I see something abnormal. I never have a problem with notifying, I've just been worried about some abnormal labs a pt of mine had at 0200 on nights that I saw when I got there at 0700 (blood sugar 63, lactic 9, pH low, etc). Labs were signed off by night MD that pt was put on D5LR and labs chronically abnormal due to stage 4 gastric cancer.

I made another post about it, but pt coded later and I was left wondering if I should have discussed the labs with day MD before she went for a procedure, or at least re-checked blood sugar or something. I think she was just really sick, but I keep thinking about it. ahh being a nurse is so stressful. This happened 10 weeks ago and still bugging me. I hate to feel like I missed anything. 

A patient with stage 4 stomach cancer and a lactate of 9 is actively dying, rechecking a blood sugar or double checking that the MD saw the labs won't cure stage 4 stomach cancer and won't even just alter the timing of the inevitable.  There's no reason for you to feel guilty about the fact that all lives end eventually even despite our best efforts.  

macawake, MSN

Has 13 years experience.

4 hours ago, LibraNurse27 said:

Thanks all! I try to stay on top of my labs and notify asap if I see something abnormal. I never have a problem with notifying, I've just been worried about some abnormal labs a pt of mine had at 0200 on nights that I saw when I got there at 0700 (blood sugar 63, lactic 9, pH low, etc). Labs were signed off by night MD that pt was put on D5LR and labs chronically abnormal due to stage 4 gastric cancer.

I made another post about it, but pt coded later and I was left wondering if I should have discussed the labs with day MD before she went for a procedure, or at least re-checked blood sugar or something. I think she was just really sick, but I keep thinking about it. ahh being a nurse is so stressful. This happened 10 weeks ago and still bugging me. I hate to feel like I missed anything. 

You sound like a conscientious person. I think it’s good to always reflect on how we practice nursing. Analyzing situations and our actions, identifying areas that need improvement and learning from mistakes we make, makes us better at the job we do. But there can be a fine line between productive analysis and introspection which is a good thing, and disproportionate and unwarranted self-blame which most definitely is not.

Please take both Muno’s and Been there, done that’s posts to heart! Your patient’s death is not on you. 

Take care! 

LibraNurse27, BSN, RN

Specializes in Community Health, Med/Surg, ICU Stepdown. Has 8 years experience.

Thanks all! It was a dramatic code in interventional radiology and I really wish the pt had agreed to DNR and not went for a PEG tube placement, but that' a different part of the story! Thank you all for your reassurance and knowledge