Whyyyyy? Rant from a Lab Tech

[raianne]

Hi! I am not a nurse yet. I start an accelerated BSN program in August. I have been a lab tech for five years. I read urines and run the machines that do coags and blood gases and chemistry panels and all that fun stuff. After college, I lived with two roommates who were nurses, and before I became a lab tech, they would always come home from work and talk trash about the lab. It was helpful to me to be able to talk to them when I got this job, because I feel like there's a lot of miscommunication between the nurses and lab techs, and it's nice to talk to someone on the other side. Anyway, here's my rant of the night.

When we have a critical value on a patient, or a value that seems suspicious, we call the nurse. They have to accept the value before we enter it in the computer. Once they accept the value, give us their last name and we end the call, that value is getting entered in the computer and we are not allowed to take it out. I can not tell you how many times I've called a nurse, gave them the value, asked them if they accepted it, gotten their name, and entered the value in the computer only to get a call back in the next five minutes saying it was wrong and asking if we can take it out. We can't!!!! That's why we're calling in the first place!!!! Whyyyy does this happen?

Tonight I had a critical vanco trough on a patient. A lot of times, when that happens, the patient actually has vanco running when the trough is drawn, so I called the nurse to check. I told her the value and said that it was really high for a trough and asked if the patient had vanco running. She started freaking out about how nobody told her the patient had a trough drawn and asked when it was drawn. I said 2040. She said now she was going to have to call the doctor and she can't believe no one told her he had a trough done. I said, "so you're accepting it?" She said yes and gave me her last name. I hung up, entered the value, and five minutes later I get a call back. "Did you just call me about a vanco trough? What time was that drawn?" "2040" (I already told her that the first time.) "Oh, that patient has had vanco running since 2000. Can you take it out of the computer?" "No, I can't, I'm sorry." "Ok fine bye" (in a cranky voice.)

I know that she probably had fifty million things to do and this value was the least of her worries, but this happens so often that it just gets annoying. I needed to vent. Thanks for listening!

[caeRn]

Sorry about your situation, but i think its great you are on another side of healthcare before entering nursing. Its always good to be able to put yourself in the other persons shoes. I have heard nurses get mad at tech on phone when it is critical lab as if it is the labs fault. ridiculous!

[Coffee Nurse, BSN, RN]

Just have to say -- who draws a vanco trough when the med is running??

[Kim O'Therapy, BSN, RN]

You did nothing wrong. If the lab calls me about a critical value, there is NO choice if it is entered or not, the lab enters it into the system. Where I work, by policy, the lab documents all lab values, calls the nurse with any critical values and I call the doctor and document that I called the doctor. I simply would have stopped the Vanco and called the doctor. Having said that, as a nurse, I don't hang Vanco until I check for any possible orders regarding a trough/bag# order. If I think a critical lab value called into me by the lab technician may be inaccurate d/t dilution (not wasting the initial draw from a central line, etc.) or concentration (drawing while Vanco is running), I STILL notify the doctor and get an order to redraw. Let's say that I made a mistake and had hung the bag without checking labs first. OK, I will probably get a slap on the hand or maybe written up, or worse. However, it is not the lab technician's job to cover up my mistake by removing the critical value from the computer. Just my opinion.

[Ahhphoey]

Kim O said:

You did nothing wrong. If the lab calls me about a critical value there is NO choice if it is entered or not, the lab enters it into the system. Where I work, by policy, the lab documents all lab values, calls the nurse with any critical values and I call the doctor and document that I called the doctor. I simply would have stopped the Vanco and called the doctor. Having said that, as a nurse, I don't hang Vanco until I check for any possible orders regarding a trough/bag# order. If I think a critical lab value called into me by the lab technician may be inaccurate d/t dilution (not wasting the initial draw from a central line, etc.) or concentration (drawing while Vanco is running), I STILL notify the doctor and get an order to redraw. Let's say that I made a mistake and had hung the bag without checking labs first. OK, I will probably get a slap on the hand or maybe written up, or worse. However, it is not the lab technician's job to cover up my mistake by removing the critical value from the computer. Just my opinion.

Yeah, we don't have the choice of whether or not the lab gets entered either. It's gonna get entered regardless. We also get a call for critical labs, document it and call the doctor if the lab is not already covered by some protocol.

[pennyaline]

Just have to say -- who draws a vanco trough when the med is running??

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.

[Kooky Korky, BSN, RN]

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.

I don't agree. If they know they need to draw a vanc trough level, they are intelligent enough to be trained to look for themselves at what's infusing or ask the nurse "Is that vancomycin infusing" and come back later. A quick conference with the nurse should clear it all up, anyway.

[Jokerhill]

I don't agree. If they know they need to draw a vanc trough level, they are intelligent enough to be trained to look for themselves at what's infusing or ask the nurse "Is that vancomycin infusing" and come back later. A quick conference with the nurse should clear it all up, anyway.

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 your get upset with them, it is more work for them (most of the time they know you screwed up the collection, but with out proof they can only report what the 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.

[cherrybreeze, ADN, RN]

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.

[Ruby Vee, BSN]

just have to say -- who draws a vanco trough when the med is running??

i'm thinking the lab drew it without checking with the nurse first.

[Ruby Vee, BSN]

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.

i just want to know how you get the lab to come and draw your tests within a window that narrow!

vent accepted and noted. i've heard myself on the phone with the lab more than once saying something stupid like "so why are you calling me with this hemoglobin of 7.9? the last one was 6.5 and this is a definite improvement! you'd think the lab would take a look at the trends before calling a "panic level." but it's not their job to look at the trends. it's mine. and it's mine to notify the provider.

although in my previous job, i'm sure the coag lab had a dart board with various excuses taped to it: "tube wasn't full," "specimen clotted", "specimen not recieved", etc. that they would "consult" rather than running the test.

[wrigh146]

First, at my facility we have lab, RN, and pharmacy that work together to ensure patient safety, which is the REAL issue here. Lab Techs are absolutely responsible for being aware of meds infusing that could alter lab results. If they are late in drawing a timed draw, they need to make the RN aware. Also, I have gotten many PTT results that were not accurate because lab drew from the arm the heparin was running in. Instead of placing blame we all have to work together to ensure accuracy or we may as well not waste our time.