Laboratory Professionals Member Community

I totally agree that the results that were given to the nurse should not have been held because the nurse questioned the results. It's presumptive of the nurse to not trust the laboratory procedures. Maintenance and QC are done around the clock and critical results are always repeated to ensure results are corresponding and repeatable. The nurse made an error in judgement asking you to *hold the result until she called the doctor *. Her responsibility was to call the doctor with the given result.

I'm surprised the nurse asked you hold the result. Normally for me to do is checking out the history of patient's staying period and compare the previous and current results, if they are same, shouldn't be made any discrepancies but still have to report as abnormal results anyway. Unless if they weren't same results, then I'd suggest the nurse to redraw and run the same results are confirmed. The reason is two beds in a room perhaps, the blood draw from wrong patients that causes discrepancy. (This case I often seen during my lab work.)

Actually, the laboratories have all SOP policies to follow the standard institute for hospital, or any local that are running the blood tests with if any discrepancies or off the charts. The SOP will instruct to procedure if this is the case. Hope that will relieve your concerns.

I have worked in labs at two large NYC hospitals, where the policy is to release critical values (CVs) in the LIS first, then immediately notify the appropriate LIP. This ensures the result is in the patient's EMR for timely care. I am surprised your lab lacks an SOP for handling CVs, as this is an important aspect of the lab. While providers may question results, releasing CVs ASAP is critical. If an issue is identified later, a corrected report can always be issued.

I don't work in chemistry but if the patient never had a high result like that, I would wonder if the specimen was drawn from the wrong person.  If it was the only time he was drawn, then I would call the nurse or doctor and report the result to them first then send it out by the system with a flag.

I am curious what other people say.

Thanks 

.Marie 

HI Diverah - Did this patient had a previous BUN done and if yes, didn't you had delta check rules built in the instrument around sudden lab values changes? If it would have been first result, then I would still call the result as critical and do further review based on provider's feedback. I would bring to your leadership attention and investigate if it could have been drawn from a different patient and also document in daily logs of the things you or your team have done (like QC, instrument maintenance etc.) to justify the accuracy of results. 

Thanks,

Sachin Gupta

Hi Diverah, just wondering – were the BUN results verified before notification of the staff nurse? 

Also, you noted that you didn't have a procedure for handling critical values.  CLIA, TJC, CAP all address requirements for reporting of critical values – and you should also check any applicable state and local regulations re: reporting critical values.   

This article that is a little dated, but may be helpful giving you some insight on these issues. 

https://pmc.ncbi.nlm.nih.gov/articles/PMC7065418/#S6

Best, Carolyn.

Hello Diverah,

Grace and peace to you. 

BUN is not frequently included on critical value lists. BUN is useful in evaluating renal disease and nutritional status.

Most common cause on increased serum BUN is congestive heart failure. 

Critical/Panic values are defined as values that are outside the normal range to a degree that may constitute an immediate health risk to the individual or require immediate action on the part of the ordering physician.

Update your Critical Value Lists. 

God bless you.

Hi, Diverah,

A couple things about critical results. First,...in my lab, BUN is not generally considered a critical result. However, that wasn't your question.

I would presume that your lab indeed does have an SOP for communicating critical results. But that does not take into account when an RN or client gives you the ol', "I'll call the doctor and get back to you." After informing the RN that your instrument is functioning within normal parameters, I would agree with the majority here, that the result should have been posted with appropriate internal and external documentation. Critical results need to be reported promptly, which includes posting the result to the patient's chart. I've learned not to necessarily distrust when an RN tells me that they will get right back to me, rather that I appreciate that they can get quite busy and may have many more patients that they care for at present; they may not be able to follow through as quickly as they may say. So it is considered good lab practice to post the result and include appropriate external documentation of the critical call, and detailed internal documentation of the conversation.

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Christopher Koster Technolgst/Scientst, non-supervisor(eg CT,MLS,MT)
Woodland Hills CA
(323)314-7670
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Hi,

Just like others have contributed and your supervisor, too, you didn't delay the patient's result in any way. To avoid going through such unnecessary stress again, you can ask your supervisor or your manager to prepare the SOP for phoning out critical results. Providing you followed what the SOP says, you should not entertain any fear or concern about delaying a patient's result. Ideally, once you have phoned out the result, collected the RN's name and documented what transpired in your LIMS, you validate the result. Your job is done. In my Trust here in the UK, the audit trail in our LIMS will show the name of the test, name of the receiver and the time you phoned out the result. In some cases the staff at the receiving end might be busy to take the call. You also don't have to worry because there is a code for that, ENG (engaged). If no one answered the call, there is a code for that, too. If the receiver does not want to take the result, there is also a code for that. In fact, no one in my Trust would contemplate no taking a critical result let alone doing it. If it happens that you phoned out a wrong result, an incident would be raised against you.

In summary, follow all your quality guidelines/protocols such as making sure your IQCs passed before analysing or releasing patients' results be it critical or normal. If your laboratory does not have SOP for validating or phoning critical results, it does not speak good of quality assurance or QMS implementation.