Nurses are often go-betweens for doctors and lab techs, speaking for either. For the laboratory, it usually doesn’t matter if the nurse represents the doctor (“He wants a STAT potassium on the patient in 12”), but is the reverse true?
Recently, for example, a physician ordered a direct bilirubin that our chemistry analyzer reported with a hemolysis flag even though the specimen was clearly not hemolyzed. This is likely a technical issue with new methodology, something that can be time-consuming to resolve. And usually there isn’t enough sample on a newborn for confirmatory referral testing.
In this case, is the lab better served by explaining to the nurse, the doctor, or both? Is it profitable to try to explain the nature of the error -- some of which is guesswork -- and risk looking incompetent? Most nurses and doctors have no idea what happens in a laboratory.
There are a few possible approaches:
- “The sample is unacceptable and needs to be recollected.”
- “The instrument can’t analyze this sample without an error, and we are looking into this.”
- “We haven’t resolved a method issue, but until we do we’ll send it to our reference lab.”
- “Let me call a pathologist for you to talk with.”
Experience has taught me that most nurses and doctors don’t believe us when we say a sample can’t be analyzed unless it’s clotted, hemolyzed, QNS, etc. (It’s just pushing buttons, right?) Even with hemolysis, some physicians still want the numbers to “interpret.” Our professional credibility is at risk when we suggest something that they might believe is patently untrue.
Our best approach when an analysis error occurs is to avoid explaining details. Avoid making the nurse represent our profession. Tell the doctor option 3 or option 4 above, both of which present action to resolve the issue.
So long as the doctor gets the numbers, the patient is treated. And it’s our job to give the numbers, not explain why we can’t.
NEXT: Lab Order Sets