Clinical Judgment and Lab Values
Many times before a treatment session I will speak with the RN and discuss if the patient is appropriate for skilled therapy. Literally 99 percent of the time, the RN will say "Oh yes, please go get the patient out of bed." Occasionally a nurse will ask to hold the pt due to uncontrolled pain, fatigue, or unstable vital signs.
The problem occurs when I look at the chart and see a glucose of 345, or a hemoglobin/hematocrit reading of 7.1/23 percent. Prothrombin time of 45 seconds.
There is a fine line of discussing these cases respectfully with nurses or other health care providers without subtracting from their role as caregivers. When I explain the patient is not appropriate for PT, many will respond with "If I can walk him to the bathroom, you can work with him from therapy." Many nurses believe it is their responsibility to determine what impact lab values have on other treatments and have a difficult time accepting our opposing clinical judgment.
It's always a compromise to say "I don't feel comfortable treating a patient with this current status. Let me have my supervisor speak with you if you have any further questions."
Educating our co-caregivers on risks of activity and importance of recovering from medical complications before strenuous activity is an important part of our job. Have you ever dealt with this? Where do you draw the line of acceptable lab values for a pt to work with therapy?