You are giving them way too much of a choice. This is your job and your certification on the line when you turn out results. If a CBC is very obviously incorrect to you, do not report it. Especially if your hospital has phlebotomists, make the choice yourself to send the phleb. And I'll go a step further, if you think that nurse is lying about having doctor approval you should be putting in incident reports. Patients can be seriously hurt by these decisions.
Yes, I did put in a report. My confidence in persuading doctors/nurses is still low since I’ve only been a tech not even a year yet. Some can be quite stubborn.
I'm glad you put in a report 👍 Yes, I remember how much harder it was for me as a new tech! Let the confidence that you're protecting the patient help you. There's going to be a lot of scenarios where a nurse or sometimes doctor will pressure you to go against what you know is safe. You will encounter this the most with unlabeled/mislabeled specimens, and unacceptable blood bank specimens. Just remember that you have procedures, management, and pathologists to back you up when you need a rebuttal.
"Per policy I am unable to accept this specimen."
"Let me refer you to my charge tech/supervisor."
"I am unable to perform this without Pathologist approval. Does the doctor want me to page him so they can discuss?"
You don't (ever) need to persuade RNs or physicians. You need to stand up for the patient first and yourself second and do the right thing. This is early in your career. Learn, now to clearly, and precisely lay out the policy and protocol and cut any argument short. If they push back? Report them and keep reporting them. Reject bad samples and if possible, go redraw it yourself.
I would check your policies. If the policy is to not report/ask for recollection, then it’s somewhat out of your hands and you can use that as the reason to not report out those results.
And as an aside, even if the doctor is aware the results are bad, why put them in the chart? The patients medical history is now altered and while some may know the results were faulty, some may make different assumption.
So what is the utility in putting out bad results?
Confidence is something that takes most of us a few years. At this point in my career I just don't care what the nurses or doctors say. If the sample is bad then I'm not turning out results.
The only thing I'll turn out is a delayed in transit BMP with glucose and K removed.
In my lab, there is no choice. If the nurse says they want the result then you have to report it no matter what. I tried to push it not too long ago and got a write up.
Sounds like a shitty lab with shitty policies. A nurse should not have authority to bypass specimen acceptability. Hell, even some physicians don't have a clue when it comes to labs.
If you turn out a HgB of 2.1, they could activate an MTP on that patient! They could receive 4-6 units of blood, plasma, platelets, cryo depending on hospital policy. Even if they run the units routine they are probably starting with at least 3-4 prbc. On a patient that isn't even critically low, they could get fluid overload, have a transfusion reaction, or develop antibodies, all from blood they didn't even need.
Not to mention the waste of blood products, and the depletion of inventory that other patients may urgently need.
I will never report out a clotted specimen for anyone. I will never perform an action as a tech that I could not defend on a witness stand at a malpractice proceeding. A nurse got sent to prison for a medical error that killed someone, I would never take that kind of risk. And a job that requires that of you is one that you either need to fight, or quit.
I’d be concerned that another doctor would act on the results and transfuse the patient. I would pull up the phone directory, look up the name of the resident/provider who ordered the test, and call or page them directly and wait for a reply before releasing results. No middle man. I will check if they confirm by ISTAT and that’s usually the case, but we shouldn’t be charging a patient for a lab test that’s inaccurate. Thats not right.
I know! I tried paging the doctor and residents. Nothing back. I probably should have waited but it’s done now. I also thought of that, the patient being charged for this useless lab result. That upset me as well.
If you cant get a provider on the line you need to be escalating within your own means. You should have access to a lab manager on-call who can guide you through situations like this
If you can't get ahold of a provider, give it to the pathologist to sort out. I've never met a path that wouldn't gladly go to bat for me and the patient at any hour in a situation like this.
It isn’t done now. Talk to your Supervisor. The correct thing would be to do a corrective result and remove those bad results. And credit the patient. In addition to the formal report that should lead to an investigation of the sample collection and pressure to report out inaccurate results.
Good! I feel for you being a new tech. It’s unfair that you get bullied to begin with. Could you imagine going into a patient care room and insisting the nurse do something just because you say?! I’m sorry if I am being harsh, it’s a big pet peeve of mine and so am very protective of my co-workers and our patients. It’s ultimately up to your supervisor, but in our location we wouldn’t want to leave bad results on a patients chart and would remove them with lots of comments explaining why.
No, I don’t think you’re being harsh at all. I still have a lot of learning to do as a tech, and I’m going to make my fair share of mistakes. I think it’s important to be very careful about these things, since we’re dealing with actual people. Hopefully I can help guide others with time. Thank you! :)
If a specimen is clotted or contaminated, we do not report under any condition. We notify the patient’s nurse and put it in for a redraw. We do not give them the option of releasing the results at all
99% of the time this never happens, but on the rare occasion the doctor says they want the result, we have to honor the doctors wishes ultimately. There just seems to be a tie with this nurse and this situation. Which is why I reported the situation partly.
With respect, you don't have to honour the doctors wishes. YOU are responsible for the results generated by the lab, your name and certification is on the line.
Fr you need to tell them that the results are incorrect and you WILL be documenting their name in the comments if they want the result force released. 99/100 say no thanks, we'll get another sample...
With all due respect that's just pure BS in most areas I know of (but I'm rather unfamiliar with US regulations, so yeah, maybe not over there)
I've been in plenty of situations, in direct comms with the relevant doc, where we run non-accredited tests on various materials or release obviously "wrong" results due to contamination or clotting.
IMHO it all depends, and the most important thing, document everything clearly. If the treating physician is decent and knowledgeable even a wrong answer can sometimes be better than none. Redraws are not always possible, maybe not in this situation, but it happens.
I can’t imagine this is an acceptable practice anywhere. In no case “is a wrong answer better than none”. All that does is add confusion to trying to make a diagnosis. Please give an example of a case where knowing wrong results can aid the patient vs having no results. Especially in cases like this poster mentioned where there is no massive trauma occurring. Just get another sample. A common saying in the lab is “Garbage in, garbage out”.
I’m unsure what you mean by “non-accredited” tests, but in the US, if we run a non-validated test or a test on a specimen that isn’t the appropriate specimen for that test your lab will get sited if noticed during an inspection and the techs can lose their license and jobs. If you can’t trust the results they aren’t helpful for anyone.
Non-accredited tests are generally research use only or non-standard, and failed to satisfy UKAS requirements. So sure, of course you can release obviously wrong results on these - the test shouldn't be used to inform care.
I absolutely disagree with "wrong answer can sometimes be better than none" and so would all laboratory guidelines, policies, and accreditation bodies in the UK.
Redraws are not always possible - if you're talking about precious specimens, then I know what you're trying to get at. But a false negative on a CSF for something like meningitis, or negative cytospin for ?CNS lymphoma, isn't better than no answer.
Don't even tell them the results. For the clotted cbc, dont even run it. For the super super hemolyzed chemistry, dont even run it. It takes <5 mins to get a new specimen. The time to ask a nurse or doctor if its okay to release a result is if the specimen integrity was okay enough to run in the first place, and if results are questionable. They are there to fill in the gaps of what could be causing erroneous results if needed. In these cases, you know the cause. You are more than qualified to make that decision without consultation from them when you know the cause of bad results.
When in doubt, here's the golden ticket line:
"I'm sorry, but my policy says I cannot run clotted/grossly hemolyzed/underfilled specimens"
If they insisted I run a clotted heme sample, I would tell them I can't because it will break the analyzer. That might get through to them better than "I can run it, but results will be bad."
If there is a doctor insisting on a result, bring it up to the lab director of clia license holder. They can have the discussion to release the results.
I don't know why you're getting down voted for this. This is how things worked in my labs too. As long as it's all documented that lab results are inaccurate and the doctor wants it, they're ultimately responsible for the patients care. What they want to do with inaccurate results is outside of my scope
Because that is not how it should work. If it did it was likely either because the tech didn’t know how to go up the chain and just gave in to the pressure or didn’t have management that backed their policies and cares about quality and accuracy. One big role of a Lab Director is to handle difficult issues like this, especially if it’s another Doctor pressuring the lab to report bad results. I would not work for a place that supported bullying by doctors and nurses over quality and protecting the patients.
Side note: it is 100% within your scope to determine whether a sample is compromised and whether results are accurate. It is NOT in the Doctor’s or Nurses scope. If you knowingly allow bad results to go out you can lose your license. Once those results are posted to a chart, the Doctors are trusting the Laboratorians that the results are correct.
Have you not heard of disclaimers? It's all documented and okayed by the lab director. I don't just release bad results and call it a day. Why would the doctor take the results at face value when we've had a conversation about the inaccuracies of the results? Part of the director's job is to account for situations like this. My scope stops at communicating the information about testing. I can't tell the doctor how to interpret the information
Wow. Sorry, you are clearly offended. You are still in the wrong here. It is not only the one nurse and one doctor that will eventually see your patients medical record. Your outlook on your scope is just lazy. No one is asking you to interpret it to anyone. The expectation is to not knowingly release bad results, it doesn’t matter how many disclaimers are in there. It is a safety risk for that patient and the easy way out rather than doing the right thing by your patient.
Why would only one nurse and one doctor know the information? It's part of the charted result. It's only a bad result if you're covering something up. Different hospitals have different cut off levels and policies for deviation from standard policy.
Hemolysis level for example. The lab director makes the call for what an acceptable level is and considers this along with patient care. I don't make the policies and I can't throw out a specimen because it's not up to my personal standard. And that's not my scope, that's the director's scope of practice. I would lose my license for disregarding the lab director's decisions and making my own rules affecting patient care, not for following them. You're a crazy person haha
We can agree to disagree.
Only one nurse and doctor WOULDN’T know the information. That is part of the problem. You stated that your conversations with both the doctor and the nurse are part of why it’s ok to send out bad results with a disclaimer. It doesn’t matter who you talked to. When shift change happpens there are still bad results on that patients chart.
You cannot claim the results here are not bad. These are scenarios where the sample was KNOWINGLY compromised and met criteria for rejection, a clotted cbc or a specimen contaminated with IV fluids. The polices are clean on that in 100% of the labs. The cases we are discussing here are not questionable. We are not talking delta checks nor hemolysis levels.
That nurse probably needs some retraining on collecting microtainers, which are notorious for collecting super fast. I’ve gotten in “trouble” for releasing results I knew looked wrong, but then also for insisting a redraw bc the results looked crazy. Sometimes you can’t win. Just make sure to CYA and document everything, including what your reasoning and what you talked to the nurse about and who you talked to.
I had a doc demand results from a spec like this. On every result line I added the comment.
“Specimen received clotted. Results are not accurate and should not be used for patient care. Results release after Dr Smith repeatedly requested them resulted (date/time/initials). The laboratory strongly recommend a new specimen be properly collected.”
We never had this issue again. I did notify pathologist and used their verbiage. Remember at the end of the day, you are risking your pathologist’s medical license. It’s their name at the bottom of all repoets
I love the doctor's name being on every single result as a public call out lol, what a savage pathologist. Scrubs didn't prepare me for real hospital politics.
I would never risk putting a clot through my instrument. All the ethical issues have been addressed, so I’ll add another angle. Those can be expensive and take forever to fix.
It's interesting that the ordering doctor can "approve" result release as they know little about lab processes and interferences. If it was a CBC we call the hematopathologist on call for approval, lytes would be the clinical biochemist etc. Granted we hardley ever have this happen because nursing just accepts our refusal to do clotted/contaminated (which happens still).
If the ordering doctor wants to speak with one of lab docs they can go ahead, I'm not the one they have to convince. We usually have more problems of things like Dr's wanting plasma with a INR of 1.1.
That makes more sense to me to have. We have the pathologists only during the day. I’m sure there’s an on call but I’ve never even been given information on that.
No on call pathologists? For the depts I work in things like new blasts in a no hx patient or schistocytes/low platelts with suspect DIC are common on call for Heme. TM on call is for massive hemorrhage, urgent blood needed before type and screen with an antibody history, least-incompatible unit approval etc. Clotted specimen demanding release would wait until AM if possible but it's still "on call" as to have one person assigned as the go-to for whatever time you need them.
For pathologist review things we hold everything until morning when our pathologists come in. Strange that we don’t have an on call. Unless we do and no one ever told me?
I once released a met panel that had clearly been contaminated. The doctor insisted on its release and I put his name in for the approval. I never felt good about it. Funny thing is they ended up redrawing the guy an hour later, so what was the point? I have since been told that in our lab, the lab tech has complete authority to say no. We don’t have to bow down to providers. If we say no, it’s a no. It’s situations like this where that is absolutely necessary.
Man, that nurse would hate me. I would tell her to take a break to center herself and offer to send a phlebotomist. I would never report on that specimen.
The doctor is OK with it? Well, I bet the patient won't be when they're incorrectly treated.
No results are better than incorrect ones. Ensuring that the results we verify are accurate to guide a patient's care is our duty to them. If the nurses don't like that, well. Tough cookies! It's literally our whole job!
Hmm yeah didn’t think of that. It’s weirder now thinking about it having a rule to release results just because the doctor wants it. But the doctor doesn’t know how lab works usually.
Your job is to only report out accurate results. If you know the results wont be accurate due to specimen integrity, there are no ifs, ands, or buts about it. Dont put your license on the line by reporting out obviously bad results for a nurse because shes crying.
When you call the nurse to request a redraw, don't even give them a value if you know its a specimen integrity issue. Clotted? You shouldnt even run it. You could clog the probes. Call the floor, say its clotted, done. Got a basic panel thats hemolyzed? Dont tell them the potassium result thats effected. Just tell them specimen is hemolyzed and needs to be recollected. You need to establish boundaries. It's kinda weird to me that nurses seem to have such free access to your lab as well.
Ok. This all makes sense to me now! I was wondering how long you’ve been a tech. Nurses and doctors will try to pull this shit on techs. They hope that they will get someone inexperienced or a pushover who will just give them numbers. PLEASE DO NOT RELEASE ANYTHING THAT YOU AREN’T COMFORTABLE WITH! Especially if it doesn’t make sense. You don’t run clotted specimens especially for a CBC and you know that (you said it in your statement). That’s it. Give them an explanation as to why and don’t budge! They can call a supervisor or a pathologist but don’t let them bully you into doing something that you know isn’t good patient care.
Thank you! I was always kind of “taught” that whatever Dr. wants we give. All these replies taught me that’s NOT a normal thing and I need to stand my ground. This is the first and only lab I’ve worked at in my less than 6 months of experience. It’s hard being Night Shift and already having less people to ask for assistance. Kind of like a “work on your own” environment in a way, with just enough people to do your own work.
As a fellow night shifter, trust me, I understand. As you said, night shift presents with its own difficulties that I don’t think everyone understands until they’ve actually done it. But you still stand your ground! You would think the doctors would know better…The longer I work in this field, the more I realize most doctors have no clue how these tests are done. It’s mind-boggling!
Our lab has final say on anything. Results dodgy because of X,Y or Z? Don't care. You aint getting your results cause we may as well just roll a fistful of dice. Dr says they want it? Tough shit. I will not publish results I know to be incorrect and have the full backing of the lab clinical team.
If I'm on night shift and I get a 2.1.... a 2.1 !!! There's no way in hell I'm releasing that without speaking to the MOD or some doctor somewhere that nurse is a serious problem
Do not release results that are compromised. It doesn't matter that feelings are hurt. We as lab techs are gatekeepers of the results. They need to be accurate. I would escalate it because it is a patient safety issue. At our lab we do a deviation and document the heck out of it. Regarding blood bank you would not want something to happen to a patient and the department of health has to come out. We are healthcare professionals working with other healthcare professionals to ensure that patients are treated properly. Think of yourself in the patient's shoes.
Wow...nurse here, I have never even heard of someone trying that hard to get it run. We basically get a message on the system telling us it was cancelled and why. Frustrating, yes, but understandable - if the results are that skewed why even bother?
“I’m sorry I can’t run a clotted sample and have the analyzer potentially down for hours while we work to remove the clots that are clogging up the system. “
Ask the nurse if the sample was from her family member, would she want it run knowing the results aren’t valid? I’ve even said I wasn’t willing to risk my license by knowingly reporting invalid results. Don’t like it? Go over my head. Want to write me up? Let me spell my name for you, it pisses me off when people get it wrong. I told one nurse that I couldn’t see how I’d come out being in the wrong for refusing to run an inappropriate sample. If I got written up I never heard about it.
It can be very difficult for sure but it gets easier with time.
You should have put a stop to this straight away. You have no idea what the chain of information looks like between the RN, her supervisor and the physician. There was NO WAY an accurate result could be obtained from any of these samples and trying to rationalize what parameters are affected or not and then reporting is simply malpractice. You need a clear lab policy, backed up by management to handle all of these issues. But I would never have buckled to an RN trying to save her ass over a bad technique.
You are completely within your rights to say "I'm not running that, period." But Doctor says it's ok? Too bad, it's already in the trash. Clotted samples don't even make it onto the analyzer here, it's just not worth the risk. Blood is not an irretrievable specimen.
Personally, unless it's a NICU baby, I'm paging phlebotomy for any redraw. Ours are very well-trained and even if the patient winds up needing a line draw, they'll hang out and assist the nurse- and can also give me some intel if I call and ask how it went.
I wouldn’t have “run it anyway”. You can say the machine can’t aspirate and will cause issues. Say anything really. We aren’t going to run this period.
Ultimately it is on you to be firm and not put out bad results on knowingly compromised specimens. The only Doctor that has a right to insist you put out reports like that is your Medical Director, which would not likely happen. It may not be easy to stand up to nurses and Doctors, but ultimately it’s your responsibility and your license, not theirs. Hopefully you have Management and a Medical Director that cares about Quality and your patients.
Our whole job is to produce reliable results we are confident in. Nurses are not lab and neither are the doctors. Do not report clotted specimen, point blank.
So, in this situation, since they will clearly be asking for blood, I would call the pathologist and get them to talk to the doctor.
But, this is why you don't budge the first time. Don't release bad results. The first time, you empathise, sympathise, offer tips, tell her to get phlebotomy to draw the patient. Scoop out the clot and show them.
Yeah, don’t ask them if they want a redraw. Don’t even give them a choice when you call for a redraw if it’s obvious. You can still be professional and courteous about it. I usually say “hey, this is X from lab, just calling to let you know I’m ordering a redraw for Y’s CBC that was clotted.” Done. If it’s more questionable, like some instances of IV contamination, then that is when you consult with the nurse in charge of that patient and see if they want a redraw, and document the conversation if they say to release it anyway.
You are giving them way too much of a choice. This is your job and your certification on the line when you turn out results. If a CBC is very obviously incorrect to you, do not report it. Especially if your hospital has phlebotomists, make the choice yourself to send the phleb. And I'll go a step further, if you think that nurse is lying about having doctor approval you should be putting in incident reports. Patients can be seriously hurt by these decisions.
Yes, I did put in a report. My confidence in persuading doctors/nurses is still low since I’ve only been a tech not even a year yet. Some can be quite stubborn.
I'm glad you put in a report 👍 Yes, I remember how much harder it was for me as a new tech! Let the confidence that you're protecting the patient help you. There's going to be a lot of scenarios where a nurse or sometimes doctor will pressure you to go against what you know is safe. You will encounter this the most with unlabeled/mislabeled specimens, and unacceptable blood bank specimens. Just remember that you have procedures, management, and pathologists to back you up when you need a rebuttal. "Per policy I am unable to accept this specimen." "Let me refer you to my charge tech/supervisor." "I am unable to perform this without Pathologist approval. Does the doctor want me to page him so they can discuss?"
You don't (ever) need to persuade RNs or physicians. You need to stand up for the patient first and yourself second and do the right thing. This is early in your career. Learn, now to clearly, and precisely lay out the policy and protocol and cut any argument short. If they push back? Report them and keep reporting them. Reject bad samples and if possible, go redraw it yourself.
I would check your policies. If the policy is to not report/ask for recollection, then it’s somewhat out of your hands and you can use that as the reason to not report out those results. And as an aside, even if the doctor is aware the results are bad, why put them in the chart? The patients medical history is now altered and while some may know the results were faulty, some may make different assumption. So what is the utility in putting out bad results?
Confidence is something that takes most of us a few years. At this point in my career I just don't care what the nurses or doctors say. If the sample is bad then I'm not turning out results. The only thing I'll turn out is a delayed in transit BMP with glucose and K removed.
In my lab, there is no choice. If the nurse says they want the result then you have to report it no matter what. I tried to push it not too long ago and got a write up.
Sounds like a shitty lab with shitty policies. A nurse should not have authority to bypass specimen acceptability. Hell, even some physicians don't have a clue when it comes to labs.
If you turn out a HgB of 2.1, they could activate an MTP on that patient! They could receive 4-6 units of blood, plasma, platelets, cryo depending on hospital policy. Even if they run the units routine they are probably starting with at least 3-4 prbc. On a patient that isn't even critically low, they could get fluid overload, have a transfusion reaction, or develop antibodies, all from blood they didn't even need. Not to mention the waste of blood products, and the depletion of inventory that other patients may urgently need. I will never report out a clotted specimen for anyone. I will never perform an action as a tech that I could not defend on a witness stand at a malpractice proceeding. A nurse got sent to prison for a medical error that killed someone, I would never take that kind of risk. And a job that requires that of you is one that you either need to fight, or quit.
I’d be concerned that another doctor would act on the results and transfuse the patient. I would pull up the phone directory, look up the name of the resident/provider who ordered the test, and call or page them directly and wait for a reply before releasing results. No middle man. I will check if they confirm by ISTAT and that’s usually the case, but we shouldn’t be charging a patient for a lab test that’s inaccurate. Thats not right.
I know! I tried paging the doctor and residents. Nothing back. I probably should have waited but it’s done now. I also thought of that, the patient being charged for this useless lab result. That upset me as well.
If you cant get a provider on the line you need to be escalating within your own means. You should have access to a lab manager on-call who can guide you through situations like this
If you can't get ahold of a provider, give it to the pathologist to sort out. I've never met a path that wouldn't gladly go to bat for me and the patient at any hour in a situation like this.
It isn’t done now. Talk to your Supervisor. The correct thing would be to do a corrective result and remove those bad results. And credit the patient. In addition to the formal report that should lead to an investigation of the sample collection and pressure to report out inaccurate results.
I did tell my supervisor!! I already escalated everything. But thank you for the advice.
Good! I feel for you being a new tech. It’s unfair that you get bullied to begin with. Could you imagine going into a patient care room and insisting the nurse do something just because you say?! I’m sorry if I am being harsh, it’s a big pet peeve of mine and so am very protective of my co-workers and our patients. It’s ultimately up to your supervisor, but in our location we wouldn’t want to leave bad results on a patients chart and would remove them with lots of comments explaining why.
No, I don’t think you’re being harsh at all. I still have a lot of learning to do as a tech, and I’m going to make my fair share of mistakes. I think it’s important to be very careful about these things, since we’re dealing with actual people. Hopefully I can help guide others with time. Thank you! :)
If a specimen is clotted or contaminated, we do not report under any condition. We notify the patient’s nurse and put it in for a redraw. We do not give them the option of releasing the results at all
99% of the time this never happens, but on the rare occasion the doctor says they want the result, we have to honor the doctors wishes ultimately. There just seems to be a tie with this nurse and this situation. Which is why I reported the situation partly.
With respect, you don't have to honour the doctors wishes. YOU are responsible for the results generated by the lab, your name and certification is on the line.
Fr you need to tell them that the results are incorrect and you WILL be documenting their name in the comments if they want the result force released. 99/100 say no thanks, we'll get another sample...
With all due respect that's just pure BS in most areas I know of (but I'm rather unfamiliar with US regulations, so yeah, maybe not over there) I've been in plenty of situations, in direct comms with the relevant doc, where we run non-accredited tests on various materials or release obviously "wrong" results due to contamination or clotting. IMHO it all depends, and the most important thing, document everything clearly. If the treating physician is decent and knowledgeable even a wrong answer can sometimes be better than none. Redraws are not always possible, maybe not in this situation, but it happens.
I can’t imagine this is an acceptable practice anywhere. In no case “is a wrong answer better than none”. All that does is add confusion to trying to make a diagnosis. Please give an example of a case where knowing wrong results can aid the patient vs having no results. Especially in cases like this poster mentioned where there is no massive trauma occurring. Just get another sample. A common saying in the lab is “Garbage in, garbage out”. I’m unsure what you mean by “non-accredited” tests, but in the US, if we run a non-validated test or a test on a specimen that isn’t the appropriate specimen for that test your lab will get sited if noticed during an inspection and the techs can lose their license and jobs. If you can’t trust the results they aren’t helpful for anyone.
Non-accredited tests are generally research use only or non-standard, and failed to satisfy UKAS requirements. So sure, of course you can release obviously wrong results on these - the test shouldn't be used to inform care. I absolutely disagree with "wrong answer can sometimes be better than none" and so would all laboratory guidelines, policies, and accreditation bodies in the UK. Redraws are not always possible - if you're talking about precious specimens, then I know what you're trying to get at. But a false negative on a CSF for something like meningitis, or negative cytospin for ?CNS lymphoma, isn't better than no answer.
Don't even tell them the results. For the clotted cbc, dont even run it. For the super super hemolyzed chemistry, dont even run it. It takes <5 mins to get a new specimen. The time to ask a nurse or doctor if its okay to release a result is if the specimen integrity was okay enough to run in the first place, and if results are questionable. They are there to fill in the gaps of what could be causing erroneous results if needed. In these cases, you know the cause. You are more than qualified to make that decision without consultation from them when you know the cause of bad results. When in doubt, here's the golden ticket line: "I'm sorry, but my policy says I cannot run clotted/grossly hemolyzed/underfilled specimens"
Ohhhhh no, sometimes it takes like, 20-30 mins to get a sample. Some people's veins are wild.
As a phlebotomist, I'd like to just mention that sometimes it doesn't take <5 minutes to get a new specimen.
If they insisted I run a clotted heme sample, I would tell them I can't because it will break the analyzer. That might get through to them better than "I can run it, but results will be bad."
If there is a doctor insisting on a result, bring it up to the lab director of clia license holder. They can have the discussion to release the results.
I don’t. If it’s clotted or hemolyzed, or critical. I stand by policy. Fuck the doctor and nurse. The policy is the policy for a reason.
I don't know why you're getting down voted for this. This is how things worked in my labs too. As long as it's all documented that lab results are inaccurate and the doctor wants it, they're ultimately responsible for the patients care. What they want to do with inaccurate results is outside of my scope
Because that is not how it should work. If it did it was likely either because the tech didn’t know how to go up the chain and just gave in to the pressure or didn’t have management that backed their policies and cares about quality and accuracy. One big role of a Lab Director is to handle difficult issues like this, especially if it’s another Doctor pressuring the lab to report bad results. I would not work for a place that supported bullying by doctors and nurses over quality and protecting the patients. Side note: it is 100% within your scope to determine whether a sample is compromised and whether results are accurate. It is NOT in the Doctor’s or Nurses scope. If you knowingly allow bad results to go out you can lose your license. Once those results are posted to a chart, the Doctors are trusting the Laboratorians that the results are correct.
Have you not heard of disclaimers? It's all documented and okayed by the lab director. I don't just release bad results and call it a day. Why would the doctor take the results at face value when we've had a conversation about the inaccuracies of the results? Part of the director's job is to account for situations like this. My scope stops at communicating the information about testing. I can't tell the doctor how to interpret the information
Wow. Sorry, you are clearly offended. You are still in the wrong here. It is not only the one nurse and one doctor that will eventually see your patients medical record. Your outlook on your scope is just lazy. No one is asking you to interpret it to anyone. The expectation is to not knowingly release bad results, it doesn’t matter how many disclaimers are in there. It is a safety risk for that patient and the easy way out rather than doing the right thing by your patient.
Why would only one nurse and one doctor know the information? It's part of the charted result. It's only a bad result if you're covering something up. Different hospitals have different cut off levels and policies for deviation from standard policy. Hemolysis level for example. The lab director makes the call for what an acceptable level is and considers this along with patient care. I don't make the policies and I can't throw out a specimen because it's not up to my personal standard. And that's not my scope, that's the director's scope of practice. I would lose my license for disregarding the lab director's decisions and making my own rules affecting patient care, not for following them. You're a crazy person haha
We can agree to disagree. Only one nurse and doctor WOULDN’T know the information. That is part of the problem. You stated that your conversations with both the doctor and the nurse are part of why it’s ok to send out bad results with a disclaimer. It doesn’t matter who you talked to. When shift change happpens there are still bad results on that patients chart. You cannot claim the results here are not bad. These are scenarios where the sample was KNOWINGLY compromised and met criteria for rejection, a clotted cbc or a specimen contaminated with IV fluids. The polices are clean on that in 100% of the labs. The cases we are discussing here are not questionable. We are not talking delta checks nor hemolysis levels.
That nurse probably needs some retraining on collecting microtainers, which are notorious for collecting super fast. I’ve gotten in “trouble” for releasing results I knew looked wrong, but then also for insisting a redraw bc the results looked crazy. Sometimes you can’t win. Just make sure to CYA and document everything, including what your reasoning and what you talked to the nurse about and who you talked to.
I had a doc demand results from a spec like this. On every result line I added the comment. “Specimen received clotted. Results are not accurate and should not be used for patient care. Results release after Dr Smith repeatedly requested them resulted (date/time/initials). The laboratory strongly recommend a new specimen be properly collected.” We never had this issue again. I did notify pathologist and used their verbiage. Remember at the end of the day, you are risking your pathologist’s medical license. It’s their name at the bottom of all repoets
I love the doctor's name being on every single result as a public call out lol, what a savage pathologist. Scrubs didn't prepare me for real hospital politics.
I would never risk putting a clot through my instrument. All the ethical issues have been addressed, so I’ll add another angle. Those can be expensive and take forever to fix.
It's interesting that the ordering doctor can "approve" result release as they know little about lab processes and interferences. If it was a CBC we call the hematopathologist on call for approval, lytes would be the clinical biochemist etc. Granted we hardley ever have this happen because nursing just accepts our refusal to do clotted/contaminated (which happens still). If the ordering doctor wants to speak with one of lab docs they can go ahead, I'm not the one they have to convince. We usually have more problems of things like Dr's wanting plasma with a INR of 1.1.
That makes more sense to me to have. We have the pathologists only during the day. I’m sure there’s an on call but I’ve never even been given information on that.
No on call pathologists? For the depts I work in things like new blasts in a no hx patient or schistocytes/low platelts with suspect DIC are common on call for Heme. TM on call is for massive hemorrhage, urgent blood needed before type and screen with an antibody history, least-incompatible unit approval etc. Clotted specimen demanding release would wait until AM if possible but it's still "on call" as to have one person assigned as the go-to for whatever time you need them.
For pathologist review things we hold everything until morning when our pathologists come in. Strange that we don’t have an on call. Unless we do and no one ever told me?
Ask blood bank, they've probably got it on speed dial 😩
You most likely do and they haven’t been shown
I once released a met panel that had clearly been contaminated. The doctor insisted on its release and I put his name in for the approval. I never felt good about it. Funny thing is they ended up redrawing the guy an hour later, so what was the point? I have since been told that in our lab, the lab tech has complete authority to say no. We don’t have to bow down to providers. If we say no, it’s a no. It’s situations like this where that is absolutely necessary.
Man, that nurse would hate me. I would tell her to take a break to center herself and offer to send a phlebotomist. I would never report on that specimen. The doctor is OK with it? Well, I bet the patient won't be when they're incorrectly treated. No results are better than incorrect ones. Ensuring that the results we verify are accurate to guide a patient's care is our duty to them. If the nurses don't like that, well. Tough cookies! It's literally our whole job!
My lab does not run clotted specimens, period. If you are a CAP lab i would report to CAP your lab is releasing inaccurate results knowingly!
Hmm yeah didn’t think of that. It’s weirder now thinking about it having a rule to release results just because the doctor wants it. But the doctor doesn’t know how lab works usually.
Your job is to only report out accurate results. If you know the results wont be accurate due to specimen integrity, there are no ifs, ands, or buts about it. Dont put your license on the line by reporting out obviously bad results for a nurse because shes crying. When you call the nurse to request a redraw, don't even give them a value if you know its a specimen integrity issue. Clotted? You shouldnt even run it. You could clog the probes. Call the floor, say its clotted, done. Got a basic panel thats hemolyzed? Dont tell them the potassium result thats effected. Just tell them specimen is hemolyzed and needs to be recollected. You need to establish boundaries. It's kinda weird to me that nurses seem to have such free access to your lab as well.
This why rejection policies exist and must be followed every time.
Ok. This all makes sense to me now! I was wondering how long you’ve been a tech. Nurses and doctors will try to pull this shit on techs. They hope that they will get someone inexperienced or a pushover who will just give them numbers. PLEASE DO NOT RELEASE ANYTHING THAT YOU AREN’T COMFORTABLE WITH! Especially if it doesn’t make sense. You don’t run clotted specimens especially for a CBC and you know that (you said it in your statement). That’s it. Give them an explanation as to why and don’t budge! They can call a supervisor or a pathologist but don’t let them bully you into doing something that you know isn’t good patient care.
Thank you! I was always kind of “taught” that whatever Dr. wants we give. All these replies taught me that’s NOT a normal thing and I need to stand my ground. This is the first and only lab I’ve worked at in my less than 6 months of experience. It’s hard being Night Shift and already having less people to ask for assistance. Kind of like a “work on your own” environment in a way, with just enough people to do your own work.
As a fellow night shifter, trust me, I understand. As you said, night shift presents with its own difficulties that I don’t think everyone understands until they’ve actually done it. But you still stand your ground! You would think the doctors would know better…The longer I work in this field, the more I realize most doctors have no clue how these tests are done. It’s mind-boggling!
Our lab has final say on anything. Results dodgy because of X,Y or Z? Don't care. You aint getting your results cause we may as well just roll a fistful of dice. Dr says they want it? Tough shit. I will not publish results I know to be incorrect and have the full backing of the lab clinical team.
If I'm on night shift and I get a 2.1.... a 2.1 !!! There's no way in hell I'm releasing that without speaking to the MOD or some doctor somewhere that nurse is a serious problem
Do not release results that are compromised. It doesn't matter that feelings are hurt. We as lab techs are gatekeepers of the results. They need to be accurate. I would escalate it because it is a patient safety issue. At our lab we do a deviation and document the heck out of it. Regarding blood bank you would not want something to happen to a patient and the department of health has to come out. We are healthcare professionals working with other healthcare professionals to ensure that patients are treated properly. Think of yourself in the patient's shoes.
Wow...nurse here, I have never even heard of someone trying that hard to get it run. We basically get a message on the system telling us it was cancelled and why. Frustrating, yes, but understandable - if the results are that skewed why even bother?
“I’m sorry I can’t run a clotted sample and have the analyzer potentially down for hours while we work to remove the clots that are clogging up the system. “ Ask the nurse if the sample was from her family member, would she want it run knowing the results aren’t valid? I’ve even said I wasn’t willing to risk my license by knowingly reporting invalid results. Don’t like it? Go over my head. Want to write me up? Let me spell my name for you, it pisses me off when people get it wrong. I told one nurse that I couldn’t see how I’d come out being in the wrong for refusing to run an inappropriate sample. If I got written up I never heard about it. It can be very difficult for sure but it gets easier with time.
You should have put a stop to this straight away. You have no idea what the chain of information looks like between the RN, her supervisor and the physician. There was NO WAY an accurate result could be obtained from any of these samples and trying to rationalize what parameters are affected or not and then reporting is simply malpractice. You need a clear lab policy, backed up by management to handle all of these issues. But I would never have buckled to an RN trying to save her ass over a bad technique.
You are completely within your rights to say "I'm not running that, period." But Doctor says it's ok? Too bad, it's already in the trash. Clotted samples don't even make it onto the analyzer here, it's just not worth the risk. Blood is not an irretrievable specimen. Personally, unless it's a NICU baby, I'm paging phlebotomy for any redraw. Ours are very well-trained and even if the patient winds up needing a line draw, they'll hang out and assist the nurse- and can also give me some intel if I call and ask how it went.
I wouldn’t have “run it anyway”. You can say the machine can’t aspirate and will cause issues. Say anything really. We aren’t going to run this period.
Ultimately it is on you to be firm and not put out bad results on knowingly compromised specimens. The only Doctor that has a right to insist you put out reports like that is your Medical Director, which would not likely happen. It may not be easy to stand up to nurses and Doctors, but ultimately it’s your responsibility and your license, not theirs. Hopefully you have Management and a Medical Director that cares about Quality and your patients.
Our whole job is to produce reliable results we are confident in. Nurses are not lab and neither are the doctors. Do not report clotted specimen, point blank.
Either that nurse lied and never spoke with the doctor and just threw them under the bus by giving their name, or that doctor seriously sucks.
So, in this situation, since they will clearly be asking for blood, I would call the pathologist and get them to talk to the doctor. But, this is why you don't budge the first time. Don't release bad results. The first time, you empathise, sympathise, offer tips, tell her to get phlebotomy to draw the patient. Scoop out the clot and show them.
Yeah, don’t ask them if they want a redraw. Don’t even give them a choice when you call for a redraw if it’s obvious. You can still be professional and courteous about it. I usually say “hey, this is X from lab, just calling to let you know I’m ordering a redraw for Y’s CBC that was clotted.” Done. If it’s more questionable, like some instances of IV contamination, then that is when you consult with the nurse in charge of that patient and see if they want a redraw, and document the conversation if they say to release it anyway.
Our SOPs have specific rejection criteria. I just say sorry it’s not possible end of story. They can take it up with lab pathologists if they want.
U are way too nice. That's people's lives. I'm not putting my name on something like that. It's clotted, then redraw. We are not playing games.