Critical Values - January 2009 - (Page 20) Volume 2 • Issue 1 • January 2009 At one time, the laboratory did not have what most people would consider a good working relationship with the ED, or with any other nursing department for that matter. Nevertheless, the relationship with the ED was by far the most strained. Constant problems ranged from complaints about prolonged turnaround times to rejected nurse collections. Although many issues troubling both nursing and the laboratory could be resolved easily, no initiative had been undertaken to address them. Attending the ED staff meeting seemed to be the most effective way to start the process. The laboratory director was surprised, to say the least, that anyone would volunteer for such a colossal challenge; nonetheless, she agreed that it was necessary. Emergency nurses are, simply by the nature of their profession, very to-the-point, matter-of-fact, “don’t mess with me, I’m here to get the job done” people. Thus the ED nurses were very hesitant to have a laboratory employee attend their staff meeting. Even before anything was said, they were grimacing like they were about to have a root canal. After introductions, one of the first items discussed was the role of medical technologists and their educational background. Then creating a liaison to the laboratory and the benefits for the ED were discussed. The ED nurses were assured that this process was not for reprimands or lectures, but instead a means for taking any concerns to the laboratory and helping address them. Previously, if a nurse identified a problem, he or she would speak to the ED Clinical Coordinator, who would pass the information on to the ED Director, who would then speak to the Laboratory Director, who would pass it on to a Laboratory Clinical Coordinator, who would then determine who could address the situation, unless he or she needed further clarification on the issue, which would take even more time. With the new liaison process, an ED nurse can directly approach the liaison with a concern. Depending on the severity of the issue, the liaison can either address it immediately or pass it on to the appropriate person. ED nurses were told to contact their liaison via phone or e-mail or even to visit the laboratory if they preferred, at any time, for any concern. Suddenly ED nurses and laboratory staff became partners in health care. The suggestions, questions, and comments began to surge in. “What number are we supposed to call to talk to a technician?” “How long should it take for someone to come draw labs?” “Why won’t the laboratory accept a specimen I collected at the patient’s bedside but labeled at the nurses’ station?” “I think we need blood culture bottles stored in the ED.” “We need the laboratory to bring the blood to the ED instead of checking it out in the blood bank.” Many of the questions were easy to answer; some were more challenging. Often, addressing the issue involved A Strained Relationship education. After a couple months of meetings, the nurses were pleased to see the liaison at their meetings, and the suggestions, questions, and comments turned into, “The lab’s great—you all are doing a great job.” For situations that couldn’t wait, the ED Clinical Coordinator or Director was able to contact the liaison immediately. In one instance, a request was made that the format of patient reports printed in the ED be changed. The ED charts are on clipboards, and unfortunately, the patient demographics appear at the top of the printed laboratory report, so the names are covered when they are placed on the chart. At least once, a laboratory report was filed on the wrong chart. The physician reviewed the results, and the patient was nearly treated based on another patient’s results. Fortunately, the error was caught before any treatment occurred, and as a result, a potentially serious problem was identified. The request that the demographics be placed at the bottom of the report was submitted to the Clinical Coordinator/LIS specialist directly from the liaison. After one phone call to the ED Director to determine which demographics were needed at the bottom and what information was to remain at the top, the changes were made within an hour of the request. It was amazing how many questions or concerns could be solved as simply as this one. Sometimes the request for change cannot be accommodated because of procedural issues or policies, but meeting with the department provides a venue for discussion and explanation of those situations. One situation that did not change policy but did create an opportunity to explain the rationale for the policy was the age-old question, “Why won’t the laboratory accept a specimen I collected and labeled at the nurses’ station, even if I know I drew it from that patient?” Nurses are what many view as grey, compared to the rather strict blackand-white view of medical technologists; again, it’s the nature of their work. Nurses sometimes (maybe most of the time) have to make do with what they have. Medical technologists, on the other hand, have procedures that must be followed; most of the time there are no exceptions. They even have procedures about how to write procedures! Nurses respond much better to explanations of what can result from doing it the “wrong” way, than to a directive such as “because that’s the way it is.” The explanation that regulatory agencies such as The Joint Commission require specimens to be labeled at the bedside, a description of how many specimens are submitted to the laboratory for testing, and how many of those are mislabeled gave the nurses a better understanding of the requirements. Once the repercussions for a mislabeled specimen and the seriousness of the outcome for the patient were explained, the nurses understood why they needed to label the Redesigned Patient Report Liaison Process Laboratory Specimen Collection 20
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