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  MGH SICU guidelines for lab testing


CAP Today



February 2008
Feature Story

Physician order is required for all laboratory tests.
RN is accountable for all tests sent.

Retroactive physician orders are acceptable during acute clinical events.
RN should discuss patient/ clinical event with the MD and send labs ordered by the MD. The RN is responsible for obtaining the POE order before the shift is over.

Routine AM laboratory tests are defined as CBC, Na, K, Cl, CO2, BUN, creatinine, glucose, magnesium, phosphorus. Duplicate laboratory tests are not acceptable.

Additional routine AM laboratory tests include TPN labs as ordered on the TPN template and blood bank samples every 72 hours.

Routine AM laboratory tests and patient-specific laboratory tests are ordered on SICU rounds and sent on the night shift if possible.

Post–repletion electrolyte labs can be sent as needed and are ordered on the POE laboratory screen or using the SICU electrolyte template.

Arterial blood gases are not routine and require a physician order.

Admission lab tests are generally not stat and may be done at any appropriate time within the first hour of admission. RN will review admission orders, discuss the rationale for any additional tests with the MD, and obtain an order for those tests. PT, PTT, and troponin T are not routine admission lab tests. Critical care PCA will not send admission lab tests until directed by RN.

MGH guidelines for diagnosing MI
  Time 0: Troponin T, CPK, CPK-MB
Time 8 hour: Troponin T
Time 16 hour: Troponin T