IMM 21 and 22: Labs & Diagnostic Tests Flashcards
What must pharmacists have to order lab tests? (5)
- professional relationship with patient
- competence to order the correct test and interpret results
- patient consent
- no conflict of interest
- access to patient information to determine: if a lab test is required, which lab test to order, interpretation of result in context of patient, actions to be taken in response to results
What are additional requirements for pharmacists to order lab tests?
test ordering must be to provide services within pharmacist scope of practice
- identifying, assessing and resolving drug therapy problems
- monitoring drug therapy
What are the steps to determine if you should order a lab test?
- complete clinical assessment of subjective and objective findings
- if lab results will not change your decision-making, do NOT order it
- ie. patient has all the symptoms of uncomplicated cystitis, for which you can
prescribe
- consider what you would do with a lab result that is high, low, or normal
- if you wouldn’t do anything different, do NOT order it
- ie. rivaroxaban is an anticoagulant (blood thinner) known to increase INR – INR is not used to adjust dose or change therapy for
rivaroxaban
3a. review available blood work to determine when the test was last ordered
- what is the likelihood that the results have changed since it was last measured
- has the patient’s medications or adherence to their medications changed
- has the patient’s medical conditions changed in a way that might change their lab results
- has enough time passed since the change that you would expect to see a difference in their labs
- how frequently do clinical practice guidelines recommend that this test is performed
3b. review available blood work to determine what other tests have been done
- has another test been done that provides the same/similar information
- determine if the patient already has a requisition from another healthcare provider to order the required laboratory tests
- if so, do NOT duplicate ordering of the laboratory test
What is the problem with unnecessary tests?
- costs to patient and health system
- inconvenience to patient
- may result in inappropriate treatment decisions – ie. f a test is performed too early, a medication may be unnecessarily increased or decreased
Which tests can pharmacists order?
- hematology profile (CBC)
- anemia markers (B12, ferritin, iron, transferrin)
- electrolytes: sodium, potassium, chloride, calcium, magnesium, phosphate
- renal tests: creatinine, GFR, urinalysis, albumin/creatinine ratio, 24H CrCl
- liver tests: INR, albumin, bilirubin, alk phos, ALT, AST, GGT, LDH, total protein
- endocrine tests: A1c, fasting BG, random BG, TSH
- cardiovascular: lipid profile, CK
- therapeutic drug levels
- drug screening
What are the responsibilities of pharmacists upon ordering tests?
- obtain informed and voluntary consent from the patient or caregiver
- discuss distribution of the results to other healthcare professionals, such as family physician
- inform the patient is a laboratory test is not covered by the Medical Services Plan
- inform the patient of any testing requirements (fasting, sample collection, etc)
Do pharmacists have to get permission from the patient’s physician to order lab tests?
no
- pharmacist may, in collaboration with the patient, decide to have the results sent to other members of the patients care team
What do pharmacists have to do upon receiving lab test results?
pharmacist’s responsibility to ensure that lab results received are interpreted and acted upon in a timely fashion
- must communicate the results and plan to the patient in a timely manner
- cannot rely on patient’s primary care provider to respond to laboratory results, even if the labs were copied to them
What might a pharmacist do after receiving and interpreting lab test results?
- make necessary modifications to patient’s care plan
- discussing results with patient’s other healthcare providers
- refer the patient to another healthcare provider for assessment
How quickly do pharmacists need to respond to lab test results?
depends on the results received and the degree of abnormality
- normal results: must be communicated with the patient, but can be at a time that is convenient for patient and pharmacist
- abnormal results: depends on how abnormal the results are
What are critical values?
values markedly outside of reference ranges that indicate the potential for significant risk of life-threatening events
When do critical values need to be assessed?
immediately (24hrs/day, 7 days/week)
- Lab Operator will call the ordering pharmacist, or predetermined alternate, if a critical result is identified
- pharmacist is responsible for immediately assessing and acting upon the result
What do pharmacists have to do if a critical lab result is unexpected?
must refer the patient to the emergency department or other source of medical care
What are non-critical abnormal values?
values outside the reference range, but less likely to cause significant risk of life-threatening
What do pharmacists have to do with non-critical abnormal values?
- communicate the results to the patients
- determine a plan of care – may include alteration of drug therapy, or referral to another medical professional for assessment and management
