The purpose of this project was to standardize the practice of ambulatory care nurses relaying abnormal test results to patients, while remaining in their scope of practice, through the development and implementation of protocols and competency training.
It is imperative to patients’ health that they receive test results in a timely, appropriate, and understandable manner. Providers had previously been responsible for relaying abnormal results, but often requested the assistance of nurses to relay results due to provider time constraints. This practice falls outside of the nursing scope of practice. Nursing leadership knew a solution was needed to keep nurses working within their scope, while continuing to support providers and patients. A review of the literature found no evidence-based practice (EBP), articles, or research regarding nurses relaying abnormal test results to patients. The state board of nursing was contacted and advised that there must be policies and protocols in place that include a competency signoff for nurses to relay these results. With no guidance through EBP, nursing leadership followed the guidance from the board of nursing and developed 12 abnormal lab result protocols.
Nursing leadership developed these protocols with information from Up to Date, Mayo Clinic, and the CDC. Protocols were reviewed by an interprofessional group including medical doctors (MD) and nurses. In a joint effort with providers, the medical director created EPIC smart phrases that coincided with each protocol, extracting key points from the protocols and including EPIC smart text options for providers to easily modify to meet specific patients’ needs. Working with this interprofessional team, a workflow was developed allowing providers to review the abnormal lab results with accompanying protocols, and send nurses messages requesting they relay the results using the EPIC smart phrase.
Once the protocols were finalized, competency training for all nurses through simulation phone calls with providers was completed. Messages in TEST patient charts were sent to individual nurses for each lab result being tested for competency. The nurse and provider simulated a phone call with the provider acting as the patient and the nurse calling the patient with the abnormal lab result. The nurse was evaluated utilizing a rubric completed by the provider. Nurses who did not pass the competency were re-educated and repeated the competency.
By utilizing protocols and competency training, nurses can safely and effectively work at the top of their licenses. The development of these protocols has significantly impacted patients, nurses, and providers. Nurses report feeling more confident in their knowledge about these lab results and more equipped to answer patient questions that arise during these calls. Providers and nurses have shared that this has improved the nurse-provider relationship, with nurses feeling more comfortable approaching providers with questions and providers better understanding the nursing scope of practice. Nurses and providers state this comfortability comes from the interactions during the competency training sessions. Through nurses, patients now receive abnormal lab results sooner, and the information the patients receive is standardized and consistent.