shift is wild

What you chart every shift

A critical lab value: write down who you told and when

You made the call and got the orders. If the chart only says "MD aware," nobody reading it later can tell any of that happened.

8 min read built on 6 full opinions updated 2026-09-24

Written by a med-surg RN, ten years, day shift. Why there is no name on it

Denise reacting to this topic

The lab calls with a potassium of 6.8. You read it back, page the provider and get orders. Often it all takes a few minutes. If the chart doesn't show those steps, nobody reading it later can know they happened.

The short version

  • Chart the call from the lab. Write the time, the caller's full name, the test, the value with units, and that you read it back.
  • Chart who you told. Write the provider's full name and role, the time you reached them, and how: phone, page or secure message. If you only sent a message, say whether anyone answered.
  • Chart what came of it. Write the orders you got, or that you got none. Then what you did, and when you'll recheck.
  • Nobody calls back? Chart that too, and escalate. Follow your unit's chain of command. Write down each step with its time.
  • Chart it when it happens. A note about a 2 a.m. phone call written the next afternoon is weaker. It's also easier to dispute.

What goes wrong

The usual mistake isn't skipping the call to the provider. It's making the call and then writing MD aware, or nothing at all.

Here's why that's a problem. Whoever reviews the chart later can't ask you what happened. You might be on another unit or at another hospital. Or you just can't pick out one night from hundreds. The chart has to answer on its own:

  • Did the value reach someone who could act on it?
  • Who?
  • When?
  • What did they decide?

If your note doesn't answer those questions, a reader can fairly assume the step never happened.

Secure messages cause a second problem: sending a message isn't the same as reaching someone. It might go to someone who isn't on call. If your note only says you sent it, the chart shows a message and nothing about whether anyone read it.

The third problem is timing. Write up a phone call hours later and the person on the other end may remember it differently. Then it's your note against their memory.

It is not hypothetical

Mapes v. State of Louisiana through the LSU Board of Supervisors (Louisiana Court of Appeal, Fourth Circuit, 2022). CourtListener

  • A patient's platelet count came back at 25. The hospital's protocol required the lab to tell the nurse verbally, and the nurse to tell the doctor verbally.
  • The lab told the nurse at about 5:30 p.m. The court wrote that "the record does not contain any indication that the UMC nurse then verbally notified the doctor." About twelve hours later the patient was discharged. A few days after that, the patient died of a brain hemorrhage.
  • A medical review panel found that the nurse's failure to report verbally breached the standard of care.
  • The trial court had granted the hospital summary judgment. The appeals court reversed it and sent the case back for further proceedings.

Estate of Crnjak v. Lake Hospital System, Inc. (Ohio Court of Appeals, Eighth District, 2024). CourtListener

  • A patient was discharged from the ER with a UTI diagnosis. About nine hours later, blood cultures showed a blood infection. The court wrote: "No one contacted Rose to inform her that she had a blood infection or otherwise instruct her." She died at home four days later.
  • This case has a timing lesson too. The PA charted a 2 a.m. phone call with the primary care doctor about twelve hours after it happened. At trial, that doctor disagreed with what the note said.
  • A jury found against the hospital. The appeals court affirmed.

Fazzari v. New Hanover Regional Medical Center (Court of Appeals of North Carolina, 2021). CourtListener

  • A platelet count of 24 was flagged to a physician by secure electronic message. The court noted: "it is unclear whether there was any response to this secure electronic message."
  • The plaintiffs alleged that the messaging system had the wrong on-call information on file.
  • The appeals court affirmed dismissal on a different point: the plaintiffs' expert witness didn't meet North Carolina's rule for who may testify on the standard of care. The court never ruled on the messaging itself.
  • Still, the facts show what a chart looks like when all it records is that a message went out.

Richter v. Presbyterian Healthcare Services (New Mexico Court of Appeals, 2013, substituted opinion). CourtListener

  • This one is about lab results reaching physicians, not a nurse's phone call. Diagnostic results from a 2001 admission came back around the time of discharge. The court wrote: "The tests were never read or acted on by her physicians."
  • The court reversed summary judgment on some of the claims about how the results were delivered.

What to write instead

How it often gets charted What holds up better
Critical K called. MD aware.1412: Received call from J. Ramos, lab tech: K+ 6.8 mmol/L, drawn 1340. Read back and confirmed. 1418: Paged Dr. A. Chen, hospitalist. 1424: Dr. Chen returned call; value and current meds (lisinopril, KCl 20 mEq daily) reported. Orders received: see below.
Notified MD re: low plt, no new orders.0215: Plt 22 K/uL (prior 48 K/uL on 9/22) reported by phone to Dr. M. Patel, night hospitalist, with trend and scheduled 0600 heparin. Read back by Dr. Patel. Orders: hold heparin, repeat CBC 0600. Heparin held; charge RN S. Lee informed.
Secure chat sent to MD re: glucose 42.0305: Glucose 42 mg/dL (POC, confirmed with lab draw). Hypoglycemia protocol started, D50 25 mL IV given 0308. 0310: Secure chat sent to Dr. R. Okafor, on-call per schedule. 0325: No response. Paged Dr. Okafor. 0331: Dr. Okafor returned call; value, treatment, and 0323 recheck 88 mg/dL reported. Orders received.
Labs called to floor. Will monitor.1605: Lactate 4.6 mmol/L called by K. Brown, lab. Read back. 1609: Reported to Dr. L. Novak, ED attending, in person. Dr. Novak at bedside 1615. Orders: 30 mL/kg LR bolus, repeat lactate in 2 h. Bolus started 1622. Repeat lactate due 1822.
Note written the next day: Called MD overnight re: labs.Late entry for 9/23 2310, written 9/24 0140: Na 118 mmol/L reported by phone at 2310 to Dr. T. Wu, hospitalist. Read back by Dr. Wu. Orders: fluid restriction 1 L/day, repeat Na 0400.

Words that do the damage

Phrase What's wrong with it Write this instead
MD awareWho? When? How did they find out? It doesn't say.Provider's full name, role, time and method (phone, page, in person)
Notified MDWhich doctor? Did you actually reach them?Provider's name, plus when they confirmed receipt or called back
Critical lab calledNo test, no value, no caller, no time.Test, value with units, lab caller's full name, time, read-back done
No new ordersDid the provider hear the value and decide against orders, or never hear it at all?Value and trend reported to [name]; no new orders at this time per [name]
Will monitorMonitor what? When?The specific recheck, with a time: Repeat K+ due 1800
Messaged providerSending isn't reaching.Message time, recipient, whether they answered, and your next step if they didn't

What the guidance says

Copy this

Chart note: critical value received and reported

`` [DATE] [TIME]: Critical value received by phone from [LAB CALLER FIRST AND LAST NAME], [LAB CALLER ROLE]. Test: [TEST NAME]. Result: [VALUE] [UNITS]. Collected [COLLECTION TIME]. Prior result: [PRIOR VALUE] [UNITS] on [PRIOR DATE]. Value read back to caller and confirmed. Patient at time of call: [BRIEF ASSESSMENT, e.g. VS, LOC, SYMPTOMS]. [TIME]: [METHOD: PHONE / PAGE / IN PERSON / SECURE MESSAGE] to [PROVIDER FIRST AND LAST NAME], [PROVIDER ROLE]. [TIME]: Reached [PROVIDER NAME]. Reported value, trend, and [RELEVANT MEDS OR CONDITION]. Provider read back value. Orders received: [ORDERS, or: No new orders at this time per PROVIDER NAME]. Actions taken: [WHAT YOU DID AND AT WHAT TIME]. Follow-up: [RECHECK OR REASSESSMENT] due at [TIME]. [YOUR NAME], RN ``

Chart note: provider not reached, escalation

`` [DATE] [TIME]: Critical value received by phone from [LAB CALLER FIRST AND LAST NAME]. [TEST NAME] [VALUE] [UNITS]. Read back and confirmed. [TIME]: [PAGE / SECURE MESSAGE] sent to [PROVIDER FIRST AND LAST NAME], [ROLE], on call per [SCHEDULE / ON-CALL LIST]. [TIME]: No response. Repeat [PAGE / CALL] to [PROVIDER NAME]. [TIME]: No response. Charge RN [CHARGE RN FIRST AND LAST NAME] informed. [TIME]: Per chain of command, value reported to [NEXT PROVIDER OR SUPERVISOR FIRST AND LAST NAME], [ROLE]. Value read back. Orders received: [ORDERS or NONE]. Patient status at [TIME]: [BRIEF ASSESSMENT]. Actions taken: [WHAT YOU DID AND AT WHAT TIME]. [YOUR NAME], RN ``

Late entry: charted after the fact

`` Late entry for [ORIGINAL DATE] [ORIGINAL TIME], written [TODAY'S DATE] [CURRENT TIME]. At [ORIGINAL TIME], [TEST NAME] [VALUE] [UNITS] received from [LAB CALLER FIRST AND LAST NAME], read back and confirmed. At [TIME], reported by [METHOD] to [PROVIDER FIRST AND LAST NAME], [ROLE]. Provider read back value. Orders received: [ORDERS or NONE]. Actions taken: [WHAT YOU DID AND AT WHAT TIME]. Entry delayed because [BRIEF FACTUAL REASON, e.g. rapid response on another patient]. [YOUR NAME], RN ``

Handoff line

`` Critical [TEST NAME] [VALUE] [UNITS] at [TIME]. Reported to [PROVIDER FIRST AND LAST NAME] at [TIME]. Orders: [ORDERS or NONE]. Pending: [RECHECK] due [TIME]. Not yet done: [ANYTHING OUTSTANDING or NOTHING]. ``

If you remember one thing

Every critical value note answers four questions. Who gave you the value? Who did you tell, and when? What did they decide? What did you do about it?

Read the decisions yourself

Every case below is a published decision on CourtListener. Open them. Nothing on this page asks you to take our word for what a court said — and where we only had the search result rather than the full opinion, it says so.

All the decisions behind this guide, in one page — searchable by court, year, or what happened.

What people say on the floor

Nurses talking to each other about this, quoted as they wrote it. This is opinion, not a source. It is here because it shows what the argument actually is — the rules above come from the decisions and the published guidance, not from these threads.

What everyone else says

Guidance from professional bodies, insurers and other people who write about this. Useful, but it is advice, not law — that part is above.

How would you chart it?

This is the part we cannot research. If you have a way of writing this that has held up — put it here. No account, no name needed. Nothing that could identify a patient: no room numbers, no dates of birth, no MRNs. Use placeholders, the example still works.

700