Orders, handoffs and other people

The swab the lab asked for that nobody ordered

A lab or vendor asks for a specimen and you can't find an order. What to check, who to call, and what the chart needs to say.

7 min read built on 4 full opinions updated 2026-10-27

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

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The reference lab calls, or a vendor rep shows up at the station, and asks you to collect a swab, a repeat tube, or an extra specimen on your patient. You open the orders. Nothing. Before you collect anything, you need an order you can point to. And whatever you end up doing, the chart has to show who asked, what you looked for, who you checked with, and what happened next.

Key points

  • A request from a lab or vendor isn't an order. Until a provider orders it, treat it as a message for the provider.
  • Search the orders first, including future, standing, and protocol orders. Chart what you searched and what you found.
  • Call the provider. Chart who you reached, when, and what they decided.
  • Collect only when there's an order in the system, or a telephone order you read back and entered under your facility's policy.
  • Label at the bedside with collector initials, date, time, and source. Check the label against the order.

What to write

How it often gets charted How it reads better
Swab collected per lab request.1410 Call from [LAB NAME], [STAFF NAME], requesting nasal swab for [TEST]. No active, future, or protocol order found in chart. Specimen not collected. Dr. [NAME] paged 1415.
Lab wants repeat tube, drawn.1520 Lab ([STAFF NAME], ext. [####]) reports specimen hemolyzed, requests recollect for existing order #[ORDER #]. Order verified active. Recollected 1535, labeled at bedside, sent.
MD aware.1430 Spoke with Dr. [NAME] by phone re: lab request for [TEST]. Dr. [NAME] will enter order. Order received in chart 1442. Specimen collected 1450.
Vendor sample sent.1100 [VENDOR NAME] rep requested buccal swab for [TEST]. No provider order found. Rep referred to Dr. [NAME]'s office. No specimen collected. Charge RN [NAME] informed 1105.
Specimen obtained.1615 Urine culture collected, clean catch, per order #[ORDER #] (Dr. [NAME]). Labeled at bedside with 2 identifiers, collector initials, date, time, source.
Provider said not needed.1440 Dr. [NAME] reviewed lab request for [TEST], declined order. Lab ([STAFF NAME]) notified 1445 that specimen will not be collected.

Every version on the right answers the same four questions. Who asked, what you searched, who decided, what you did.

Template

Chart note: request received, no order found

[DATE] [TIME] Request received from [LAB OR VENDOR NAME], [STAFF NAME AND TITLE], callback [PHONE/EXT], for collection of [SPECIMEN TYPE] for [TEST NAME].
[TIME] Chart reviewed for active, future, standing, and protocol orders for [TEST NAME]. No order found.
Specimen not collected pending provider review.
[TIME] [PROVIDER NAME AND TITLE] contacted via [PHONE/PAGE/SECURE MESSAGE] regarding request.
[TIME] Provider response: [ORDER WILL BE ENTERED / ORDER DECLINED / NO RESPONSE YET].
[TIME] [LAB OR VENDOR NAME] notified of status: [COLLECTION PENDING ORDER / WILL NOT BE COLLECTED].
Charge RN [NAME] informed at [TIME].
[YOUR NAME, CREDENTIALS]

Chart note: order obtained, specimen collected

[DATE] [TIME] Order for [TEST NAME] entered by [PROVIDER NAME] / received as telephone order from [PROVIDER NAME], read back and verified, entered per facility policy. Order #[ORDER NUMBER].
[TIME] [SPECIMEN TYPE] collected from [SOURCE/SITE] by [METHOD]. Patient identified with [TWO IDENTIFIERS].
Specimen labeled at bedside with patient identifiers, collector initials, date, time, and source.
[TIME] Sent to [LAB NAME] via [TUBE SYSTEM/COURIER/HAND DELIVERY].
Requesting party ([LAB OR VENDOR NAME], [STAFF NAME]) notified of collection at [TIME].
[YOUR NAME, CREDENTIALS]

Message to charge nurse or supervisor

[DATE] [TIME]
Patient: [NAME], room [ROOM], MRN [MRN]
[LAB OR VENDOR NAME] ([STAFF NAME], [PHONE/EXT]) asked me to collect [SPECIMEN TYPE] for [TEST NAME].
I found no provider order for this test in the chart.
I contacted [PROVIDER NAME] at [TIME] by [METHOD]. Status: [AWAITING RESPONSE / ORDER ENTERED / DECLINED].
Specimen has [NOT BEEN COLLECTED / BEEN COLLECTED AT [TIME] UNDER ORDER #[ORDER NUMBER]].
Please advise if this lab or vendor needs a different contact route for future requests.
[YOUR NAME, CREDENTIALS]

Words to avoid

Word or phrase Why it hurts Use instead
per lab requestReads like the lab ordered the testper order #[####], Dr. [NAME], or lab requested; no order found
MD awareWhich provider? When? What did they decide?Provider name, time, how you reached them, their decision
as ordered (when you never saw the order)You're claiming something you didn't checkorder verified in chart at [TIME]
obtainedNo source, no methodnasal swab, left naris, clean catch urine, venipuncture R AC
per protocol (with no protocol named)Nobody can tell which protocolName the protocol or standing order
sentNo time, no destinationsent to [LAB] via [TUBE/COURIER] at [TIME]

Collected per lab request names no order

The usual mistake comes from trying to help. The lab sounds sure, the request looks routine, and it's a two-minute job. So the nurse collects it, sends it, and writes Specimen collected per lab request.

That line causes trouble later. It names no order, so nobody can say who decided the test was needed. If the system ties the collection to an order, it might be an old order, one from a different encounter, or one a clerk or another nurse put in under someone's initials. The result comes back and lands in nobody's inbox, because no provider asked for it. Then someone asks why the test was done. The chart says the lab wanted it.

The lab can vouch for what happened after the specimen got to the lab. Everything before that (the request, the order check, the call to the provider, the collection itself) exists only in your note.

Bottom line

The lab can ask. Only a provider can order. Chart who asked, what you looked for, who decided, and what you did.

Official guidance

  • Label every specimen with its source, the collection date and time, and the initials of whoever collected it. (CDC, IRMC labeling policy)
  • Every lab test needs an order from the treating provider. If electronic ordering is down, the lab will take a paper order, but only a complete one with all the required information. (CMS, UCSF Clinical Laboratories)
  • Document the collection against an existing order in the system. Collection labels print from that order. No order means the specimen has nothing to attach to. (PMC, Epic tip sheet)

In court, 2000–2022

What happened in 4 court cases

Lyons v. Walker Regional Medical Center: Supreme Court of Alabama, 2000. An ED patient had electrolytes, PT and PTT drawn. The front sheet had a notation crediting the order to a nurse by her initials. From the opinion: "Laurie Hunter testified that she did not order that the electrolytes, PT and PTT specimen be collected." The ED physician testified he never ordered them either. Results came back at panic values after the patient had left, and nobody followed up. The court reversed the summary judgment for the hospital and the nurse and sent the case back. What matters for you is simple. The specimen got collected, and nobody could say who asked for it.

People v. Beck: Appellate Court of Illinois, 2018. This time the request came from outside. Deputies at a crash scene had 911 dispatch call the emergency department and ask for a blood draw on the patient being brought in. Someone in the ED answered that "we usually always do." The defense raised it in a pretrial motion: was the draw medical, or done because law enforcement asked? When a request comes from outside the care team, your chart is where you show what the specimen was actually collected for, and on whose order.

People v. Deroo: Appellate Court of Illinois, 2020. The flip side of Lyons. The record kept two things apart: the treating physician ordered the alcohol test as part of emergency care, and the deputy testified that she did not direct or order the hospital staff to draw the blood. The order source was clear, so that question had an answer. The nurse couldn't remember whether she or a phlebotomist did the draw. But the labeling and verification routine she described held up as a record of how specimens were handled.

In re G.R.: Ohio Court of Appeals, 2022. Newborn specimens went to an outside reference lab. The lab's medical director testified about the results. Then came cross-examination: "Johnson-Davis also testified that she did not know if the hospital had properly stored, packaged, or transported the samples prior to the testing by the laboratory." The outside lab speaks for its own part, and that's it. The bedside part is whatever the hospital wrote down.

Court decisions

Published decisions, linked to CourtListener.

All decisions behind this guide

From nurses online

Quoted as written. Opinion, not a source.

  • Taught during hospital orientation, but it was not something we ever focused on in nursing school- especially since not all of this is universal. For example, we don’t send urine in specimen cups, we sent them in tubes that are just slightly bigger than blood tubes.

    A question from the lab! : r/nursing reddit

  • If no such protocol exists for the current situation, then the nurse must request an order from the physician. No order means no testing. Asking the lab to run a test without an order is inappropriate.

    r/nursing on Reddit: Does the RN Scope of Practice, in general, include ordering testing a reddit

  • I have come to expect that the folks who work in the lab although not all seem to forget that fact. I had a nurse send down a blood gas specimen with a capped needle. The phone calls made and incident reports and safety reports and multiple calls from one tech was ridiculous. I wanted to ask them if

    r/nursing on Reddit: Made a lab labeling mistake as a new grad reddit

  • I was oriented by a senior nurse who is also on the practice council. I was trained how to collect some specimens (urine, tissue for pathology, cord blood) that get sent to lab, but otherwise I have no access to butterflies (or other spec collect devices), lab tubes, or the ability to print lab tube

    r/nursing on Reddit: Nurses “not allowed” to draw blood reddit

Other guides

Advice, not law.