Routine laboratory assessment of nursing home patients

Little is known about protocols for routine laboratory testing in nursing homes. To determine what laboratory protocols are employed by community nursing homes, directors of nursing service in the 73 long-term-care facilities in Portland, Oregon were surveyed. One-hundred percent responded, and 56% reported having laboratory testing protocols. Ninety percent of protocols employed screening tests, and 88% employed monitoring tests, but content varied widely. Although physicians are ultimately responsible for ordering laboratory tests, protocols were derived from various sources including nursing staff, pharmacy and laboratory consultants, and Department of Health and Human Service guidelines. It is recommended that physicians take a leadership role in helping nursing homes develop clinically useful, cost-effective testing strategies.