How often should laboratory tests be performed on a patient in a long-term care (LTC) facility, such as a nursing home?

From the Guidelines

The frequency of laboratory tests for nursing home patients should be determined by their individual health conditions, medications, and care plans, with routine lab work conducted every 3-6 months for stable residents, and more frequently for those with chronic conditions or on certain medications, as supported by the American Diabetes Association's position statement 1. When considering the management of patients in nursing homes, it's essential to take into account the challenges in transition care, including the lack of standard transition of care documents and inadequate communication of test results and medication orders 1. Key factors to consider when determining the frequency of laboratory tests include:

• The patient's stability and medication regimen
• The presence of chronic conditions, such as diabetes or those requiring anticoagulants
• The need for close monitoring of electrolyte-altering drugs or other medications
• Acute changes in condition that may trigger additional lab work The attending physician should use clinical judgment to determine the appropriate frequency of laboratory tests, considering these factors and ensuring that testing is medically necessary and covered by insurance providers 1. Additionally, guidelines for evaluation of fever and infection in long-term care facilities, such as those provided by the Clinical Infectious Diseases journal 1, emphasize the importance of prompt diagnostic laboratory studies and discussion of findings with the primary care clinician. However, the most recent and highest quality study, the American Diabetes Association's position statement 1, provides the most relevant guidance for determining the frequency of laboratory tests in nursing home patients.

From the Research

Laboratory Tests on Patients in Nursing Homes

• The frequency of laboratory tests on patients in nursing homes is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the studies discuss various aspects of renal function, diuretic therapy, and laboratory tests such as blood urea nitrogen and serum creatinine levels 2, 4, 5, 6.
• For example, a study from 1984 found that furosemide therapy can affect renal function and laboratory test results, including blood urea nitrogen and serum creatinine levels 2.
• Another study from 2020 discusses the importance of understanding laboratory abnormalities, including electrolyte imbalances and renal function, in nursing practice 3.
• The studies suggest that laboratory tests, including blood urea nitrogen and serum creatinine levels, can be useful in monitoring patients' renal function and response to diuretic therapy 4, 5, 6.

Renal Function and Laboratory Tests

• Renal function can be assessed through laboratory tests such as blood urea nitrogen and serum creatinine levels 2, 4, 5, 6.
• These tests can help identify abnormalities in renal function and monitor patients' response to diuretic therapy 2, 4, 5.
• However, the interpretation of laboratory test results must consider various extrarenal factors that can affect blood urea nitrogen and serum creatinine levels 6.
• A study from 1975 notes that elevations in blood urea nitrogen and/or serum creatinine levels do not necessarily indicate structural renal disease, and that interpretation of these tests must be done with caution 6.

Diuretic Therapy and Laboratory Tests

• Diuretic therapy can affect laboratory test results, including blood urea nitrogen and serum creatinine levels 2, 4, 5.
• A study from 1984 found that furosemide-induced diuresis did not deplete intravascular volume, but rather expanded plasma volume in the absence of diuresis 4.
• Another study from 1985 found that diuretic therapy can increase plasma urea levels in patients with chronic renal failure, due to reduced urea excretion and increased tubular reabsorption of urea 5.