Can ER doctors give dialysis orders?

  1. 0 I am so confused on this issue. I've been called in the middle of uckthe night only to find the er dr wrote an order for a pt to be dialysed and discharged. lucky for me i read the progress notes and it said the nephrologist was aware but i didnt see a consult on the pt. I called the nephrologist in the middle of the night (luckily i knew he was a nice one) and he gave me orders. So i dialyzed the pt. Other nurses h ave been in my situation and have fought with the staff saying it can wait till morning and that the nephrologist need to give clear orders and that the er dr cannot write dialysis order..only a nephrologist can. i know that is true but is what the hospital doing right? I'm so confused on this issue. The pts potassium was a bit high and thats why i proceeded to go ahead and call the dr. in the other cases of my coworkers..they have been called in the middle of the night for a fairly normal potassium of 5.3 (which is normal for a chronic kidney failure pt).

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  3. Visit  nursingisok profile page

    About nursingisok

    Joined Oct '08; Posts: 85; Likes: 55.

    13 Comments so far...

  4. Visit  workingmomRN profile page
    0
    Have you asked the nephrologists about this? I would also ask your supervisor and get a copy of your hospital's policy and make sure that everyone is on the same page regarding this issue. I would definitely be uncomfortable dialyzing someone with orders from an ER doctor. I believe you did the right thing in calling the nephrologist on call. Most doctors don't understand dialysis unless they have worked in it.
  5. Visit  Tish88 profile page
    0
    You need to have dialysis orders from a nephrologist, not any other doctor regardless of their specialty. There should also be a consult to a nephrologist and the dialysis RN should obtain the dialysis orders before starting a treatment.
  6. Visit  zimm4er profile page
    1
    Ditto to tish. I do not come in unless I am called by my nephrologist. If I did they would give me hell.
    Tish88 likes this.
  7. Visit  Tish88 profile page
    0
    I just love the times when an ER doc calls the nephrologist and tells them the patient needs dialysis because they are in CHF, then the nephrologist don't go in and see the patient but calls you out (trusting the ER docs observation) to do a stat treatment. (mainly because the patient has missed a treatment!!)
    You get to the hospital only to find the patient sleeping flat in bed with no oxygen on and in NO distress!!! I always ask to see the chest xray and the ER doc that read it. Many of times they did not even do a CXR! That is when I call the nephrologist to tell him/her my observation and to tell them I will be back in the morning to dialyze the patient. If they insist that the pt is to be done, I simply say, "fine I will wait for you to see the patient that you are consulted on and await their orders". After over 20+ years of doing acute dialysis treatments, you start getting respect from "your" docs and they trust your judgement.
  8. Visit  Norazizahi profile page
    0
    u have to get order from nephrologist. and as ER doctor u have to refer this pt to medical oncall person. thats what in malaysian practise
  9. Visit  nursingisok profile page
    0
    the er doctor doesnt write the orders. they dont know how to. they just write stat dialysis call dr so and so for orders. and that's what i do. the good ones come out and see the pt but we do have a dr who will just give orders over the phone without seeing the pt but if i dont dialyze the K will go higher and thats my license.
  10. Visit  Tish88 profile page
    0
    Quote from nursingisok
    the er doctor doesnt write the orders. they dont know how to. they just write stat dialysis call dr so and so for orders. and that's what i do. the good ones come out and see the pt but we do have a dr who will just give orders over the phone without seeing the pt but if i dont dialyze the K will go higher and thats my license.
    The ER doc should NOT even write "stat dialysis" . They should ONLY being writing for a consult for the nephrologist.
    By writing "stat dialysis" is just like giving dialysis orders and we can not act on those as an order. After a consult is in and the nephrologist is notified, they should be the one to notify you with a stat treatment.
    That will cover your license.
    As for the K+ levels - they can be treated in the ER -- Kayexalate and an insulin drip works wonders!!!!
  11. Visit  nursingisok profile page
    0
    do you work in acute dialysis or the clinic? ER drs CAN give a stat dialysis order...unfortunately . but we get the orders from the nephrologist.
  12. Visit  Tish88 profile page
    0
    I work in acutes and cover over 12 hospitals.
  13. Visit  Tish88 profile page
    0
    Quote from nursingisok
    do you work in acute dialysis or the clinic? ER drs CAN give a stat dialysis order...unfortunately . but we get the orders from the nephrologist.
    Are you an acute dialysis RN for a hospital or do you work for FMC/Davita/DCI or any other dialysis company? FMC/DCI and Davita policy is ALL orders must be from a nephrologist. I also go to 3 different states and it is the same in all 3 states.

    I have done acute hemodialysis treatments for well over 20 years.
  14. Visit  nursingisok profile page
    0
    good for you. like i said....i get my orders from a nephrologist. but an er dr CAN write stat dialysis. they are drs and we are not. but i obtain orders from the nephrologist when i arrive. i call trhem and bug them and i always get the orders because i look in the chart and see that the er physician discussed the case witht he nephrologist. i always look for that note. i think its good that u have 20 yrs in hemo.i myself however am applying to grad school. i dont want to do one thing for too long.
  15. Visit  Tish88 profile page
    0
    Quote from nursingisok
    good for you. like i said....i get my orders from a nephrologist. but an er dr CAN write stat dialysis. they are drs and we are not. but i obtain orders from the nephrologist when i arrive. i call trhem and bug them and i always get the orders because i look in the chart and see that the er physician discussed the case witht he nephrologist. i always look for that note. i think its good that u have 20 yrs in hemo.i myself however am applying to grad school. i dont want to do one thing for too long.
    So basically you are saying the ER doctor is not writing the dialysis orders - you call the nephrologist for orders, based on the order from the ER doctor to consult nephrology for a dialysis.
    I only do acute treatments per-diem now. I am currently an administrator for an outpatient surgical center.
    Good Luck in grad school!


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