[chipper]

This just happened last night on my shift, (7p-7a). A resident that is IDDM had an BS of 522 @hs. We are to report to the Doc if this one is over 500. It was a Friday night, followed protcol and order of the s/s and gave resident the alloted humalog. Resident was asymptomatic. Their Doc was not on call but was having the Doc on call paged. I tried two times to reach this person, but to no avail. Left our number so they could call back. My fellow nurse had a resident on their side that was doing bad and tried to get ahold of this Doc, leaving numbers and messages for them. This all happened around 8pm. We tried a few more times, but by then, it was going on 12am and the residents had stablized. My question is, Aren't the physicans on call accountable for these residents? Is this not neglect that they never called back? This Doc is known for this behavior and has done this in the past. Since they did not call back, it makes me wonder what risks as a nurse I would be taking with my licensure with this resident. I know that I would want to send them in to the hospital if they took a turn for the worse, but HEY! I need a Doctors order for that! What do ya'll think? Has this happened to you?

[Hellllllo Nurse]

This has happened to me in the LTC setting. I have called my DON at home and told her of the situation. She got a hold of the doc and got us orders. I don't know what the nurses' legal responsiblies are when a doc ignores calls. I'm interested to know, too.

[?burntout]

This is when you DOCUMENT the times you paged/beeped the MD....EVERY TIME. If you call an answering service and talk to a live person, you chart the time and name of this person and a synopsis of your message in the patient's chart. If they don't call back after a reasonable amout of time, it is time to go up the chain of command and document yet some more.

[joyflnoyz]

If we didn't get a doc to return a page after about 15-20 minutes (depending on the severity of the problem). One hour, no answer, then we paged the medical director of the facility for orders.
There was one night the receotionist left at 8 PM, but forgot to switch the phones over to "night mode". We never knew anyone was trying to call in! YIKES (on night mode, incoming calls ring at all the stations, day mode everything goes thru the receptionist)

[michelle95]

In my LTC, I know that if I had a really bad situation that required emergency intervention...I would go on and send them to the hospital (writing the order, of course) and just have the doctor chew me out later. But, the medical director of my facility would much rather me send them out than wait on him and they die.

To me, LTC is their home, and what would they do at home if they couldn't get a doctor? Go to the ER.

But, it also depends on how bad they are. For an asymptomatic high BS, I wouldn't send them...but, I would certainly document that I had paged the doc.

[itsme]

We have had this problem alot lately. Now when I chart I will put something like this "Call placed again to on call MD, Cont. to await call back" We had all three shifts charting that over one whole weekend for orders for a MRSA+ urine culture. Finally on Monday the medical director called us and we told him what was documented. It was ridiculous. Sometimes certain newer docs think that the Nursing home pts just dont matter.

[michelle95]

Sometimes certain newer docs think that the Nursing home pts just dont matter.

Can't really fault them when most of society acts the same way.