"No New Orders Received" ..... ? - page 4

When you notify the physician of something regarding your patient and receive no new orders, do you document that? I can just document: "Notified MD of infant's increased work of breathing. Will... Read More

  1. by   elizabells
    Quote from RainDreamer
    Luckily we always have an attending neo on nights, sleeping just down the hall. And yeah, I told the neo about the PAL, just because the resident's response kinda scared me! Ended up pulling it a few hours later. Luckily I've never had to call a doc at home, that'd scare me!
    My primary baby's day shift primary is notorious for Monday morning quarterbacking during report. The morning after the parents had rescinded the DNR and the baby proceeded to code x 3 (never done it before in his 5 months - I swear he knew and was screwing with us) she had an absolute fit and insisted I should have paged the baby's primary attending (who wasn't even on service at the time) at home at 3am to discuss whether we ought to be doing compressions. Uh-HUH.
  2. by   leslie :-D
    Quote from cardiacRN2006
    When I've fought and fought-and it looks like I'm not going to get what I want-I say this (and I really feel that the pt is in distress)

    "So, just so I can document this correctly-you are OK with the pt doing X and with his VS being X, and you don't want to do X?"
    i just came upon your post and felt compelled to respond...
    yes!
    this is what i have been doing for yrs.
    i always (always, always) tell the dr., "since i'll be documenting my concerns in the nsg notes, i need to confirm a, b and c."
    the look on their face (or the looooooong pause on the phone) is my 'warm and fuzzy' for the day.
    oh,.
    and of course, the new orders.

    leslie
  3. by   elizabells
    Ahh, reflective listening.

    "So if I understand you, what you're saying is..."

    Who knew therapeutic communication would come in just as handy with docs as with patients?
  4. by   cardiacRN2006
    Quote from earle58
    i just came upon your post and felt compelled to respond...
    yes!
    this is what i have been doing for yrs.
    i always (always, always) tell the dr., "since i'll be documenting my concerns in the nsg notes, i need to confirm a, b and c."
    the look on their face (or the looooooong pause on the phone) is my 'warm and fuzzy' for the day.
    oh,.
    and of course, the new orders.

    leslie


    Yes indeed! I just said this during the last shift I worked. It's amazing how they completely stop in thier tracks when you say this.....
  5. by   Spitfire1500
    Yes, I agree that you should always document that no new order were rcvd. Case in point: I was working ICU one night and had a 400 pounder that was tanking with no BP. Called the doc for some orders and he gives me a 250cc challenge. I rolled my eyes, gave the bolus and had the doc back on the phone within 5 minutes. I made no less than six calls to the doc, hoping to get some pressors on board. I documented EVERYTHING, including every single vital sign, assessment finding and lab value that I had given to him along with his exact response. Finally the consulting nephrologist comes in very early, so I grab him and drag him down to the room. He started to get angry at me asking why I had let the patient deteriorate to such a point. I explained to him what I had been going through with the attending and he really went ballistic. There was a phone on the wall outside the patient's room and he called the attending and really blessed him out. The next morning I was in the DON's office having been accused of not relaying vital information to the attending. I retrieved my notes from the night before and showed them to the DON and the hospital CEO (who had gotten involved by this point). They both agreed that the physician was in the wrong and was trying to cover up his own inaction. I got an apology from the DON, but never got one from the attending. He avoided me like the plaugue from then on.
  6. by   lindarn
    Quote from Spitfire1500
    Yes, I agree that you should always document that no new order were rcvd. Case in point: I was working ICU one night and had a 400 pounder that was tanking with no BP. Called the doc for some orders and he gives me a 250cc challenge. I rolled my eyes, gave the bolus and had the doc back on the phone within 5 minutes. I made no less than six calls to the doc, hoping to get some pressors on board. I documented EVERYTHING, including every single vital sign, assessment finding and lab value that I had given to him along with his exact response. Finally the consulting nephrologist comes in very early, so I grab him and drag him down to the room. He started to get angry at me asking why I had let the patient deteriorate to such a point. I explained to him what I had been going through with the attending and he really went ballistic. There was a phone on the wall outside the patient's room and he called the attending and really blessed him out. The next morning I was in the DON's office having been accused of not relaying vital information to the attending. I retrieved my notes from the night before and showed them to the DON and the hospital CEO (who had gotten involved by this point). They both agreed that the physician was in the wrong and was trying to cover up his own inaction. I got an apology from the DON, but never got one from the attending. He avoided me like the plaugue from then on.
    It might also be a good idea to make copies of your nurses notes. MDs, and others, have been know to remove notes from the chart to make you look bad, and exonerte them. I have seen it happen more than once! CYA!!

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  7. by   AuntieRN
    Quote from RainDreamer
    Well I asked the question, because it is something to question, as I've had someone recently tell me that it's not appropriate, but couldn't give me a good reason why.

    If I notify the doctor about something and don't receive any new orders, then I always type in my notes "no new orders received".

    I was just curious as to what everyone else does, but by the looks of it, my first assumptions were correct.

    Thanks everyone!
    I always chart when I called, who I called, when they called back and if I received new orders I chart "new orders received" and if there are no new orders I chart "no new orders received." Doctors will cover their butts and lose yours in a second...its a dog eat dog world out there.
  8. by   RN4NICU
    Quote from lindarn
    It might also be a good idea to make copies of your nurses notes. MDs, and others, have been know to remove notes from the chart to make you look bad, and exonerte them. I have seen it happen more than once! CYA!!

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    Luckily, with the trend toward paperless, this is less of a problem.

    Also know that when you present your copies as evidence, you will have to answer for why you have personal copies of a patient's medical record. That violates the policies of every hospital I know, and likely would violate privacy laws as well. You could very easily burn the a** you are trying to cover.
  9. by   RN4NICU
    double post
    Last edit by RN4NICU on Nov 19, '07
  10. by   Todd SPN
    Yes, I chart it. When I send a FAX I always ask "Any new orders?" Hopefully I'll get response of yes or no.
  11. by   grace90
    Quote from pagandeva2000
    I would probably say "no new orders" as well. Can't trust those physicians.
    When I've reported an issue to a physician and gotten a nasty reply, or no reply or hung up on, I chart what happened. i.e.:

    "Dr. HeadinRear notified of pt's increased pain and threat to go AMA without increased pain medication. No new orders received. Dr. HeadinRear's reply was "I don't care if she wants more pain medication. She's not getting any. She can go AMA for all I care. Don't call me on this patient again."

    or "Dr. ChronicGrouch paged x3 on pt's high blood pressure. No response received at this time."
  12. by   Rnurse4963
    cya recently called a md and forgot to chart it he denied i called him "cover your ass" chart that you called and no orders received he might say he gave you orders because doctors think they can say and do whatever they want
  13. by   Xbox Live Addict
    Quote from grace90
    When I've reported an issue to a physician and gotten a nasty reply, or no reply or hung up on, I chart what happened. i.e.:

    "Dr. HeadinRear notified of pt's increased pain and threat to go AMA without increased pain medication. No new orders received. Dr. HeadinRear's reply was "I don't care if she wants more pain medication. She's not getting any. She can go AMA for all I care. Don't call me on this patient again."

    or "Dr. ChronicGrouch paged x3 on pt's high blood pressure. No response received at this time."
    Yes. Document all the juicy four-letter words the doctor may use too. Seriously. And call your supervisor right away. I had a scenario exactly like this years back and charted down two pages of notes when things settled down. The family of the resident fired the doctor from his care.

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