Is there a Doctor in the house? Working a code without one in an LTAC

  1. I work in a freestanding LTAC and there are times when we have no doctor present. In the case of a patient coding, we are supposed to call the doctor on call for that patient's group, and take orders from him/her over the phone for working the code. Until the doctor calls we just follow ACLS protocols. We're not supposed to call EMS to come and take the patient out either. Does anyone else work places that do this? I have to admit, I'm not really comfortable with this. I guess I'm not very trusting because what if we get a doctor on the phone who won't give orders or, in the case of a bad outcome, refuses to call the code over the phone, or doesn't admit to giving orders, or never even calls back, etc. What do you all do in your LTACs? Thanks for any and all input. Sorry if I sound paranoid.

    Pam
    •  
  2. 30 Comments

  3. by   KellNY
    Quote from MrsWampthang
    In the case of a patient coding, we are supposed to call the doctor on call for that patient's group, and take orders from him/her over the phone for working the code. Until the doctor calls we just follow ACLS protocols. We're not supposed to call EMS to come and take the patient out either.
    3 words:

    Oh HELL no!
  4. by   TracyB,RN
    Quote from KellNY
    3 words:

    Oh HELL no!

    DITTO!!!!!!!

    They don't want you to call EMS for transport? Run, run, run!!!!!!
  5. by   AnnieOaklyRN
    uh yeah... that is a law suit waiting to happen!!
  6. by   jmgrn65
    why on earth would you not call ems, the majority of code i have participated in the patient is intubated, can you handle vents, gtts etc. It doesn't make sense not to call ems.
    I agree with op LAWSUIT, I would also bet that if patients and thier families knew this little tidbit of info they would be getting the h*** out of there!
    and so would I. Unless you don't like your license much.
  7. by   justme1972
    Quote from jmgrn65
    why on earth would you not call ems, the majority of code i have participated in the patient is intubated, can you handle vents, gtts etc. It doesn't make sense not to call ems.
    I agree with op LAWSUIT, I would also bet that if patients and thier families knew this little tidbit of info they would be getting the h*** out of there!
    and so would I. Unless you don't like your license much.
    I'm not a nurse, but calling EMS doesn't make sense either.

    Mainly because, I recently found out that not all EMS are difibulator certified and in cases of a code, have to WAIT on the person that is certified to show up before they respond, and of course, you mine as well not even leave the house b/c the person will be dead.

    No way would I work in a facility where patients were coding with no doctor.
  8. by   TazziRN
    Quote from Hopefull2009
    I'm not a nurse, but calling EMS doesn't make sense either.

    Mainly because, I recently found out that not all EMS are difibulator certified and in cases of a code, have to WAIT on the person that is certified to show up before they respond, and of course, you mine as well not even leave the house b/c the person will be dead.

    No way would I work in a facility where patients were coding with no doctor.
    That's called a tiered response. When EMS is activated all levels are sent, often the first on scene is a BLS unit. But at least the ALS unit is on the way, versus not being en route at all!

    I would not be working in a facility like that.
  9. by   reesern63
    I don't think so.
  10. by   NPinWCH
    You, as the nurse, are held to a standard of care. If you don't maintain the standard you breech your duty. Unless the pt has an advanced directive in writing indicating that you shouldn't begin rescusitation, or there is family present with power of attorney indicating the same. You have a duty to rescue, which includes all ACLS steps. The first of which is, "Call a code/activate EMS".
  11. by   P_RN
    To me you are a ciizen, the patient is a citizen and they have the "right" to be provided withwhat their taxes pay for....don't start an immigration fight here please. You have the "Right" to call EMS on anyone you darned well please. A good paramedic on the spot beats a dozen docs in a call box.
  12. by   jmgrn65
    Quote from Hopefull2009
    I'm not a nurse, but calling EMS doesn't make sense either.

    Mainly because, I recently found out that not all EMS are difibulator certified and in cases of a code, have to WAIT on the person that is certified to show up before they respond, and of course, you mine as well not even leave the house b/c the person will be dead.

    No way would I work in a facility where patients were coding with no doctor.
    When you call ems a squad comes and yes I think they all emergency squads have defibs, at least aed's. they can also take the pt to the hospital while treating/coding pt.
  13. by   justme1972
    Quote from TazziRN
    That's called a tiered response. When EMS is activated all levels are sent, often the first on scene is a BLS unit. But at least the ALS unit is on the way, versus not being en route at all!

    I would not be working in a facility like that.
    Thanks...we had a neighbor about 6 years ago that died. She had a heart attack at home, they called 911, and when first responders finally got there, we found out they had to go and "pick up" the only guy that was working that night that was certified to use one of those machines. Of course, because it took them 24 minutes to repond, she was dead when they got there.

    What irritated the woman's husband the most was that the first question they asked when they walked in the door was if she had a DNR order. He didn't even know what that was, and he couldn't even believe that was a priority when they walked in.
  14. by   suzanne4
    If a patient codes in a physician's office, trust me the first thing that they are going to do is call 911 and get some help.

    And if you take the time to think about it, most of the doctors that cover LTAC, are family practice physicians , or internal medicine that do not have a hospital practice, and are not used to running codes in the first place. How can they be giving you orders of what to do; when they are not there to assess the patient?

    Long term care facilities of any type do not have the equipment to run a full code. Most of the staff there is not trained in ACLS, nor are they able to always read strips in the first place. Nor is their usually any of the equipment available, that is why 911 should always be called. That is what they are there for. Even if the LTAC is across the parking lot from a hospital, they need to be called.

    I would also follow up what is written in the policy and procedure manual of the facility, and follow that. Not the order to phone the physician for orders. Many times you are the only nurse there, so if you are speaking with the physician, who in the world is running the code?
    Last edit by suzanne4 on May 27, '07

close