I am currently doing a summer externship at a large community hospital. I have one year of nursing school under my belt and will start my last year this fall.
I have a "procedure" question regarding Dr.'s orders and who to call about them.
I had a patient admitted c a wound infection to his inner thigh r/t a mass removed from his scrotum, member and inner thigh region. After his surgery he was d/c but 5 days later returned to the hospital because of wound infection. Byt the time I had him as a patient he was 7 days post op. Was passing some gas, voiding well but had not had a BM since before his operation. He was complaining of abd. pain and distention. I knew that doctors would be making rounds relatively soon and told him that I would keep an eye out for the doctor or resident to address this with them and that if he should see them when they come to check on him, that he should also bring it up to them at that time. He had allready tried colace for 2 days and an enema the day before which did not work for him. The patient requested a phos. soda because he had used those before and they worked very well for him.
As the evening wore on I became busy with other patients and when I went to check on this particular patient later on, he said that the doctor had seen him and that he explained to the doctor that he wanted the phos. soda. I said I would check for new orders and see what the dr. wrote. I checked the chart and the doctor wrote an order for another enema. I explained this to the patient who refused the enema because he only wanted the soda. He was very adamant about this.
I went to my preceptor who looked at the order and instructed me to page the doctor (who is not normally on our service) that wrote the order for the enema to see if we could d/c the enema and get the 30mL of phos soda. We did not know if there was a particular reason that the phys. did not write for it in the first place.
I paiged the doctor who wrote the order, he was still in house. He was really sarcastic about being paged to order a phos. soda to clear this guys bowels and how he was a Chief, etc. etc. He did allow me to take a verbal for the phos. soda, so my patient was happy.
I guess my question is, if I wasn't supposed to call this doctor that was in house and wrote the original order, who else should I call, one of his residents? And how are you supposed to know what level of phys. a doctor is if you don't normally work with them?
I say if he didn't want to be called about a phos. soda, he should have listened to his patient better and written right the first time, but I'm just a student, perhaps this is a wrong ideology?
My preceptor had no problem with me contacting this doctor directly to change his order. Another preceptor I had for a day a few weeks later and probably didn't know the whole story said she would never call a Chief for an enema/phos. soda. I wonder who she would have called then?
Is there some sort of protocol in dealing with doc.'s?
