Who writes incident reports, you or the doc

  1. After having a terrible nite, I have come to realize that I'm sick of doctors that are rude. I had an admission last nite from the ER, which the pt was seen by the ER doc at 5pm. He arrived on my floor at 11pm. Shortly after his arrival, I had a discharge, transfer to ICU and an admission. There was an order for a consult to be called "today". The ER secretary didn't call the consult because it wasn't STAT. Chart checks on the floor were not done till 3am (that would be the next day) I had to call the doc at 6am because of no order for tylenol for a temp. He asked me if the consulting doc had seen the pt and I said no and explained to him (very nicely) that I didn't get the patient till almost 11pm. He said that the blame should go on the ER for not calling in the consult. About 5 minutes later he called back and wanted me to write an incident report about why the consult wasn't called. At that point I was at the boiling point (obviously he didn't make any points with the nurse in the ER, so TAG.........I was it). I told him if he wanted the incident report made, he should make it himself and turn it in as it was the ER's place to call. Needless to say, I got a visit from the head honcho from the ER and she informed me that it was the DOCTORS place to write the incident report. I already had it done so I gave it to her. Just wondering if anyone else has had this happen to them. While I still had my feathers ruffled, I asked her why a doctor would order a diet for the patient, po meds and accu checks when the patient was NON_RESPONSIVE. I really don't think he even saw the patient. She said that was a good point.
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  2. 14 Comments

  3. by   canoehead
    If the doc wants an incident report filed and you don't agree that there was an incident then it is his right to write one out himself. If he orders you to write one I see no need to follow his order-just tell him he can do it himself. Of course, if there was an incident and you agree there was it is good form to write one in the name of protecting future patients.

    The offending doc in this scenario sounds like a turd, but you gotta separate that from whether the patient suffered because the consult wasn't called. At our hospital if a doc wants a consult called immediately they generally make the call themselves and give a report to the other doc as a courtesy. Perhaps that would have been appropriate in this case since he wanted it done ASAP.
  4. by   gwenith
    Ditto the above
  5. by   SmilingBluEyes
    No one TELLS me to write incident reports. I do them when I am involved, and know the writing of such a report is necessary to cover the situation and my behind. If a person feels it is needed, let HER or HIM write it up. NO CAN FORCE you to write an incident report.
  6. by   MandyInMS
    Guess in that situation first I'd call my nursing supervisor and inform her of the situation..even though I KNOW what she'd say...make out the report stating it was under the instruction of Dr.Turd...and have her co-sign it with me...blah @ incident reports...nobody likes those darn things :/
  7. by   yannadey
    I 2nd what SmilingBluEyes said.
  8. by   niteshiftnurse
    Thanks for the advise. It will be interesting to see if anything comes of it. You guys are great
  9. by   nimbex
    ok. have to fess up, when a doc says "write up a report", I always have, never occured to me to say no. AND, I'm a fairly outspoken person.

    So thanks to you all, my new answer is..."do it yourself if you feel the need".
  10. by   P_RN
    He who finds writes. NEVER include incident report filed in your notes.
    KISS...keep it simple......"patient received on unit at 2300. Consult called to Dr T.... at 0600.

    Sometimes I'd put a sticky on for the NM with names etc but usually an incident report is a Heads Up for management so they're not caught off guard when questioned. NEVER assign blame.
  11. by   redshiloh
    Those orders written for a nonresponsive patient need to be written up...I believe that would be medical malpractice.
  12. by   mattsmom81
    We have 'complain forms' that we utilize when docs or family members are unhappy. This eliminates every piddly complaint going to management in the form of incident reports.

    If the doc INSISTS on the incident report, I do it, making it clear I am writing it at HIS request. Also been known to paper clip the unit's side of things (outside the facts) so that gets looked at too.

    I had a peeved pulm doc the other night with similar scenario...ER doc intubated and called PCP...PCP gave phone order to ER staff at about 8 pm -pulm consult for vent mgmt...pt got to me at 1130 pm and of course ER hadn't called pulm. So I get to call the very
    unhappy doc after midnite. <sigh>

    Now I don't know why it's so hard for our ER staff to at least CALL the consults at a reasonable hour...but it is. Seems like a passive aggressive thing to me....or turf issue.

    We nurses just do the best we can with all these egos. <sigh>
  13. by   Agnus
    If incident reports are utilized as they were designed to be they are for tracking errors and finding and eliminating the cause.
    THEY ARE NOT SUPPOSED to be for disaplining someone.

    He who finds an error writes the report. If some one (such as a Doc) asks me to write one. I write only what I know to be factual. If all that I know is that the Doc asked me to write it and if I have no first hand knowledge of a situation I say that the Doc aske me to write it and I have no first hand knowledge.

    I have never had a problem doing this but then again my facility does not use these punitively.
  14. by   whipping girl in 07
    I have to agree with the person who said, let the doc write the incident report, since HE had the problem.

    Reminds me of a recent incident where a doctor had not seen his patient in ICU all weekend. He made his "rounds" via phone, calling to see how the patient was doing, etc. During one of his phone calls, he asked how the patient was tolerating getting OOB. The nurse told him that the patient had a sat of .88-.90 on 1.00 NRB and therefore she had not gotten her up for fear of desatting. He told her to put an incident report on the chart so he could write her up for not following his orders. The nurse had been calling the doctor's house and cell phone all weekend (does not use an answering service so there's no paper trail when he can't be reached) trying to get some help with the patient's respiratory status and was getting no answer. When he'd "round" by phone, he was updated but gave no new orders. So after all this happened, the nurse was getting ready to leave and was telling me about it. So I asked her if she'd written the doctor up for not seeing his patients (or having a colleague make rounds). Of course she hadn't, so she called him back and told him that if he was going to write her up for not getting the patient OOB, that was fine because she could justify her actions with her nurses notes, but she'd be forced to write him up also for not seeing his patient.

    Long story short...no one wrote anyone up, and he sees his patients every day now or sends a colleague. Still doesn't use an answering service though.

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