Sending residents to the ER without a doctor's order. - page 3
I can usually get the doctor to return my call on night shift. However, last night the Dr. was out of town. I called his answering service and she said a different Dr. was on call for this doctor.... Read More
May 9, '05I send people to the ER all the time without a Dr's order.
But our 2 staff doctors and the facility approve of it.
However, first, all of us nurses try to get hold of the doctor to let him know what is going on, and if he wants to give orders that we can carry out, fine, or he can decide to have them sent to the ER himself, but if by chance we cannot get the doctor we send them to the ER. Even if it turns out to be nothing, or something minor, we have that option, if we are worried at all, in any way about the people we take care, we can send them out. It's not a problem where we work.
I guarantee you, if we didn't do something and it turned out bad for the person, we would be in trouble. We'd have parents down on us like.....well, I won't use THAT particular term.
But it would be bad, believe me.
May 10, '05I thankfully don't work for the facility that fired my friend,but I did have two pts that were seriously ill and called the on call dr who called back after 2 minutes and sent them to the er. I have yet been in the position that i cannot reach a dr. and i needed to call 911 first. Alot of the dr.'s say well if they are dnr-cc then keep them!!!:angryfire
May 11, '05I just sent one in day before yesterday without MD order. He had a change in condition and has s/sx of MI, then all the sudden started slurring and had facial droop. He is a full DNR with comfort care only...okay...well my facility doesn't have a pharamcy on the weekend so there goes any comfort meds, and we don't have O2 (assisted living)...so there shoots that one...so I sent him in to get "comfort" considering we had no way to provide it!
Well that and the patient asked...can't deny them..and the paramedics knew this was a tricky call (I know my paramedics well and we consult before every transport...they trained me ). and called his son to see what the family wishes were (nice teamwork..I love my paramedics!)...that is when the patient took the phone and went from speaking clearly to slurring and the son said TAKE!
He is still at the hospital..don't know what is up yet, but considering they didn't just bring him back (the old folk boomerang as we call it) shows again...my clinical judgement was fair and just .
I tell people that if you want NOT to be taken to the hospital or 9-11 called, you MUST get on hospice so that facilities like ours aren't liable for not sending...if they are on hospice they have a do not send order, and you can feel free to consult with them if you find yourself thinking that they really should go in (I had a patient that fell while on hospice and we sent them in since that had nothing to do with their hospice Dx).
Plus, hospice does an AWESOME job of getting comfort implementations in place and all the things necessary to help a patient with end of life and not sending them into a hospital...