Sending residents to the ER without a doctor's order.

Specialties Geriatric

Published

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. When I called that doctor I didn't get a real human on the phone. I just got an answering machine that said "Leave a message and we'll get back to you the next day. Anyway, after 30 minutes and no doctor available I had her sent to the ER. It turned out she had gone into congestive heart failure. Anyway, how about you? Do you ever send out residents to the ER without a doctor's order? Thanks :)

What health care facility DOESN'T require all medical staff (RNs, LPNs, CNAs, PCTs, etc) to be trained in CPR?

A few that I no longer work in-we have come a long way in 30 years in long

term care. I swear to you that I took a DON job in a facility where the administrator told me after I took the job that "everyone here is a DNR" and he meant it. The policy and procedure manual had about 15 pages and one was a policy on who watered the plants. Of course, no one had written " no code" or advanced directive orders. I have been the only nurse with one aide in a building with 60 residents on the night shift. I could have quit, but then there would be the person who thought that was OK to put residents and staff in that position and the poor aide, which I thought was not the best deal for the residents. It got better, eventually.. We have laws that govern staffing but they were no enforced as well as they are now. :roll

Bottom line-just because there are rules doesnt mean they are being enforced. :nono:

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I had a friend who actually got fired for sending a pt to the hospital without a doctors order. At my facility the answering service pages the on call dr. until she talks to him and then they call us back. And if we don't hear from them within 15 minutes we call back. I can feel how helpless you would be knowing that your pt is in serious trouble. I hope your pt is okay.

It is a sad state of affairs when you can get fired for performing a duty that if you didn't do it you could get sued...

I quit working for a large nursing home corporation because they sent out a memo stating that no resident would be allowed to be sent to the ER without first getting the approval of the regional consultant nurse! I could not believe it-and I told them so in my resignation letter. I used to do some consultation on the side for an attorney and in my parousal of court records for the county one day found that one of the facility admininstrators and the DON were named in a law suit for negligent care...I wonder why! I tried to warn them :uhoh3:

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I 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.

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I 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

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Specializes in Education, Acute, Med/Surg, Tele, etc.

I 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...

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