Protecting The Docs

  1. does anyone else have trouble with doctors that don't flag the charts with new orders, or tell anyone, or put them in the new order rack, and somehow expect the orders to be carried out.......not sure whose job it is to educate the docs about this, and i know that they go to more than one hospital, and that they are busy, but they need to share responsibility for missed orders if they are not going to at least flag the chart. wow, guess i'm still venting (see post, when ob means o-boy, what a night) this also happened last night.
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  2. 12 Comments

  3. by   SmilingBluEyes
    I generally do not have this problem, but then when the docs round, I always check the charts for new orders. It has always been my habit and has kept me out of trouble all these years.

    Sorry yours was such an ugly night.Hope things get better soon!
  4. by   cokie
    sounds good, but i was team leading, which meant 4 charts of my own and 6 of my lvns. that is 10 charts to check, unless i can be a private i and figure out which doc saw which pt., and was it mine (and in this case was the lvns). my question is that if these people (docs) were intelligent enough to make it through med school, wouldn't one think that they would be trainable IF they want us to see there orders, and have more time to take care of their pt., instead of looking for orders in 10 charts.....just a thought.........
  5. by   fergus51
    Our docs have a slot where they have to put the charts when they write orders and the unit clerk or charge is responsible for making sure the nurse responsible knows.
  6. by   SmilingBluEyes
    Well you can always try ASKING THE DOCTORS TO FLAG their orders on the charts, reminding them you don't want to miss anything. Or if this is a continued problem with certain physicians, confront them politely and directly about this. All you can do. That or have your tech/unit clerk FLAG them for you. There ARE ways; it just takes a bit of creative problem-solving to find the solution. Preferably when you are not coming from an OH BOY kind of night.

    OH and I have to ask: who do mean to "protect"? the DOCTORS are not the ones really protected when orders are followed, my friend. YOU are. So do what you can to correct this problem as soon as you can.
    Last edit by SmilingBluEyes on Apr 9, '03
  7. by   mark_LD_RN
    most of the docs i worked with have the same habit. I see a doc on the floor i check my charts,plus i randomly check the charts for orders every few hours. when i am lead i encourage my coworkers to do the same plus i go over charts a few times a shift.

    if you find away to get them to do it let me know
  8. by   cokie
    all the suggestions sound reasonable, and i don't want to sound like a negative nellie, but #1: no ward clerk, tech, or charge checking charts for us on PM's. (have a charge, but she has pt. also)#2: really no time to check charts every couple of hours. #3 what i meant by "protecting the docs", is that when orders are missed due to the docs failure (failure to inform, whether it's flagging which we have, racking, which we have, or telling someone, and i was there, but didn't realize she was my lvn;'s doc. ,,,,seems like the blame always lands firmly on the R.N.'s shoulders, no finger is pointed at the doc..... thank you for all the great suggestions though. i will have a talk with this one doc next time i see her......will let you know how it goes........
  9. by   kitty=^..^=cat
    Whenever a med or other order is missed, fill out an incident report and note that the MD didn't flag the order.

    Also, does your hospital's medical staff have a "Obstetrics Committee" or "Perinatal Committee" that the docs attend? If so, you might talk to your nurse manager about putting the issue on the agenda and letting the MDs know that failure to flag orders has resulted in x# of missed meds/treatments and x# of delayed meds/treatments.

    Also, risk management can perhaps help you get the message delivered, since patient safety is such a huge issue these days.
  10. by   cokie
    ok, update, i chickened out. saw the doc, had a chance to talk to her, didn't. cluck, cluck, cluck,,,,,,......,,,,,.....oh well, we can use the eggs..........
  11. by   mother/babyRN
    No matter how intelligent any doctor is, unless you ask them to do so, it probably won't happen consistantly. You simply have to check often and diligently, and if it continues to be a problem not only for you but for others as well, you might have your manager bring it up to the OB chief, so they can discuss the situation and come up with a solution that works for everyone. Ultimately, you are responsible, however, for chart checking, if you are in charge.....I kid around with the docs and sometimes find I have to treat them like my children in order to get them to do as I need them to do....
  12. by   mother/babyRN
    I have asked docs writing orders ( and the night shift is a whole other world for those cranky tired people) just to try to remember to come find me ( they are good about that) or who ever is in charge, and leave the opened chart ( which is the position they were writing in) on the desk so that I will see it when I go by....
    I know it is busy to check all the time, but it is ultimately up to you and it is the rare doc who will take responsibility for something they ordered not being done. Doesn't matter to most of them that they didn't happen to inform you that they wrote new orders. It is all about training the little suckers....
  13. by   GailWHNP
    Originally posted by kitty=^..^=cat
    Whenever a med or other order is missed, fill out an incident report and note that the MD didn't flag the order.

    Also, does your hospital's medical staff have a "Obstetrics Committee" or "Perinatal Committee" that the docs attend? If so, you might talk to your nurse manager about putting the issue on the agenda and letting the MDs know that failure to flag orders has resulted in x# of missed meds/treatments and x# of delayed meds/treatments.

    Also, risk management can perhaps help you get the message delivered, since patient safety is such a huge issue these days.
    To me, this is the best solution! There *is* a chain of command. Docs usually don't pay attention to nurses where I work on "trivial" issues (their perception, not mine) such as this; however I've found the chain of command usually helps tremendously.
    Gail
  14. by   janetrnc
    At our hospital, in order to avoid missed orders, the night nurse checks the charts for orders to make sure a nurse has signed them off then signs in red that the chart has been rechecked

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