Protecting The Docs

SmilingBluEyes · Apr 9, 2003

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!

cokie · Apr 9, 2003

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.........

fergus51 · Apr 9, 2003

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.

SmilingBluEyes · Apr 9, 2003

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.

mark_LD_RN · Apr 10, 2003

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:)

cokie · Apr 10, 2003

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........

kitty=^..^=cat · Apr 10, 2003

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.

cokie · Apr 14, 2003

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..........

mother/babyRN, RN · Apr 14, 2003

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....

mother/babyRN, RN · Apr 14, 2003

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....

GailWHNP · Apr 14, 2003

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