A little help?

[greenfiremajick]

A little help, pls? Here's what I have so far:

In order to identify a priority focus area (PFA) in the individual tracer questionnaire, it is necessary to view the priority focus process, part of which has been provided for, and by, our hospital. In the case study, I have identified the question/action of " What do you do if a physician writes an order with one of the unacceptable abbreviations? " with a notes/deficiencies identified as "Call him and clarify order. Rewrite verbal order without abbreviation," as a patient care issue for our hospital. This can directly affect the care our patient receives, most especially if the MD is unable to be reached.

After identifying this area, I need to come up with an action plan that addresses what to do if an MD cannot be reached and it is an emergent situation (I've been in a situation like this before, but it was when I was working as a neurodiagnostic tech and we couldn't reach the MD, but someone else handled it and I was brand new). Since I am unsure as to what can be done in the hospital for this type of situation, I'm asking for your help. What kind of actions could be taken to address the possibility that an MD might not be able to be reached in an ER situation and his orders are not legible, or acceptable (as per policy) to be carried out?

Thanks for any help you might be able to give!

No, I'm not asking for someone else to do my homework. I just need some suggestions.....for this one area....

[iluvivt, BSN, RN]

Every hospital has a chain of command. if a physician cannot be reached after reasonable attempts you should call the next person in that chain. Sometimes it is the house supervisor who then will call the Chief of Staff. You should always know the organizational structure in the facility in which you work.

[greenfiremajick]

Every hospital has a chain of command. if a physician cannot be reached after reasonable attempts you should call the next person in that chain. Sometimes it is the house supervisor who then will call the Chief of Staff. You should always know the organizational structure in the facility in which you work.

Thx for the reply. So this is your chain of command, then?

[WildcatFanRN, BSN, RN]

In a place I used to work the policy was this, since we had residents.

Can't get a hold of Resident then you call the Chief Resident. If no response you call the Attending over that group, by this time the House Supervisor is informed. Now, once you got to this point and still no response you have to get the House Supervisor involved because now you have to get a hold of the Chief of the Department. If it gets to that point things are going to hit the fan really quickly.

This is how one chain of command might go if I remember it correctly. I could be missing a step.

Hope this helps.

[greenfiremajick]

In a place I used to work the policy was this, since we had residents.

Can't get a hold of Resident then you call the Chief Resident. If no response you call the Attending over that group, by this time the House Supervisor is informed. Now, once you got to this point and still no response you have to get the House Supervisor involved because now you have to get a hold of the Chief of the Department. If it gets to that point things are going to hit the fan really quickly.

This is how one chain of command might go if I remember it correctly. I could be missing a step.

Hope this helps.

Thanks, much wildcat!

[proudnurseRN]

This could go a few ways at our hospital.

True emergency... call rapid response. A team of nurses, RT, and a MD (usually a resident) responds and gives orders.

An emergency that needs addressed soon but can wait a little while... continue to page on-call doctor. The final page should be a 911 or stat. If at that point you are trying to reach an on-call then we have the actual doctor paged even if not on-call.

Depending on what's going on, we may try another MD on the case. This just depends on the situation and if the other MD can help (usually in a pain control situation, or needing a stat lab or x-ray).

Finally, if none of the above apply, we call the house supervisor to proceed. However, we would never go that route in a life or death situation...that's what rapid response is for.