when to call doc wows?

bethem · May 27, 2007

i am a new nurse i worked night shift. so my dilema is it approriate to call the doctor for certain manners or not. take for instead a pt ask me to call his doc for meds to make him make stools. do we call doc late at night for such matters or wait till morning. when do you guys feel it approriate or not to call doc i need situations?
also it is my understanding we only called the doc for critical lab values is this true?

Can't you nurse initiate laxatives/stool softeners? RNs in NSW (Australia) can nurse-initiate those drugs (and some other typically over-the-counter type drugs) for up to three doses per drug. That would get you through to the morning.

Daytonite, BSN, RN · May 27, 2007

Use the search and search using this word: sbar. Read the threads that talk about SBAR. It is a technique that gives you guidelines on calling doctors for orders.

I was told this many years ago. If you are calling a doctor for an order, make sure you know what it is you are asking the doctor for and why. Have information from the patient's chart to back up your reasons because the doctor is probably going to ask you for it and you're going to look pretty stupid if you don't have it to give him.

In answer to your question, it depends upon how late at night it is. For constipation I would call a doctor up until 9 or 10pm at night. After that, everyone is going to bed. Unless the patient hasn't had a BM in 4 days (how come you're just finding that out now?) or is distended and screaming in pain (again, how come you're just finding that out now?) it waits until morning. If the patient insists, then call. There is always someone on call. But, be prepared to answer for why you didn't make the call earlier. BMs are basic assessment data.

onduty23 · May 27, 2007

thanks

CritterLover, BSN, RN · May 28, 2007

i am a new nurse i worked night shift. so my dilema is it approriate to call the doctor for certain manners or not. take for instead a pt ask me to call his doc for meds to make him make stools. do we call doc late at night for such matters or wait till morning. when do you guys feel it approriate or not to call doc i need situations?
also it is my understanding we only called the doc for critical lab values is this true?

not just for critical lab values.

in fact, there are some "critical" lab values that i wouldn't call the doc about in the middle of the night. positive blood cx on someone already being tx'd appropriatly? nope (a "critical" lab value in my facility). ok if you arn't sure the lab is being treated correctly, but if the patient is arleady on broad-spectrum abx becasue the doc anticipated positive blood cx, then i'm not calling. it can wait until morning.

call a doc for an alert k+ level on a patient that has a prn for kcl iv? nope, again, not calling.

call a doc for an alert bun or creat in a dialysis patient? again, no, not calling.

i could go on, but i'll spare you :) .

my (general) rule: is the phone call going to address the patients comfort and/or well-being, and is it (or should it) going to change management?

as for the laxative (and other basic needs) request: is there some nursing intervention that can be done first? warmed prune juice with a couple of pats of butter in it (i know, :barf01: , i agree) works wonders. unless the patient is on a restricted diet (and a very restricted diet, at that) this is within the scope of nursing interventions.

c/o gas pain? forget the rx for gas-x, walk them. (if possible)

can't pee? hands dipped in warm water (and some privacy -- some people get "stage fright") will work, too.

(i worked as a cna on a post-op floor, so many of my nursing intervention ideas come from that population)

there are many, many things that docs need to be made aware of in the middle of the night. critical labs are only a small part of it, (and those may have already been covered--in anticipation--with prn orders, negating the need for a call.) unrelieved pain is one. any significant change in patient status. much of this is difficult to determine when you are new. that is where your coworkers come in. but is always better to call, than to not call. as daytonite said, have your info together and know what you want to say.

it is also nice (though not necessary) to check with your coworkers to see if anyone else needs something they were going to call about a little later.

sometimes, there are things that need to be taken care of on your shift, but don't need to be addressed immediatly. these things can wait until after 6am, when most docs are already up. iv blew and can't be restarted and you want an order for a picc? that can usually wait until morning. especially since (this is my current job) i'm not coming in during the middle of the night to put the picc in (now, if the patient is getting something critical, you may need to call anyway to give the doc the option to come in and put a central line in -- even though that will never happen if you work where i work. it still gives them the option.)

i will say this: in the medical world (docs and med students) much ado is made over the 2am nurse call for a tylenol order. this is what i have to say: 1. if you don't want to be called for it, order it on the admit orders, i can't control when the patient spikes a temp; and 2. i didn't call to ask for tylenol, i called because the temp spike. thought you might like other things, like cultures, maybe an xray, maybe a ct (depending on the situation -- when i worked inpatient, i mostly worked surgical icu, so these were the common orders). i didn't call for the tylenol order, but did ask you for it while i had you on the phone. :)

caroladybelle, BSN, RN · May 28, 2007

Can't you nurse initiate laxatives/stool softeners? RNs in NSW (Australia) can nurse-initiate those drugs (and some other typically over-the-counter type drugs) for up to three doses per drug. That would get you through to the morning.

Nothing drugwise can be initiated in the USA for the most part without MD approval. Some places do have standing orders, some do not. Some states permit nurses to order vaccines.

-------------------------------------------------------------------------

There are more things that merit an MD call in the night other than critical labs. And a lot depends on the patient and the MD. But if I were to call most MDs after 2100 for a laxative, they would be ticked, because in most cases, it can wait until AM. And if it has been 3-5 days, they will be ticked that days did not handle this and earlier than 3-5 days, and rightly so.

The critical labs - it depends. I work oncology, and get calls about WBCs of 0.2 - generally an expected outcome during certain parts of the chemo cycle. Unless it is an admit, probably can wait until the next AM. Besides, what is the MD going to do, if they are afebrile - mostly initiate neutropenic precautions, which nursing does automatically. In a preop nononcology patient - much bigger deal.

A pre-op patient with a platelet count of 25 is a big deal. A chemo patient or leukemic that is not actively bleeding- not a big deal and often expected.

Fevers. A temp of 100.5 in a first night healthy postop - not a big deal. A temp of 100.5 in a neutropenic patient or recent chemo, though is a MAJOR deal and rates a call in most cases.

It depends on the patient, and the situation.

onduty23 · May 28, 2007

thanks a million

caroladybelle, BSN, RN · May 28, 2007

....duplicate post

meandragonbrett · May 30, 2007

I would wait until 0600 to call and get an order for MOM or another laxative. Unless the patient is rock hard and really does NEED it right NOW.