Can't get a hold of Dr.!

Mulan · Mar 31, 2011

This happens often with one of our docs. esp at night. He will call back 8 hrs later as if that's normal. We had an inservice the other day when the DON and Admn said we can NOT chart attempted to notify MD return call pending. I was like "yeah right..." and when a lawsuit drops,,,how exactly am I supposed to prove that I did infact attempt to notify the doc??

and why not?

MouseMichelle · Mar 31, 2011

Call the medical director.

ReWritten · Mar 31, 2011

After paging 3 times, if we can't get the doctor on call, we give them a call on their cell phone/home phone. That's after confirming that they are infact on call. (I work nights)

Forever Sunshine, ASN, RN · Mar 31, 2011

We try the MD, if they don't call back in 2-3 hours we are supposed to call the medical director. (who is the weirdest man on the face of the earth.. nobody likes to call him. ) But in that case.. I would give the 10 units(our orders state above 400 give 10 units and notify md) and call the doctor. if the doctor hasn't responded in an hour.. i recheck.. if its lower .. leave a note on the report sheet stating dr so and so was notified at 4:30pm for BS of 425.. 10 units reg insulin given as per sliding scale orders. Awaiting call back from MD.

morte, LPN, LVN · Mar 31, 2011

Had a similar situation with a patient I had recently while working my paramedic job. We were called to a local long-term care facility for a "request to transport patient on a monitor." Mind you, I was not working the SCTU (transport unit), but a 911 paramedic unit.
What happened was this: At 1130, patient (with multiple hx including DVTs, obesity, type 2 diabetes, HTN, released from hospital 2 days prior s/p knee replacement) c/o chest pain. Nurse gave pt mylanta and called doctor. (hmmm ?) Pain resolved within a half hour or so. MD finally called back about 1800 and told them to call for transport with monitor to the contracted SCTU service. The contracted service did not have a unit readily available. The doc then told them to call 911. Thus why we were summoned.
Of course at this point the patient was totally complaint free, so as a paramedic in a 911 situation, we were not really needed. We did a complete assessment on the patient, EKG, vitals, blood sugar, etc., and found nothing outside of normal limits. Patient had no drips or running IVs, only a capped, heparinized PICC line. Our role is not to provide monitored transports to a patient for whom ALS can not be justified. We called our medical control physician and explained the situation. In our system we respond as a non-transport ALS unit with a dual dispatched BLS ambulance. With the base physician's authorization, we released this completely stable patient to the BLS unit for transport.
This of course did not sit well with the nurse in the LTC. I felt for her, because as an RN, if I were placed in a similar situation, I'd be very uncomfortable. When I asked why they did not simply call 911 when the patient was acutally experiencing chest pain, they said that they were told that they have to have authorization from the MD first and he didn't call back...for six and a half hours. I was dumbstruck. Do the LTC folks out there really have restrictions like this?
We ultimately explained to the nurse there the patient was stable and really did not need our services on the relatively short transport to the ER. She understood fully, but I think had some trepidation about explaining the situation to the MD. I would certainly not have wanted to be in her shoes. IMHO, these folks need to have a little more autonomy in decision making. They should not have their hands tied playing phone-tag with the doctor in a potentially serious emergent situation.

I work long term care. If the mylanta worked, why was the doc even called? That said, I am sure you are familiar with the phrase "it is easier to defend a live one, than a dead on." I have been in the position of having called a doc on a lower GI bleed, sitting in a puddle of blood, no call back in 20 minutes. Called 911, patient OUT OF THERE! doc called back about 2 hours later....his answer? "Good, sometimes ya gotta do, what ya gotta do."

In this case there apparently was a problem with the service/phones....

We have seen other instances of this, waiting for a doc call back, here at allnurses....I don't get it, if nurses are routinely sending out patients that don't need to go, they need reeducation, perhaps an assessment course, not a blanket statement that no nurse at that facility can send a patient out! I have a pretty good record of send outs=admission to hospital.

Kooky Korky, BSN, RN · Mar 31, 2011

Situations like this bother me to no end. I hate feeling helpless as to intervene and waiting for the almighty MD to call back with orders that I was already anticipating. I hate being at the mercy of an MD for simple little things like this. Many of our docs forget order sets (like a tele order set includes nitro, EKG for HR > 140 sustained or :clown::clown::clown:
It's a little off subject I know, but blargghhhhh

A smart Resident should call each ward and ask if the nurses needed anything before the Resident tries to nap. At least some of the reasons for waking the Res up at night would be caught and fixed. So sad that this goes on in so many places for so many years. I wonder if it will ever get fixed. Maybe you could help the Res by suggesting this approach.

CoffeeRTC, BSN, RN · Mar 31, 2011

Were you leaving a message with the service or some other way? If there is an answering service, I will impress upon them the urgency of the matter. Sometimes they have other ways of getting ahold of docs. I've been known to hunt them down in the hospital (If I knew they were doing rounds and this was at his request)

What do you all do when it you can't get a hold of a doctor or the medical director?? This has happened to me before and I had to get creative once an other time I just erred on the side of caution and sent this person out. Turned out they had a GI bleed and some other issues.

Kooky Korky, BSN, RN · Mar 31, 2011

i work long term care. if the mylanta worked, why was the doc even called? that said, i am sure you are familiar with the phrase "it is easier to defend a live one, than a dead on." i have been in the position of having called a doc on a lower gi bleed, sitting in a puddle of blood, no call back in 20 minutes. called 911, patient out of there! doc called back about 2 hours later....his answer? "good, sometimes ya gotta do, what ya gotta do."
in this case there apparently was a problem with the service/phones....
we have seen other instances of this, waiting for a doc call back, here at allnurses....i don't get it, if nurses are routinely sending out patients that don't need to go, they need reeducation, perhaps an assessment course, not a blanket statement that no nurse at that facility can send a patient out! i have a pretty good record of send outs=admission to hospital.

i don't believe for a minute that the answering service's phones were out of order. not for a minute. i have had too much experience dealing with answering services that turn their phones off or don't answer calls while they have a toilet break or do something else for over an hour. this is inexcusable. completely unconscionable. it is a danger to patients and a serious waste of the time of the nurses who are trying to reach doctors. i'd bet my eyetooth that there was nothing wrong with their phones. :mad:

also, nurses are expected to have x ray eyes and to read ekg's that have not been run (or run bot not read by a cardiologist or specialist cardiology nurse). we are expected to make decisions without benefit of labs. we are not allowed to diagnose but that's exactly what everyone implicitly expects of us. they expect us to figure out (diagnose) what's wrong and what's needed to fix it.

i know of doctors who are on call but go to ball games, hockey games, and other loud places. even if you reach them on their cells, they can't hear you, they have to go to a quieter area, and they don't want to do that. so, they don't call you back right away. docs are human and do all kinds of things to get out of having to answer their after-hours calls - including turning off their phones. :eek: :devil: then they blame the service.

i do understand the problem. i know they're tired and need their off-duty time, family time, etc. but they also are expected to provide atc care for their patients. and they try to blame nurses for calling them, or blame the answering service's phones.

as for the don's directive to not chart that a doc could not be reached - throw that advice where it belongs - in the trash. the nurse's first job is to protect her license and her livelihood. if you think it's necessary, keep a copy of your notes about unsuccessful attempts to reach doctors.

and when you chart, keep it non-accusatory. just say "called 441-4441, no answer by dr. jones; also no answer at 123-4567; ms. smith, charge rn notified, says to ________ (whatever she said to do); patient's vs ___________; stable at present, alert, resting quietly in bed";

just keep it simple. if need be, you can contact the next supervisor up the chain and/or the medical director. what else can you do? i guess you can go on and call 911 if your pt becomes seriously unstable. better to have to defend yourself for that than to let the pt go seriously downhill while you did noting but wait for a doc to call back - a doc who will deny that you ever tried to reach him.

thank heaven for easily traceable phone records these days.

morte, LPN, LVN · Mar 31, 2011

i don't believe for a minute that the answering service's phones were out of order. not for a minute. i have had too much experience dealing with answering services that turn their phones off or don't answer calls while they have a toilet break or do something else for over an hour. this is inexcusable. completely unconscionable. it is a danger to patients and a serious waste of the time of the nurses who are trying to reach doctors. i'd bet my eyetooth that there was nothing wrong with their phones.
also, nurses are expected to have x ray eyes and to read ekg's that have not been run (or run bot not read by a cardiologist or specialist cardiology nurse). we are expected to make decisions without benefit of labs. we are not allowed to diagnose but that's exactly what everyone implicitly expects of us. they expect us to figure out (diagnose) what's wrong and what's needed to fix it.
i know of doctors who are on call but go to ball games, hockey games, and other loud places. even if you reach them on their cells, they can't hear you, they have to go to a quieter area, and they don't want to do that. so, they don't call you back right away. docs are human and do all kinds of things to get out of having to answer their after-hours calls - including turning off their phones. then they blame the service.
i do understand the problem. i know they're tired and need their off-duty time, family time, etc. but they also are expected to provide atc care for their patients. and they try to blame nurses for calling them, or blame the answering service's phones.
as for the don's directive to not chart that a doc could not be reached - throw that advice where it belongs - in the trash. the nurse's first job is to protect her license and her livelihood. if you think it's necessary, keep a copy of your notes about unsuccessful attempts to reach doctors.
and when you chart, keep it non-accusatory. just say "called 441-4441, no answer by dr. jones; also no answer at 123-4567; ms. smith, charge rn notified, says to ________ (whatever she said to do); patient's vs ___________; stable at present, alert, resting quietly in bed";
just keep it simple. if need be, you can contact the next supervisor up the chain and/or the medical director. what else can you do? i guess you can go on and call 911 if your pt becomes seriously unstable. better to have to defend yourself for that than to let the pt go seriously downhill while you did noting but wait for a doc to call back - a doc who will deny that you ever tried to reach him.
thank heaven for easily traceable phone records these days.

i did reach the doc, the alledge malfunction was between them and the doc.

LilMissAlwaysCurious · Mar 31, 2011

First, you have to know what your organization's policy is (always a good resource).

Ours would be... If the physician cannot be reached, the RN will follow-up every 15 minutes X 2 attempts. If unable to reach the MD, the RN will notify the charge nurse/ANS/lead RN to activate the Chain of Command.

Hope that helps.

smily nurse, BSN, RN · Mar 31, 2011

Document, document, document...... including that doc did now know they were on call. :yeah:

Forever Sunshine, ASN, RN · Mar 31, 2011

Were you leaving a message with the service or some other way? If there is an answering service, I will impress upon them the urgency of the matter. Sometimes they have other ways of getting ahold of docs. I've been known to hunt them down in the hospital (If I knew they were doing rounds and this was at his request)
What do you all do when it you can't get a hold of a doctor or the medical director?? This has happened to me before and I had to get creative once an other time I just erred on the side of caution and sent this person out. Turned out they had a GI bleed and some other issues.

Our medical director takes about a half hour to call back. Sometimes an hour or two. If this was an urgent issue and he was taking his sour(not sweet) time, I would notify the nursing supervisor who would then call the administrator on call(either DON or ADON for example) and give us further instructions.

Fortunately most of our residents have a physician who has an on-call physician covering for her on the weekend. They are really great with us calling back quickly or even answering the phone when we call.