Chest pain do you need an EKG order?

Matthew_RN · Jun 1, 2011

I would be ve

ry surprised if there is not a standing order. If there is not one I bet it would be in place so fast after you bring it to light you could miss it.

usRNs · Jun 1, 2011

Tnx mathew_rn :)

Turd Ferguson · Jun 2, 2011

There should be a protocol in place, however I have seen a facility that did not have such a protocol and one particular provider would raise a fuss if the nurse obtained an EKG without an order.

ckh23, BSN, RN · Jun 2, 2011

There usually is protocol in place, but personally I do the EKG and get the order after. I think a lot of it has to do with billing. The hospital not only bills for the EKG, but for the official reading of it. So if there is no order there is no reimbursement.

Matthew_RN · Jun 2, 2011

I do IS nursing for a large hospital system. I have seen some MDs like the one you said but, you would think they would come around to "helping the patient" by having the dx stuff done asap so they can treat the cause. However, with the way reimbursement is working I know some smaller hospitals could not absorb the cost if it was done and not needed. I still think it's an ego issue tho.

usRNs · Jun 3, 2011

okay so there is question of money & egos... I would think that the doctor would be please to have something to look at right away if the patient is suffering from chest pain especially when it might be fatal to the patient...

so what would you suggest to a new grad like me I have not yet done this but what if i was in a scenario where my patient might need a ekg? would i get in major trouble if i run one??

how do you guys deal with doctors who are not content with such actions? :eek:

btw :tku:

Matthew_RN · Jun 3, 2011

My first question is do you know for sure the standing order is not in place? Both of us have said we have seen this but, its rare. As far as trouble... Where do you work? If it's a larger facility or teaching facility I would be surprised if anyone would say anything. If it's small then your director may ask you to explain your actions. If that happens then just explain the clinical scenario to them and gentle remind them this was a non-invasive procedure.

You may have to eat some crow and say sorry. I would be surprised if it went further assuming this was not the norm.

usRNs · Jun 3, 2011

There should be a protocol in place, however I have seen a facility that did not have such a protocol and one particular provider would raise a fuss if the nurse obtained an EKG without an order.

My first question is do you know for sure the standing order is not in place? Both of us have said we have seen this but, its rare. As far as trouble... Where do you work? If it's a larger facility or teaching facility I would be surprised if anyone would say anything. If it's small then your director may ask you to explain your actions. If that happens then just explain the clinical scenario to them and gentle remind them this was a non-invasive procedure.
You may have to eat some crow and say sorry. I would be surprised if it went further assuming this was not the norm.

Mathew_RN

I'm not employ yet this was just an "if it were to happen"... I know I would definitely check for orders first.... Thank you so much for your feedback it is very helpful to know that I wouldn't be kicked down for performing an EKG without an order...

iamNurse23 · Aug 27, 2011

Very helpful thread :cool:

Roy Fokker, BSN, RN · Aug 27, 2011

I've actually been 'lectured' on not obtaining an ECG on a 18 year old patient who presented with focal, reproducible chest pain. Why? "Because the chief complaint listed in triage is chest pain. If the complaint is chest pain, do an ECG within 10 minutes of patient arrival. It's part of our core measures". :rolleyes:

how do you guys deal with doctors who are not content with such actions?

Label 'em "silly" (I'm being polite here) and move on to the next patient.

It's kinda like vital signs - ain't no such thing as "too many vital signs".

Patient is my priority - everything else is secondary.

Worse comes to worst - even if you're ever dragged into court or something stupid, all you have to say is: "MY patient complained of chest pain. I thought it prudent to do an ECG".

Don't fall into the "you follow orders period!" clap-trap. You're born with a brain and trained to use critical thinking for a reason. :)

cheers,

mama_d, BSN, RN · Aug 27, 2011

Working tele, if I had a pt with clinical signs of needing an EKG and didn't do one, the doc would probably wonder what kind of idiot nurse was taking care of their pt. If there's not a standing order on the chart for one, when I call them I'll tell them "I got a stat EKG and it said blah-de-blah" and let them know if there were any changes compared to the last one. As far as I'm concerned, that's their opportunity to speak up if they disagree...and if they don't (haven't had one complain yet in nearly eight years) I consider that acknowledgement that I'll be putting that order in under their name. We do our own EKGs though, so if a problem were to ever arise, it's no biggie to delete it from the machine and it's like it never happened.

Better safe than sorry, and as pointed out, it's a quick non-invasive test that can easily alert you to something major evolving.