Coordination of care

[anon456, BSN, RN]

What can a nurse do to assist in the coordination of care between specialists? I work with a complex pediatric population and they have multiple issues. The MDs come and leave separately and order things but never seem to coordinate with each other. It's hard to arrange that. For example a child needs two procedures that require anesthesia, but the docs can't seem to arrange to do the procedures together. Or they write conflicting orders and I'm stuck in the middle, and the patients' families are frustrated and confused. I am not allowed to involve a case manager-- docs order that, not nurses. How can I be a better advocate in these situations?

[nurseprnRN, BSN, RN]

Nursing case management does not require a physician prescription. It's time to sit down with these docs -- they must have a staff meeting once a month, or the like-- and explain that you -- YOU -- would like to help them coordinate care so it can be delivered more efficiently and with better patient satisfaction. You might want to get your ducks in a row ahead of time by involving anesthesia, lab, radiology, pharmacy, risk management, billing, and anyone else with a useful opinion who might be affected by this accident-waiting-to-happen. If they can't attend the meeting, have them write up little somethings for you to distribute.

Yes, you can do this. Involve your nursing manager to get his/her blessing and/or the blessing of the nursing department. it makes such good sense, I'll bet they'll let you give it a shot. Don't be afraid to ask for help.

Since you are in a hospital, it is likely that your patients are covered by some form of insurance. That entitles them to case management regardless of physician preference, because it is in the carrier's interest to keep things efficient. Call them up and ask to speak to the head of nursing case mgmt, and see if s/he can help you, too.

[RNperdiem, RN]

I agree with getting your manager involved. If you frame the problem as something that is beneficial to the patients, and you have a recommendation or two, then why not? Maybe your manager has the power to change the rules of using the case manager.