Crap, I should've paged the MD.

[NurseyPoo7]

Im a new grad, who got off orientation in May working on med surg. We also just moved our unit and all our patients the other day, so I worked on the new unit that day - it was crazy: no one knew where anything was, and we were all getting a new pt as a transfer from out old unit about Q 45 min-1hr. Most of the time, we'd still be getting report from a nurse on the old unit or had just ended the report when the pt was rolling into the room!

Anyway, I got one pt - woman in her 50s, came in with hypotension and apparently had issues with a fever and diarrhea, although she never had diarrhea on my shift, but did spike a temp which came down with Tylenol. Towards the end of my shift, a family member called and said the pt had had a tick on her not too long before her admission and they forgot to mention it to the MD. I didnt get a chance to page the MD before the end of my shift at 7 - since it was a crazy day, we were all behind and I had also recently got a transfer from a totally different unit (we were told that wouldn't happen ) and had just also found order that were written for that pt around 9am I am guessing and were never mentioned in report not orders taken off and they included 2 units PRBCs!). Anyway, I passed on the tick info in report. (BTW, I did look at the pts skin where she told me the tick had been and there was a small reddened area, but no "bulls eye" rash)

The next day, the nurse that had that pt (also a new grad, I had graduated with her) asked me if I knew anything about a tick (Family had come up and asked her about it) - I told her, yes, I was told and had told the nurse that worked night shift - I guess that nurse never paged the MD, nor passed it on in report.

I really should've paged the MD now and I cant sleep thinking I'll be sued or I caused the pt more harm with delay for possible treatment if she really does have lyme disease!

[labcat01, BSN, RN]

I dont leave a post it note as those can fall off or disapear--I just write in the progress notes and date and sign it. If I do talk to the Dr in the night and he gives a new order I will even tell the Dr "I will let you know in the progress notes how well that tx worked"

That way there is a perm record of me stating the problem or offering a suggestion.

I agree and don't beat yourself up about this. If the night nurse had called the MD he would of yelled at her (I can hear it now "why are your pest control issues my problem"). It wasn't a life or death situation and the physician wouldn't do anything except keep an eye on it to see if symptoms emerged. I feel your pain- I am a new nurse myself- but we have to be better about not sweating the small stuff (and it this case, I believe it was small stuff). Here's a hug from one new grad to another :icon_hug:

[mscsrjhm]

You did the right thing- passing on info.

I also don't like post-it notes. hole punch a full sheet- write the note- and place in chart- progress notes or Dr. orders.

Many facilities now use handy nurse/Dr. notification sheets just like this, usually 1/2 page.

Nursing is 24/7. If it could all be done by one nurse on one shift- they would have already found a way to do this and cut costs!

[wooh, BSN, RN]

Since we went to more computer charting, there's this neat little section where you can leave notes (the kind you'd just tape to the chart or whatever) for the MDs on the case. Things like, "Consider adding this med? Can we d/c this?" That's probably where I'd have left the note. Definitely something to me that could wait until the next day for the MD to find out. By 7pm, it's the on-call MD, and on-call MDs don't like to make changes in care unless there's an emergent reason to do so. This isn't emergent.

[Riseupandnurse]

I would definitely NOT call the doctor because a family thought a patient might have had a tick bite. The doctor is not going to do anything about it that night; it's probably a covering doctor anyway. I would have written a note and paper-clipped it to the progress notes so the doctor couldn't write his or her own notes without dealing with it. That works well for me.

[GrumpyRN63, ADN, RN]

[quote=vito andolini;3010489

and don't expect a night nurse, or really any other nurse, to do your job. a night nurse, especially, is not going to call a doctor unless there is a total emergency. in this case, i'd say she should have called and i wonder why she didn't.

. the nurse who relieves me can be counted on only to arrive late, dawdle until forced to take report, whine about her personal problems, call the patients bad names, and to do absolutely no follow-through at all. i have learned to tell the docs myself and, yes, i do resent it. but not as much as i fear being sued. we live in an imperfect world.:argue:

wow, sounds like you need a job change ( or possibly career change,) a vacation at the very least, lots of hostility there.

back to the op, don't beat yourself up, you passed it on to the nite nurse, the info eventually got passed on, a mere 12 hours is not going to make a difference in this case, you had a lot on your plate , you are going to omit things from time to time, its called being human

[suanna]

I'm pretty sure my MD staff would be a bit "ticked" off if you paged them to tell them thier patient had a tick on them PTA. That type of information, unless vital to a change in the patients plan of care, can be passed on most effectively by a note on the front of the chart and in shift change report. I always assure the patients family that I will make sure the information is passed on to the doctor THE NEXT TIME HE IS UPDATED ON THE PATIENTS CONDITION. -That is providing the new info isn't likely to change the present course of therapy. You did nothing wrong or out of the ordinary. It's the doctors responsibility to do a history and physical and to enquire about pertinent

problems...." any recent ticks?" from reliable sources when he is working up his diagnosis. Don't start kicking yourself over not being omniciant, or omnipotent with every patient. There will be enough people kicking you over things you can't change to keep you humble without you joining in.

[APRN., DNP, RN, APRN, NP]

Please don't beat yourself up about this. Report is for passing on pertinent information. Unless this is a major-university hospital, the labwork for Lyme disease (Lyme Western Blot, Bartonella IGM, IGg) would be sent out for processing, and the patient's family would still be waiting for the test results to come back.

Pat yourself on the back for being a conscientious nurse and remember your ABC's for the big emergencies.

[november17, ASN, RN]

I'm not an expert seasoned nurse, but here's what I would have done;

Passed it on to the night shift nurse, and then documented the conversation with the family member and the fact that you mentioned it in report.

Problem solved. Again, you can't do everything. And like the above poster mentioned, if you paged the MD to mention a tick bite, I don't think it would have resulted in anything much else happening.