Demanding patient wanting me to page MD about insignificant issue.

[0.adamantite]

Worked a late shift and had a patient who was admitted by a specialty service. It was about 11pm and patient wanted his eye vitamins NOW. (he usually took them with HS meds, but when inpatient a lot of MD's won't order vitamins, especially weird ones like OcuVite). I try to explain this to the patient, but patient wouldn't take NO for an answer. Basically insinuated that the next time I see him I better have followed up on this issue. This would mean that I would have to page a specialty service (surgeon) at 11pm for an eye vitamin as no in house MD was consulted.

What would you do in this situation?

[Here.I.Stand, BSN, RN]

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but patient wouldn't take NO for an answer. Basically insinuated that the next time I see him I better have followed up on this issue......

What would you do in this situation?

His answer WOULD have been a polite but clear, "No, I am not calling for that."

[Here.I.Stand, BSN, RN]

0.adamantite said:

Yes but what about when it gets around to a manager who is very invested in patient satisfaction?

"I am not making unreasonable clinical, professional, or collaborative decisions for any reason. When I call an on-call MD in the middle of the night for a multivitamin, I affect patient safety by unnecessarily interrupting his/her attempts at sleep, and I hurt the credibility of myself and my colleagues on the unit."

[artisticmind]

Neither of the two hospitals I worked/work for stock ocuvite in the pharmacy, pharmacy therapeutically replaces it with a daily multivitamin. And no, I would not have called to get an order for it either. I would write a reminder under the "questions/concerns" section of the dry erase board in the patients room so that they could ask the MD during rounds and also pass it off to day shift.

[Emergent, RN]

I went to the Ocuvite site to check out these wonder drops. I saw this disclaimer at bottom of page, after all their glorious proclamations regarding their product.

Seriously, I doubt it would be any problem for the pt to have these, probably worthless, OTC eye drops by their bedside without a midnight call to the surgeon.

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*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease

[CJMR]

I always look at the worst case scenario in every situation. I know my docs and I know how the situation will likely play out. If I call a surgeon at 3am not only will I NOT get the order, I will get yelled at, I will get complained about to management, and worst of all some poor patient is going to get surgery performed on them by a sleep-deprived surgeon. If I don't call the patient will be mad, they might complain about me to management, and they will take a vitamin a few hours late. So the worst thing in this situation is a sleep-deprived surgeon performing surgery because I woke them up for a vitamin. That is where I will rest my argument with the patient and with management if it goes that far. Surgical mistakes happen and sleep-deprivation is more likely to make them happen and if the patient doesn't like that...if they are so selfish that they can only think of their damn vitamin and not the other patients then screw it. It's not my first time at the rodeo and they cannot out-argue me on this issue.

[Forever Sunshine, ASN, RN]

"Here is the doctors number.. why don't you call him and ask him yourself if it is so important to you."

[Veronica Cheney]

vampiregirl said:

Yep, I'm in agreement with the prior posters.

Also I'm wondering though if this was really even about the vitamin in the first place....

I agree, sounds like the patient is experiencing a loss of control and this vitamin is his final stand LOL.

I wouldn't call, I'd probably be very direct about the loss of control and get to the bottom of it.

[icuRNmaggie, BSN, RN]

Just to be clear, prior to 2300, I would call. After that time, I would not.

[calivianya, BSN, RN]

KelRN215 said:

What if you didn't "let him" do it but he just did it without telling you? Honestly that's what I'd do in the same situation if I were a patient. I carry my chronic meds with me at all times, if the doctors were taking too long to put in my orders or the pharmacy was taking too long to deliver it and I was having breakthrough polyuria/polydipsia (I have DI), I'd just dose myself with my ddAVP like I do twice/day every day. As a nurse, I'd tell the patient that officially I can't give him the vitamin because his doctor hasn't ordered them but I wouldn't be wrestling them out of his hands if he had a family member bring them to him.

I have done that before and it has come back to bite me on the butt, so I definitely police anything that comes from home now. Last time I just "allowed" the patient to take something and told him to not let me see him do it, the patient made the next nurse aware that I had said I couldn't give his vitamins to him, but I was aware that he had the vitamins in the room. IMO, patients don't keep secrets very well when it comes to something that they believe they have to have. It only takes one coworker reporting you because you allowed the patient to take something on his own to end up in the manager's office.

Apparently, I was practicing medicine without a license since the physician did not explicitly say it was okay to take the vitamins. I didn't officially get written up but I got "counseled" on my scope of practice as a nurse in that hospital, and got printouts about how only physicians are allowed to prescribe medicines and I couldn't just do it myself because I felt like it. The whole thing was really humiliating, and I guess I developed the view from there that nothing was worth being talked down to like a disobedient child. I'd rather just call and wake somebody up than get talked down to like that again.

[Rosie1girl]

I would try reasoning with the patient and if not successful page the Dr. on call/hospitalist. That is why they are there, rarely anymore are patients admitted who cannot have the person there right orders. If not possible, I would call his Dr. at home or wherever and explain the situation and get an order. If he is irate I would explain that he was the one who "forgot" to order the med. Working in Critical Care is empowering, also experience.

[macawake, MSN]

calivianya said:

It only takes one coworker reporting you because you allowed the patient to take something on his own to end up in the manager's office.

What alternative action was available to you? You can educate and inform patients, but you can't use force. I'm certain that taking the patient's medication from him or her by force and then hiding it from him or her would be both ilegal and a violation of the patient's autonomy. This course of action would likely have landed you in real hot water, and rightfully so. You work in a hospital, not a prison.

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Apparently I was practicing medicine wihout a license since the physician did not explicitly say it was okay to take the vitamins. I didn't officially get written up but I got "counseled" on my scope of practice as a nurse in that hospital, and got printouts about how only physicians are allowed to prescribe medicines and I couldn't just do it myself because I felt like it.

You obviously weren't practicing medicine without a license or you would have heard about it in a big way, not just received some printouts to read. You didn't prescribe anything. Seems to me that you had a run-in with a physician in a cranky mood and in possession of a big ego combined with weak nurse management who won't stand up for their nurses.

(What I'd personally do if a patient took their own meds is inform the physician and also make sure that they didn't interact in an unwanted way with any of the medications that I administer).

I don't think that calling and waking up physicians at night for a vitamin prescription is a sure-fire way to protect yourself against being talked down to again. I think it it might have the opposite effect rather than the desired one.

The only way to make sure that you're treated in an acceptable way is to let people know what actually qualifies as acceptable and very clearly let them know when they fail to meet that standard and that that behavior is unacceptble.

[withasmilelpn]

Usually they are prescribed by an eye doctor for Macular Degeneration - an eye condition that leads to blindness and currently has no cure. There is some evidence they are helpful to slow progression but the evidence currently is insufficient as it was primarily done by the manufactures themselves. Antioxidant Supplements for Macular Degeneration. So keep it in mind when dealing with one of these patients, they are understandably frightened of the (possible) consequences of missing a dose. And just do the best you can with compassion given the monkey in the middle situation we are so often in.