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?

[psu_213, BSN, RN]

0.adamantite said:

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

I would flat out ask the NM "then you want me to call the physician any time a patient demands that--no matter the request of the time of night?" Don't be rude or accusatory about it. If he/she say yes, then, in the future call. If the MD is mad about a call in the middle of the night, tell the doc "the unit policy, per our nurse manager Sally Smith, is to call you at any time when the patient demands it. I'm sorry that I have to do it, but that is policy." Then it becomes an issue between the doc and the NM.

[toomuchbaloney]

Nope, I would not be calling a surgeon at 2300 for a vitamin order.

Yes, I would tell the patient that the issue will be addressed when the MD rounds in the AM.

Yes, I will smile nicely and nod politely while the patient rants about this and makes threats.

Yes, I will refer them to management and risk management if they are irate.

[calivianya, BSN, RN]

macawake said:

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.

It's really interesting that you say that - that's exactly what we are expected to do. If it's illegal to take patient's medications away, then I break the law, but if I leave medications in the room, I break hospital policy. We absolutely cannot leave medications in the room, even vitamins. We are even supposed to take creams and eye drops out and place them in the medication bin in the Pyxis, which is just contaminating the Pyxis if you ask me, especially if the patient is on contact isolation. If the patient wants a medication in the room, the provider has to be notified and an order has to be written for each medication that is to be allowed to stay in the room.

Are there really places that allow patients to keep medications in the room? I've only worked three places, but I have never worked anywhere that allowed this. It's always been against the rules because patients can then self-dose, and the hospital staff is supposed to be in control of the medications they take while they are in the hospital. Even if the patient brings a medication from home, that is kept in the Pyxis and then only the dose the patient needs at the time is brought out, and then only when it is prescribed for the patient to take it, not whenever the patient requests to have it.

This is where the "prescribing without a license" part comes in, too - the admitting provider did not continue the vitamin. Since it was not continued, it was discontinued during the hospital stay. The admitting provider's orders trump whatever the outside physician stated, so we were not to give the vitamin. I allowed the patient to take a vitamin that was discontinued by the admitting provider. As far as I am aware, the physician never got involved and didn't feel like his toes were stepped on - it was nursing and the NM that were horrified that I would give a discontinued "medication" on my own judgment. My hospital is very strict about making sure there is a current physician order before anything is given at all, even stupid things like vitamins.

[pam prawdzik]

I would acknowledge the patient. Let him know that I understood his concerns related to his night time eye vitamins. I would ask him why he felt that it was an absolute must that he receive them at that time. Ask him why he felt it would be a risk to him if he didn't get them. Then I would do some education with the client, explaining that missing a dose would not effect him. I would explain that we would speak to the physician as soon as one was available , but that the on call physician would not come to the hospital for a non emergent situation to right the order. I would also ask the patient if he had any family member that could come by with the OTC eye vitamin and administer it to him. Hopefully that would solve the issue, if not I would mention it to the physician in the am or leave a note on the clients chart.

[SaoirseRN]

I wouldn't call. I would explain that while I realize he would like his eye vitamins, that due to the late hour, we do not call physicians unless it is an emergency, which eye vitamins are not, and that we have no after-hours pharmacy and so could not obtain them anyway. (We have access to a pharmacy night cupboard but it doesn't carry anything so optional as eye vitamin drops). A note would be left for the physician to order them in the morning, but no phone call.

[Sisyphus_01]

0.adamantite said:

I told the patient I would leave a "sticky note" (a spot on the EMR where we can write non-urgent messages to the MD) about the vitamin but the patient was not having it.

Since it was close to shift change I punted it to the on-coming night RN ... not my finest moment

I usually work in the day and I once had a similar situation that was brought to the attention of my manager, who forced me to call and I got reamed on the phone by a gastroenterologist.

I'd bring him a carrot, those are good for eyes, right? HAHAHAHAHA!

Or, barring any contraindications, I'd have the patient give me $ and walk across the street to Walgreens after my shift and buy the dang things for him myself then just run by his room in a trench coat and giant hat, throw them through the door, and exit post hate. LOL. I'm sure that's not kosher in many ways, but then again, I'm not a nurse yet so I don't know the rules.

[Sisyphus_01]

pam prawdzik said:

I would acknowledge the patient. Let him know that I understood his concerns related to his night time eye vitamins. I would ask him why he felt that it was an absolute must that he receive them at that time. Ask him why he felt it would be a risk to him if he didn't get them. Then I would do some education with the client, explaining that missing a dose would not effect him. I would explain that we would speak to the physician as soon as one was available , but that the on call physician would not come to the hospital for a non emergent situation to right the order. I would also ask the patient if he had any family member that could come by with the OTC eye vitamin and administer it to him. Hopefully that would solve the issue, if not I would mention it to the physician in the am or leave a note on the clients chart.

STANDING OVATION! Perfect response.