dilemma

[Amandazhong]

I am working in the nursing home. Sometimes I have new admission on weekend, when it is difficult to contact Doctor. One day @1500, I had a new admission and I couldn't find a doctor to approve the medication list. Family had the medication resident was taking at home. I said to family I could not give non-approved medication to resident as per facility policy. Family was fine and they give medication to patient on admission day. For some reason, I couldn't contact Doctor overnight.

The next day, the patient had a seizure. My co-worker called the family and said patient shouldn't skip the medication and ask family to send medication in. Now family blames me and said that patient had a seizure because I refused to give medication to patient.

I feel so frustrated. I followed the rules and did what I could do on that day. And now family blames me for everything. My co-worker became a hero.

What would you do if the same thing happens to you?

[Anna Flaxis, BSN, RN]

Any critical medication, such as antiseizure meds, antiarrhythmics, etc., need to be given, so it is imperative to make contact with the doctor to at least get those ordered until the admitting doctor comes in to approve the med list. Anything else like a multivitamin, cholesterol pill, or anything that won't hurt if the resident misses a dose, can wait.

If the on-call/after hours doctor is not returning calls/pages/whatever, you need to contact your supervisor.

[Amandazhong]

My superviser tried to call on-call after I tried so many times, she still got nobody. This Doctor has bad reputation in the nursing home. I don't know why they still hire him.

I talked to my superviser and she knew what happened. She told me: just listen from one ear, and let it go from another ear. It's just so frustrated, I don't know what to do. Follow the rules or break the rules?

[Anna Flaxis, BSN, RN]

Practice clean and follow the rules.

I'm sorry you're saddled with a doctor like this.

[nurseprnRN, BSN, RN]

if this is the only physician the facility can call and s/he is not doing the job, then the management should be 1) looking for another physician or covering group, and 2) be reporting this one to the state board of registration in medicine. you can also call the family and say that because you have called 4 times and been unable to rouse dr sluggo, you have no medication orders and they can either get another physician to assume responsibility or come in and give the patient the meds themselves.

you just can't take no for an answer. be a patient advocate -- it's in our ana standards of practice and your nurse practice act, to which i commend your attention-- and do not quit. if when you turned over care to another shift and made that rn aware of the problem, s/he has the responsibility to continue trying to get an answer.

[NeurosciencesRN]

I am so sorry you are stuck with this dilemma. Sounds like you did the right thing by approaching your supervisor in a situation like this. To ensure something like this does not happens again (MD not available/ not answering pages over the weekend) and to encourage change I would write a letter to your Nursing home administration including giving a copy to your supervisor. This letter should also highlight the importance of patients getting the care they need and deserve (ultimately why we became nurses :). Yes, family can be called and they can hopefully make an informed decision but their loved one is in a nursing home and they are depending on a system that clearly needs a little work.

In this letter I would mention :

Details of the incidence from your point of view. Just state the facts here.

Offer suggestions to solve the problem. Ie. "maybe we should re-think having admissions over the weekend when MD staff is not available to approve a medication list." Instate a policy that if the doctor cannot be reached within x amount of time the patient will be sent back to the hospital where a physician IS available. Ask for a back-up physician for weekends.

Give thanks for your position in the facility and make you intent clear which is to "continue providing my patients with the care they need and deserve."

Good Luck

[GHGoonette, BSN, RN]

If the patient is on chronic medication, it must have been prescribed by some or other doctor. Next time, ask the family or the patient for a copy of the original script as prescribed and include the instructions in the patient's folder. If the dr on call for your facility has a problem with the script, s/he argues with the other doctor, not with you.

[leslie :-D]

if the on-call dr. didn't respond, then i'd go to medical director.

leslie

[NurseHopefulInOH]

Not trying to say you did the wrong thing which you didn't. You were following the rules. What if you gave the meds and something was wrong and the Dr did not approve it for some reason? It was be a med error and possible harm to the resident. Would the family however be able to give the medication to the resident? Just wondering for future reference