duty w/ telephone advice

[PCBUCS1]

I am a very recent grad of LNC program and would like to give inservice to the staff in outpatient surgery. Question: when a discharged pt. calls me w/ post-op fever (Pt's MD does not answer phone on weekends and has no one covering), have I established a duty to that pt. (either because he was a recent pt. or because I have just listened to his complaints)? Can telephone advice be given w/ proviso that pt. go to ER if symptoms continue or worsen? Where does liability lie? My inservice is in May so any advice would be appreciated.

Thanks,

Patricia

[RN1989]

Once a pt has been DC'd you are no longer covered by Dr's orders to give that pt care. I have NEVER see an MD that did not have someone on call at all times. I have had MDs that tried to hide being on call and received punishment for refusal to answer calls. I also know that pts frequently state that they can't get the doc to answer the phone when in reality they didn't try because they thought the nurse at the hospital was easier to get info from.

You need to review what policy your facility has for this. Every facility that I have worked for had a policy against any advice except to instruct the pt that they need to contact their physician or go to an ER.

I would recommend that your facility look at it's DC instruction sheets. You should have in large, bold lettering that the pt should NOT contact the outpt unit for questions and must contact their dr. or return to the ER for problems. Then make sure that you are re-iterating this on dc from the unit.

You should also have a call log to document that these discharged pts called and that you referred them to their physician or the ER. Giving any other advice without them being officially in your care complete with dr's orders is dangerous to you.

You must follow whatever your facility policy is - if you don't have one - get one ASAP.

[PCBUCS1]

1989-awesome! Your response was not only timely but extremely valuable. Thank you-P

[PCBUCS1]

1989,

This MD is a Medicaid dentist that does his procedures under general anesthesia. Am I at risk for not reporting that he does all his procedures under general anesth? Please advise.

Thanks, P

ps-of course he gets more reimbursement from Medicaid by doing it this way

[RN1989]

1989,

This MD is a Medicaid dentist that does his procedures under general anesthesia. -of course he gets more reimbursement from Medicaid by doing it this way

Hmmmmmmm. There are several ways to think about this. If the guy is coming to the hospital to do these procedures, then there is a possibility that the patients truly need general, otherwise he wouldn't be bringing them through the outpt surgery unit. But then again, if you are seeing large amts of these pts, that is suspicous to me in itself because I cannot imagine such a large pt population that would require general anesthesia so often.

Kinda up to you about reporting. If it were me, I probably would. But I am accustomed to doing stuff like that and ending up in all kinds of big trouble for it. But I believe that there is right and wrong and insurance, even Medicaid, fraud is wrong and only contributes to the problems in healthcare and nursing.

If you do report, be prepared for backlash. Sometimes they will try to keep you anonymous and other times you will have to go all the way and be named in order to get things finished. Depends on how they do things where you are. I have seen a couple cases where staff were brought into the mix because they knew about the fraud and didn't report. But that was only after the fraud got so big that everyone was going to go down with the ship. Most of the time they have bigger fish to fry and nothing happens to those who do not report. It's up to you to decide if there is a problem and what to do. Go into it with your eyes wide open though. You could experience problems from your employer if reporting this guy causes them lost revenue. Good luck with your decision.