Feeling embarrassed, ask the md a stupid question

[RobertJo, ADN, RN]

I've been beating myself up over this for days and I just want to get someone else's perspective. I apologize in advance for the wordiness

I work in a chronic, non acute setting where the patient's come in for treatment 3x/week, the patient's don't see a doctor or NP everyday but at least 1x/week.

I was assigned a notoriously difficult patient this week. Threatens to sue on a weekly basis, doesn't trust anyone's RN judgement, has "allergic" reactions to almost everything, and is generally a crab apple.

She has a standing order for a large dose of benadryl IVP 75mg per treatment. She complains of the medical tape itching her and our general patient population get's very dry and rough itchy skin as a manifestation of their illness.

During treatment she started crying and wailing and begging for more benadryl. I told her I can't give her anymore, because I only have an order for 75mg. Which is already a high dose. I called the on call physician because the patient was in hysterics to see if they would authorize any more. In retrospect I think the patient was just putting on a show in an attempt to get more drugs.

The physician wasn't rude or condescending but he basically said he would NEVER give any more then 75mg for something as non life threatening as itching. He was surprised that I would even call to ask.

Now i'm a new nurse about a year, I didn't expect him to authorize more but legally I thought I had to call to at least ask the doctor. I'm a nurse, I can't decide what's enough medication for a patient, don't I need a MD or NP to actually say no before I tell the patient no. I called the doctor because if the patient actually does decide to follow up on her weekly threats to sue the clinic, I thought it would be better to have it documented that the patient had a complaint, I performed an intervention by calling the doctor, and the doctor said no. If I hadn't called the doctor and she sued, the doctor could have said well nobody told me the patient was experiencing pain.

Was I wrong to call the doctor? I'm second guessing my decision. I try at all times to cover my bases with as much documentation as possible but now does the doctor think I'm an idiot?

[RikkiLynn]

You didn’t know, and now you do. So next time you can inform the patient without having to ask. Don’t beat yourself up, the doctor has likely forgotten all about this by now. I very often have to call the doctor because the patient insists, even if I know they are not going to do anything. Because you are right in saying in the off chance that they would have done something, and you didn’t call it would be on you. Next time when you're not sure and want to save face don’t ask for what the patient is demanding, instead phrase it like; “hello I’m calling because pt is still experiencing itchiness despite the medication and is very agitated, I just wanted to confirm if there is anything else we can do for them.” That way it’s up to the MD to decide, you are just telling them the situation.

[KonichiwaRN]

Doctors remembering the names of nurses is as rare as a Sushi place in Ginza selling hamburgers and fries.

[Guest219794]

Well, you should be embarrassed if you asked a stupid question.

You didn't.

75 mg is already a very high dose. There is no particular reason that 75 would be OK, but 100 is out of the question. And, clearly the 75 mg dose is a customer service issue, not a medical necessity, and easily tolerated by the PT. I suspect 100 mg for her would have the same as 25 or 50 for most people.

So- that was not a stupid question, but feel free to feel embarrassed if you do ask one.

[humerusRN, BSN]

I am seriously shocked someone can be upright on 75mg on benadryl. 25mg puts me into a coma. ?

[beekee]

Never be afraid to ask a stupid question. We don’t go to medical school. Some MDs seem to like to belittle nurses for sport. I suspect it’s to intimidate us into “bothering” them less. Trust me, that doctor doesn’t remember you or anything about this question. Stop letting this occupy space in your head

[verene, MSN]

Never be afraid to ask... until you've worked with a particular provider a while you don't know what they are likely to say yes/no to. As you noted above being able to document that you called per patient request and provider said no is sometimes a very good thing from a legal standpoint. There are also times where calling (even when you know the answer will be no) is a strategic measure to deescalate patient and maintain rapport (I've done this on rare occasion - with a heads up to the provider that I'm am calling them explicitly so I can honestly tell the patient I've called and they've said no).

[VivaLasViejas, ASN, RN]

What you did was exactly what a nurse should do in a situation like this. I can't count the number of times I've called doctors knowing perfectly well what they'd say to what I was asking, but I wanted the patient to know their request/demand was above my pay grade. I also documented my hind end off, charting patient's complaint, what I did about it, what the result was, and patient's response. Don't feel like yours was a stupid question, you were CYA. Good work.

[FolksBtrippin, BSN, RN]

Just make sure you've done everything you can do as a nurse before you call the doc.

And make sure you have something you are asking for.

I may have asked for a benzo if I had already given the patient a barrier cream and ice. Maybe also look into the possibility of a tape allergy.

You don't need to feel bad for this.

[Elfriede]

"There are no stupid questions, only stupid answers."

Not to ask is a dangerous care error.

[morte, LPN, LVN]

12 hours ago, humerusRN said:

I am seriously shocked someone can be upright on 75mg on benadryl. 25mg puts me into a coma. ?

if the patient is over sixty, could be developing a paradoxical reaction.

[ruby_jane, BSN, RN]

Let's flip the question: What if you hadn't called? If you hadn't followed up then you'd be the nurse who "didn't do anything", right??

You're probably right - the patient was uncomfortable and stressed and was probably asking for something not reasonable because she was uncomfortable.

Hang in there!