Quote from LovingLife123
Do you need an order from the physician to send to the ER? While not every fall can be sent to the ER, a fall and hit to the head should be. Was this patient on any blood thinners? Most elderly are.
The patient may have look fine on Neuro assessments but that doesn't mean there isn't a slow bleed in there.
All head injuries in the elderly should get checked. I would contact my malpractice insurance
For an emergent transfer of course we call 911. This does not require a Dr's order.
To get a CT scan to head when pt is otherwise stable, that requires a drs order. Now some Dr will give nurses room to make those judgment calls, but some Dr's will refuse to order a CT to the head after the fall unless pt is on coumadin, eliquis, xarelto, lovenox, heparin, etc. I've seen Dr order CT's after a fall to be done days later, as well.
If i had just sent the pt w/o a physician order, and lets say pt sustained injury during transport or in ER, then i would have been liable for that. I'm sure the Dr would have thrown me under bus (as Dr is trying to do now, throw me under bus for NOT sending him out w/o order, bcuz HE decided to turn off his pager all night).
I want to emphasize this pt had a primary RN doing neurochecks all night and was reported to be stable, no change in hematoma, no change in condition, no report of pain. How can i order a 911 EMS transfer for a stable pt? And again, getting a CT to the head require a MD order. I could have just assumed MD would be okay with that (and that was probable), but its also *possible* he wouldn't be, and there is always a small risk with anything, even pt transfer to ER. I've seen pts get injured during transport as well.
If i had the legal authority to order diagnostic tests and transfers i would have of course ordered this pt to get a CT then. I do not have that ability, I am a nurse not a MD, and the pt was not unstable requiring 911 EMS call.
The only thing i could have done differently was call the medical director. In hindsight i should have done that. But again, the pt was stable, as per report from the primary RN who was the one actually assessing and monitoring this pt.