Doctor's lying about telephone order - page 2

I an very upset, mad, devastated, anxious and depressed. I received a TORB from a doctor for 10 mg or medication to be given once. 4 days later patient developed EPS (which is kind of strange... Read More

  1. by   AgentBeast
    The what? Over medication related EPS? Give the kid a shot of or a couple tablets of Benadryl and call it a day.
    Last edit by dianah on Jul 15, '17 : Reason: Terms of Service
  2. by   hppygr8ful
    Quote from Irabee
    I an very upset, mad, devastated, anxious and depressed. I received a TORB from a doctor for 10 mg or medication to be given once. 4 days later patient developed EPS (which is kind of strange because EPS would develop on second day not after 4 days.) .
    I think you always have to cover your buttocks with Doctors. Our docs at the facility where I work are required to see their psych patients daily and sign off on their TOs within 24 hours. Which most of them do.

    As to the EPS taking 4 days to develop, I question that. EPS can develop quite rapidly sometimes within hours of initial dosing. It depends on the individual's sensitivity to the medication.

    Quote from Irabee
    I am suspecting that the patient was getting a "nursing dose" of the medication because no orders were documented 4 days after the shot he received from me..
    This is find really disturbing. Are you implying that nurses are giving psychotropic medications without a Dr.'s order? If you are working in the kind of facility where this is happening you need to find another job quickly. Emergency meds need to have a documented order within one hour of being given. At least that's the law in California. I have been doing psych for close to 17 years and have seen it all but I would never work in a facility with such flagrant disregard for patient's rights.

    Hppy
  3. by   blondy2061h
    Are you in the US? I thought there were mandates for EMR now?
  4. by   Maddy's Minion
    Quote from Irabee
    I received a TORB from a doctor for 10 mg or medication to be given once. The doctor told the administration that I must be written up because he only ordered 5 mg. I would admit there is a small chance that I misheard the order ( it was busy on the unit that day)
    Something is a little off. You got a telephone order read back but there's a small chance you misheard the order?
  5. by   OnceMorewithFeeling
    Quote from Ruby Vee
    I'm sure you wrote the phone order with date and time. Did your nursing note also include the phone call to the physician and the order received? If this is true, I don't see how the physician can throw you under the bus. You documented; he probably did not.
    100% this.

    You must document your phone orders. If you work in a facility where the phone orders you take later get disputed, this will protect you.
  6. by   Irabee
    I was told that taping violates HIPPA.
  7. by   Irabee
    My version: I heard 10, repeated back 10, end of conversation. His version. I heard 5, repeated back 5, started arguing about how inappropriate is to give 5 and went on giving 10 despite his order and explanation! WHY WOULD I DO THAT?????? There could be a SLIM chance that I forgot how much he told me (however, it is nearly impossible) IF he didn’t start making up stories about us arguing on the phone and me pressuring him to give higher dose. I know 200% there was no conversation of that sort. He makes up stories which leaves no room for me to doubt myself.
  8. by   Katbug
    Quote from smf0903
    Surely this physician has access to a fax machine...I would personally insist on a faxed copy of order before implementing anything this doc orders by phone from now on.
    I really like how you bring this up, this would solve a lot of problems.

    The facility I work at has a policy where we are ONLY allowed to take faxed orders, we can take them initially by phone call as just on a 'for your information' basis, but in order for it to be implemented we have to have it documented on paper via fax. A certain LPN nurse has the worst ADD at my work and giving her the telephone to take an order may have been the reason for the facility only accepting faxes now.... So I believe it can go both ways with a fax; to protect everybody, doctors and nurses alike.

    Also, if this doctor is claiming his wife overheard the conversation enough to vouch for him ordering a medication for a patient... isn't he condemning himself to a HIPPA breach? Also I mean, like stated above, is that really the best source he can come up with as he goes about telling everyone you made the mistake and not him? Demanding a write up and being so rude about it?

    I'd find a different work environment before he finds something to stick to your license or damage any chance of getting hired at an actual decent place of employment. That actually happened to a friend of mine and without a lawyer she can never have certain comments about her being 'insubordinate' removed from her record (she didn't follow her DON on mistakes that would have killed a patient, and as such she got written up and had a lot of legal issues for the DON accusing her of being the one to make the mistakes instead of saving the patients from the DON's mistakes. My friend got off as she wasn't in the wrong in any way but only after trying to apply to multiple jobs and not getting hired did she find that the DON had damaged her chances of getting a different job).
  9. by   JKL33
    Quote from Ruby Vee
    I'm sure you wrote the phone order with date and time. Did your nursing note also include the phone call to the physician and the order received? If this is true, I don't see how the physician can throw you under the bus. You documented; he probably did not.
    Quote from OnceMorewithFeeling
    100% this.

    You must document your phone orders. If you work in a facility where the phone orders you take later get disputed, this will protect you.
    I don't understand this line of thinking at all. How does double-documenting something prevent anyone from lying about which mg-doseage that was spoken? His fake claim is that he didn't say "10". Her writing "10" twice instead of once changes nothing. She has already said she wrote the order that she took on the phone. And order sheet on which she has written his T.O. is just as much a part of the medical record as a nursing note. The T.O. is the documentation of the conversation, including that it was a "telephone order"/"T.O." given by X (physician) and signed by/taken by Y (nurse). In other words, the order itself states that there was this conversation . At ____(time) _____ (Dr.) said administer _____. Writing a nurse's note saying, oh, and also "I called him and he gave me an order" adds absolutely nothing to all of this. He's not even disputing the fact that he was contacted.

    The point of a nurse's note in this situation would be to describe the circumstances under which she contacted him in the first place. The patient's condition. Which is not already part of the order itself.
  10. by   sammiesmom
    I would not worry about it. It is his word against yours and since you wrote it on the order chart TORB (telephone order, read back), you have essentially said all that can be said, he ordered it on the phone, you read it back - done, done. I don't know how your manager can write you up? You followed protocol. This doctor is obviously a dumb ass.
  11. by   Kooky Korky
    For all who say they would not work in a facility without EMR's and/or phone recorders (and I don't think this would violate HIPAA. It's about the patient in your facility, for Heaven's sake. But stranger things have happened, so who knows? Best to check with your Compliance Officer, but that's secondary to this OP's concerns.) - you can't go quitting a job any time, every time like this happens. Most of the time, we have to think about how tough it is to keep starting over, how we would lose seniority, certain benefits, etc.

    For OP - you have every right to be upset. That said - do NOT confront Dr. Butthead. The doctors win every time. That is how the medical world is structured, although things have changed for the better in recent decades. Things are more collegial than they used to be between docs and other workers, but the do still rule the roost, best I can tell.

    Docs bring in money, nurses are an expense. We all know that it is the nurse on the front lines, but docs still do bring in the bucks.

    In his defense, I'm assuming he was half asleep in the middle of the night. As for the wife overhearing, wow, maybe it does violate HIPAA. I don't know. But it would be plain to anyone who is even semi honest that she is not an impartial observer.

    Furthermore, your facility has essentially sided with you. You are not being written up, so , as others have suggested, it would be best to let this go. Unless you just can't live with the injustice of this jerk doctor being able to blame you. But please try, unless you are prepared for a huge battle.

    Someone suggested she get her colleagues to back her up. She said she has already tried this but two of them are unwilling to get involved. Can't really blame them, although it's a shame they are chicken.

    You can't really refuse to take TO's and VO's all the time. I would refuse to take them from him in anything but the most dire emergency, though, and remind him of this problem NICELY if he gets upset.

    But you MUST make time for there to be a witness. The witness must sign the order right along with you. That will be some protection for you.

    Meantime, as others have said, try to effect change in the facility. As much as I dislike EMR's, they would force a doctor to input an order that would then be in writing, not let him just give a TO or VO. And until EMR is instituted, a fax should help a lot.

    Do you think your facility would go along with requiring a faxed order from doctors after hours? The docs will probably howl loudly against it. But faxed orders will help protect the nurses and patients.

    I wish you the best.
  12. by   Ele_123
    Quote from blondy2061h
    Are you in the US? I thought there were mandates for EMR now?
    I work at a couple small specialty hospitals and they use paper charting. I was surprised and mentioned it to a couple managers and they said that although CMS requires EMR if a facility does not comply they have to pay a fine or get less reimbursement (I forget which one) and for a lot of small facilities it is cheaper to pay the fine than to pay for the EMR system, upkeep, and tech support. Kind of like the fact health insurance is "required" for all Americans, but for many it is cheaper to pay the tax penalty than to pay the premiums.
  13. by   Kooky Korky
    Quote from AgentBeast
    The what? Over medication related EPS? Give the kid a shot of or a couple tablets of Benadryl and call it a day.
    You've missed the point of OP's post. Please re-read her original post.
    Last edit by dianah on Jul 15, '17

close