I have just started working in a very busy medical clinic in Australia. The work I do as an RN at this clinic is varied and quite interesting.
One of my duties, among many others, Is to contact patients over the phone and give them results of their pathology test (blood, x-rays, urine, etc.) when requested by their treating Doctor.
Most of the time the Doctors just want me to call and ask the patients to come in for a follow-up on their results.... that doesn't bother too much. My biggest problem is with the INR results. The Doctors review the results when they come. They then write a comment on the pathology report. Sometimes the comment just says to continue with treatment as usual and come in for another INR in a week. But, some other times the Doctors write out a change to the presciption on the report itself (ex.:increase by 1mg for a week and then back to the regular prescription) ... I then have to phone the patient, tell them the result of the INR and verbally instruct them of the change to the prescription when applicable. I do not feel comfortable with that one bit. I feel like I am put in a situation of high liability and that the Doctors are also putting themselves in a dangerous situation. As far as I know they don't even write the changes to the prescription in their notes, they just scribble a half prescription on the pathology report. Not to mention the errors that could occur and be damaging to the patients.
I am in a tough spot really. That's how the Doctors want things to be and if I try to discuss this with them they will probably just tell me to find another job! What do you think about this and what would you do if you were in my shoes?
Your comments would be much appreciated.
Mar 17, '00
Consider keeping the note on which the doctor writes his orders, since this is the "order sheet." Ask medical records where they want it posted. Don't use an illegible order--clarify it. As you work with the docs more, you will increasingly know what is a reasonable order, but question, question, question anything untoward. Dictate or write a note of your call to the client and note that the client was told of changes per doctor's order. Be sensitive to clients who seem surprised or taken aback by the change in their meds and clarify their understanding and the order if need be. Phone orders are an area of medico-legal risk, so your concerns are warranted. Remember your five rights of patient medication administration and get the client to give you some feedback of what they need to do.