Sending residents to the ER without a doctor's order.

steff_rn1 · May 5, 2005

At our LTC, we often call the medical director if we can not reach one of the doctors. If we can't get the doctor, we also send them if needed, and continue to try to contact the doctor. Never had any problems with calling the ambulance before the doctor is notified.

CoffeeRTC, BSN, RN · May 5, 2005

A doc ALWAYS has to be on call. If not their regular doc then the facility's medical director. I ship frist then call in many situations. Its not unusual to wait 30-45 minutes for a return call. With the family's permission I especially don't wait.

Blackcat99 · May 5, 2005

Thanks all for your messages. The doctor I had tried to call first is also the Medical Director of our LTC. This was very unusual. He usually will call us back right away. I was sorry to hear that a nurse got fired because she sent a resident to the hospital without a doctor's order. Let's pretend my resident had not really been physically sick but just had an "anxiety attack or something." I bet my nurse manager would have been furious with me. Anyway, I still think it is best to send them out if in doubt and no doctor is available. :)

HONEYBEAR · May 6, 2005

If I have a pt that needs to be sent out, they go out......M.D. is called, if he/she does not call back right away I will re-page......but in the mean time I know my pt is out getting the needed medical tx that they need.....I will notify M.D. when they call back. Most of the time most Doc's don't mind.......and if they do, they just need a gentle reminder that per the family's request they want mom/dad/grandpa/grandma sent out no matter what........ :rolleyes:

sassynurse78 · May 7, 2005

I have done this on a few occasions. I only ever remember one time that something was said about nurses doing this, the nurse had reached the dr. and being the way that doc is, said just to keep the pt there, the nurse on duty didn't feel comfortable doing that so she called the family and explained to them that she felt the dr was making a poor decision and so of course they said send the pt. The doc was pretty hot over it. But thankfully our management wasn't, they agreed with the nurses actions. The pt ended up being sent to a larger hospital for a bypass surgery!

rnluann · May 9, 2005

I can usually get the doctor to return my call on night shift. However, last night the Dr. was out of town. I called his answering service and she said a different Dr. was on call for this doctor. When I called that doctor I didn't get a real human on the phone. I just got an answering machine that said "Leave a message and we'll get back to you the next day. Anyway, after 30 minutes and no doctor available I had her sent to the ER. It turned out she had gone into congestive heart failure. Anyway, how about you? Do you ever send out residents to the ER without a doctor's order? Thanks :)

You bet I do...I believe that it also matters whether or not you have the numbers of trained staff to do CPR, etc as well.. I would think you would be neglegent in your duties if you found a resident in distress and did not seek medical attention for him..not your fault you could not reach the doc, but I surely would document well on the entire event, especially not being able to reach the doc on call.

RoxanRN · May 9, 2005

You bet I do...I believe that it also matters whether or not you have the numbers of trained staff to do CPR, etc as well..

What health care facility DOESN'T require all medical staff (RNs, LPNs, CNAs, PCTs, etc) to be trained in CPR?

rebel_red · May 9, 2005

My motto is "When in doubt, send em out." Our docs are really great that way, especially since we (the nurses) utilizing our critical thinking and assessment skills have been absolutely dead on 99% of the time. Only once did a doc get snarky with me. And I was hot anyhow because the resident was showing symptoms of a fresh TIA. Our ER which is normally top notch turned her around in 40 minutes. Heck they can't even get their labs in 40 minutes. If I a 41 y/o woman had presented with the same symptoms, I would have been in workup (based on past experience) for at least several hours. Still po'd about that. Anyhow I talked with the doc in question the next time he came in......lets just say all is fine now.

Tres

Kandee Roses · May 9, 2005

I also work in LTC. We can write a telephone order to send our residents to the ER if we deem it a situation where we feel they need to go to get evaluated. EXCEPT one of our doctors wants us to call him first, (unless it is a matter of life or death), and if we can't get him the first attempt, he usually calls us back within a few minutes. So, it usually works out for the best.

BabyRN2Be · May 9, 2005

Granted, I'm not in LTC, and I'm not a nurse... yet. :)

What would I do? Try to call the doc; if I get no answer, I'd try to call a relative and see what they would want me to do (depending on pts condition and severity). If they say yes, I think that I'd send them out depending on condition and severity. If I didn't get an answer, I'd call the medical director. If s/he was there, I'd definitely following orders. If I didn't get a hold of anyone and the pt continued to go down the tubes, I'd call 911.

Sorry that I'm not a nurse yet, I think I'm just using critical thinking skills. :)

Blackcat99, hope your pt is OK!

Carrie162 · May 9, 2005

I have sent a patient out without a doctor's order in cases of SOB or sudden changes of mental status. I had another patient, full code, who was crumping, oxygen sat 85% on 10L via non rebreather, pulse 120, and the doctor told me to start IV Levaquin. I sent him out 911 with my DON's full approval and no MD order. The paramedics wanted to know why we waited so long.

debRN0417 · May 9, 2005

I totally agree with you...this is how we do it at my facility also.

Ditto....