I have had this happen a few times, most often due to pain meds. Pts pain out of control and I've called a couple of times for orders and they have said " she can have this and/or that and nothing else. Don't call me back."
I do write the order. Something as "MD notified of pain 8/10. MS 2-4mg every 2-4 hours prn pain. Do not call back regarding pain control issues. MD will see in am."
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I probably wouldn't. Actually who knows what I might write depending on what else is going on.
Writing it as a nursing note is probably a better idea. CYA... and the MDs don't read the nursing notes.
And really, if it came down to it, I would call back anyway if I had to for the patient. Or I've also been known to call another MD consulting the case if appropriate and there was a good relationship with that MD.
Just wondering how others handled the "do not call back order."
It would depend on the situation and the MD. If this is a habitual problem with a particualr MD....I would probably write it as an order. If not and it's a doc who seem to be having a really bad night..... I would ask on the phone....and in my drippingly sweetest voice. "Would you like me to write that as an order doctor?":nurse:
I would document it in the nurses notes as well that the MD does not wish to be disturbed with any further interventions or results. If it would continue and it an ongoing issue or life threatening I would write and order.........Stat K level do not call result til AM...... or something like that. I would quote exactly what they said on the phone.
I would continue to call the MD whether or not they want to be to advocate for my patient and to protect myself because I don't care that I'm disturbing their sleep.........I'm already awake...
I would not write it as a verbal order without telling them so. There are definite steps and formalities to entering a verbal order that must be followed (the doctor initiating it by stating it is an order, your read-back). You can't simply take anything the doctor says in conversation and assume its legal to convert it to a verbal order, even the personal comments directed at you such as "Stop calling me."
Test for you:
1. If a doctor assigned to your patient is sitting next to you and says "Man, I had a busy day, I'm going to have a nice big shot of booze the second I'm home." do you run and enter "Take one large shot of Southern Comfort post discharge" on all your patient charts?
2. If the doctor above, instead had said "I'm starving, if I don't get something from the cafe soon I'm going to pass out." do you all of a sudden call dietary and tell them to deliver food trays to every patient who had complaints of dizziness recently?
3. If the doctor above says to you in passing "Wow, the family in room 205 is very difficult. Wish I had rounded when they weren't here lol." do you run to the phone and call for security to remove the family from the facilities?
Answer: If you answered "no" to all the questions, congrats, you have passed the "Difference between personal comments and verbal orders" test.
Now, the problem with simply entering the "Don't call me anymore" personal comment as a verbal order is that it is an act of passive aggression. If something happens later that night, and some other nurse follows your verbal order and a poor outcome results......................well, get back to me on how far the "But the doctor did say not to call him" defense gets you. The first answer you will get will be "Did he OK that as a verbal order?". And to top it off, the person who is affected by all this is the patient. Is it their fault the nurse was being passive aggressive?
What you want to do is verbally and assertively inform them "I am obligated to call when pt. C/O pain dictate it and to document all unanswered pages. I have no choice or alternative to this unless I have an order directing me to do differently. IF YOU WISH FOR ME TO ENTER A VERBAL ORDER ONTO THE CHART STATING I AM NOT TO CALL THOUGH, I CAN DO THIS." Believe it or not, yes, I've had doctors give just that, a verbal order not to call for pain issues. Now, (after performing the verbal read back of course) I have gone through the formal steps of entering a valid, legal verbal order and now I can say "Hey, the doctor said not to call."
Specializes in psych, addictions, hospice, education.
I had a patient who kept fainting. The doctor ordered an EKG and a potassium level. I called with the results (EKG normal, K low). He ordered a K supplement for the morning and told me not to call him unless the patient hung herself. I charted that. As luck would have it, that doctor was one of the few who read nursing notes. He was livid....
I've done it and depending on the situation, would do it again. One example -- I was working night shift and received a pt. back from dialysis at about 2330. We were getting slammed with admissions, etc., so I didn't get to look over the chart for a couple of hours. Found that a big order was missed during dialysis and talked it over with the charge nurse, who said I had to let the MD know. I paged him for two hours before he called me back and said, "Don't you EVER call me back in the middle of the night for something like that again." I repeated it back to him and said, "Got it," and hung up. Wrote it as a TORB. You can bet that if I had not called, it would've been my butt on the line. And I won't be talked to like an idiot for doing my job.
I had a patient who kept fainting. The doctor ordered an EKG and a potassium level. I called with the results (EKG normal, K low). He ordered a K supplement for the morning and told me not to call him unless the patient hung herself. I charted that. As luck would have it, that doctor was one of the few who read nursing notes. He was livid....
I've done it and depending on the situation, would do it again. One example -- I was working night shift and received a pt. back from dialysis at about 2330. We were getting slammed with admissions, etc., so I didn't get to look over the chart for a couple of hours. Found that a big order was missed during dialysis and talked it over with the charge nurse, who said I had to let the MD know. I paged him for two hours before he called me back and said, "Don't you EVER call me back in the middle of the night for something like that again." I repeated it back to him and said, "Got it," and hung up. Wrote it as a TORB. You can bet that if I had not called, it would've been my butt on the line. And I won't be talked to like an idiot for doing my job.
I get that a lot when I call docs for troponin results. I absolutely write it as an order. That's what he/she said, it shows they're aware, what you did, and what they "ordered." It is definitely appropriate.
Specializes in Cardiac Telemetry, Emergency, SAFE.
We have SBAR papers specifically for nursing notes and T.O's. If they say dont call back, i do write "MD to address in AM" on the nursing note side. We are to use this every time we call the doc regardless of whether or not er get orders. CYA, at all times.
Kinda depends on the doc and the situatution as to where the most appropriate to chart it...progress notes, pain assessment/interventions, or as an order.
I had a pt one night who was going downhill, full code. Called the doc a few times to apprise him of the situation and try to get an order to transfer to a higher level of care. He told me not to call back unless the pt coded...I repeated it to him and wrote an order "Do not call MD for remainder of shift unless to report pt has coded". Sure enough, had to call RRT which deteriorated into a code and pt died. When I called in the am to notify him of the death, he was angry that he hadn't been called prior to the RRT. He is a real butthead and refuses to take afe care of his pts if it inconviences him, so I definitely wrote that as an order b/c it was likely he'd have me written up for not calling him, if I had not had the order written officially. If I didn't know what he was like I probably wouldn't have and then my butt would have been twisting in the wind.
I had a surgeon tell me that once. I was calling about his fresh post-op patient regarding uncontrollable nausea/vomiting and he was so mad that he was called in the middle of the night that he refused to give any orders and told me not to call him again and to let all the other nurses know not to call him about n/v for this patient. The easiest way to let everyone know is to write an order so it shows up on everyone's nurse order sheet. So I wrote it as an order. I heard he had a temper tantrum the next morning when he came in and saw it, but I never heard about it from management. I ended up having to call the house physician to get something ordered.
Had a patient with coumadin levels, I had to report because they were always drawn early, and I can't leave without criticals being called. He was usually in the building and rounding early on our floor, but not always. So, I had to call and he said NEVER CALL ME ON COUMADIN LEVELS, I said would that be just for today or everyday that I work........didn't go over well.
Esme12, ASN, BSN, RN
20,908 Posts
It would depend on the situation and the MD. If this is a habitual problem with a particualr MD....I would probably write it as an order. If not and it's a doc who seem to be having a really bad night..... I would ask on the phone....and in my drippingly sweetest voice. "Would you like me to write that as an order doctor?":nurse:
I would document it in the nurses notes as well that the MD does not wish to be disturbed with any further interventions or results. If it would continue and it an ongoing issue or life threatening I would write and order.........Stat K level do not call result til AM...... or something like that. I would quote exactly what they said on the phone.
I would continue to call the MD whether or not they want to be to advocate for my patient and to protect myself because I don't care that I'm disturbing their sleep.........I'm already awake...