Walkie/talkie patient with a cervical neck fusion on his second day post op. Continues to have sore throat and hasn't eaten much in the last day.
Patient: I'm having really bad heartburn, could you get me some tums?
Me: I'll check your chart to see if you have something that could help like Mylanta...No, I'm sorry the doctor didn't prescribe anything. Have you tried eating soda crackers, drinking water, going for a walk...etc.
Patient: Can't you call the doctor, you guys do that kind of thing all the time.
Me: You want me to call the neurosurgeon for some tums?
Patient: Well, yeah
Me: I'm sorry sir, I can't wake up the neurosurgeon for tums.
Patient: Well, don't you have some in your purse that you can slip me??
Me: Um, no
What are some things patients have asked you guys to call the MD for?
I, too, work in Neurosurgery and I would have called for an order for this at 3am. The difference is I work in a teaching facility and we have a resident in-house 24/7 who would just write the order.
I disagree that the surgeon would not be able to operate in the morning if he got woken up for 2 minutes to give a verbal/telephone order for an antacid. He'd still operate in the morning if he got called into an emergent case or had to come in at 3am to see a patient in the ER, wouldn't he?
I don't know that anyone said he couldn't operate. Point was, I wouldn't want him operating on me after being woken up, possibly multiple times in a night, for short order OTC requests on a patient's whim, after the patient being unwilling to try any other remedies for his heartburn than the magic bean of a calcium carbonate tablet. I say "whim" because the way I understood the OP, this is the first she's heard of his complaint of heartburn, and correct me if I'm wrong.
I'm being specific in my comments here. Some of you need not try to make it more than what it is. You have a patient who is unwilling to attempt other remedies before calling physician. Therefore he's not getting a 3am call from me. Drink some water, have some crackers, whatever, and sit upright for an hour, then we'll talk. By then it will be a more reasonable time to call a neurosurgeon for an OTC. Try something else first at least.
well guys, here's the thing...i'm with netglow and redhead i'm going to try other nursing interventions before i call the md. i think trying some crackers, milk, going for a walk etc and then reassessing the patient is a better plan then going around waking people up.
you don't want to get on the phone to the md and have them ask "well, did you try feeding the patient?? um, jeez no i never thought of that...
the patient wasn't awake, staring at the ceiling, he was up walking around in his room and when i happen to ask if i could get him anything else that's when he said "yeah, do you have any tums i have really bad heartburn". he was fine with the plan to walk the halls and try some crackers. as nurses we are assessing every situation and at that time this situation did not merit a phone call.
kelrn215, our neurosurgeons are usually placed on as an am consult. in house mds take care of the patient's until they are seen...so far i have never seen a neurologist on the floor to admit someone.
pmfb-rn, my apologies for misunderstanding. i'm sure we have some great prn otc order sets, however, this particular neurosurgeon on the case does not believe in having lots of prn meds, from what i have heard from other nurses he was lucky to have percocet...
Honestly, is it any wonder patients can become furious at times? Heartburn is miserable and if it's a severe bout there is indeed a risk of aspiration. Why should it be so difficult for a patient to get a couple of Tums just because they're in the hospital?
I agree that I'd be a little reluctant to call a surgeon at 3am for Tums but if non-pharmaceutical interventions hadn't worked and there really was no other option or no-one else to call and the patient was miserable, I would. It's not a matter of 'teaching the doctor to write proper orders', it's getting the patient what he or she needs.
This is something worth fighting for if your facility doesn't have standing orders or nurse-initiated medications. Bring it up at staff meetings, try to get that changed. Standing orders for things like heartburn, mild headache, constipation, etc are an 'opt out' thing where I work in that the doctor has to specifically state 'no Tums, nothing for constipation, etc' if there's a reason for that or if the usual standing orders are not appropriate for the particular patient.
I always have a couple of headache tablets and some Tums with me, they'd be with me in hospital too and I'd be taking them from my own little stash if I couldn't get them when needed. No, scratch that, I'd probably just take them myself anyway! Lol.
Specializes in Oncology; medical specialty website.
Only once have I flatly refused to call a doc. When I worked in peds., I had a 6y old who bled so badly after a T&A, he required a transfusion. After the blood was finished, I went to hang a bag of fluids (ordered), and the father said, "I don't want that. It's expensive." No amount of teaching would convince him his child still needed the IV. He asked me to call the doctor to ask for the IV to be D/C'd and I said "No." I told him I knew the doctor would want to continue the IV, and I wasn't going to bother the doctor with an unnecessary call. I told the father if he wanted, he was more than welcome to call the doctor himself. He did, and the doctor must have given him an earful, because he was much more polite afterwards.
Generally, if a pt. needs something and I don't have an order for it, I call. Yes, I have written for the odd Tylenol here and there (for pain) if it was the middle of the night. I know at least one person will flame me for it, so let me get this out of the way. "Bite me." I personally wouldn't blow off heartburn. At the very least, it can be extremely uncomfortable. At worst, it could be a harbinger of a serious event to come.
I really don't understand why you didn't call? Your patient has unmet needs that could be met simply. The surgeon chose not to write PRNs for very common, normal and expected problems overnight. I assume that means he is lonely and wishes to speak to a nurse at 3:30AM.
This is a case of a physician not doing their job. Wake them up a few times and maybe they will learn to write appropriate post op orders.
If you are worried about being yelled at by a doctor, well you need to put your adult pants on and deal with it. I am never yelled at by physicians, at least not for more than very briefly. I don't tolerate being yelled at by anyone and any physician who yells at me will regret it.
Yeah, one reason oncology was awesome was, the docs trusted us to write orders like that, and would just sign them in the morning.
Haldol, no, a nurse got fired for that one.
We had residents we could call though for our postop patients- and I think all the postop patients had protonix IV or whatever the PPI of choice was at the time.
I would definitely be in the "try other things first" camp. If that didn't work, I don't know. I mean, I have HORRIBLE reflux. (I need to lose weight, and the "good" reflux meds interact with another med I take, so I make do with pepcid and prilosec.) So I get that heartburn sucks. I also know that if admitted to the hospital, I'm going to make sure during waking hours that my admitting doctor has ordered my daily reflux medications. I'm someone isn't a chronic GER, and gets heartburn at home, do they go to the pharmacy at 3am?
And the "risk of aspiration" is a bit ridiculous. These aren't tube fed people without a cough reflux being left laying in trendelenburg. A guy walking around the room is not going to aspirate because of a lone night of heartburn.
I don't know, tough situation. I don't avoid making 3am phone calls because I'm afraid of being yelled at, but because there are things that really can wait. Not every discomfort needs a medication. Truly, not every discomfort needs an intervention. Sometimes in life, we're uncomfortable.
I don't know what I'd do. But whatever I'd do, I wouldn't judge another nurse based on what they decided to do about a case of heartburn in a guy with a cough reflex at 3am.
Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I once had a patient who was a nervous wreck and asked for Benadryl. No IV access, and wouldn't you know, IV Benadryl was the only kind ordered. I told her, well, I will call the surgeon and ask him to change the route (this was at about 3AM), hoping she would say "oh no dear, don't wake him up for that". She just looked at me. I felt like a jerk when I called the doctor.
In the interest of full disclosure, she wasn't itchy or having insomnia and needed a sleep med. She liked having nurses and aides in the room, getting attention, and being waited on hand and foot. I think everybody's had at least patient like that, who thinks that because they're in the hospital they are intensively ill and will take any and all medication you can give them.
I would have thought the risk of apnoea and/or aspiration is a bit ridiculous too (and almost certainly is in the case of the OP's patient as he was walking about in the room) until it happened to me one night a few months ago. Absolutely terrifying. Obviously the apnoea passed quickly and I didn't aspirate but I can't help wondering what might have happened if I had been less mobile and unable to move quickly into an upright position.
redhead_NURSE98!, ADN, BSN
1,086 Posts
I don't know that anyone said he couldn't operate. Point was, I wouldn't want him operating on me after being woken up, possibly multiple times in a night, for short order OTC requests on a patient's whim, after the patient being unwilling to try any other remedies for his heartburn than the magic bean of a calcium carbonate tablet. I say "whim" because the way I understood the OP, this is the first she's heard of his complaint of heartburn, and correct me if I'm wrong.
I'm being specific in my comments here. Some of you need not try to make it more than what it is. You have a patient who is unwilling to attempt other remedies before calling physician. Therefore he's not getting a 3am call from me. Drink some water, have some crackers, whatever, and sit upright for an hour, then we'll talk. By then it will be a more reasonable time to call a neurosurgeon for an OTC. Try something else first at least.