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?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I would call the doctor and let him decide what to give the patient. He's the one that went to school for who know how many years.
*** Gee, wouldn't that be great? It would be great to call a physician, present my assessment findings and pertinant information and recieve an order. Wow! I can hardly imagine it. Better than what I get about 9/10 times, "well what do you usually do?", or "just tell me what you want me to order", or "golly gee I am not sure, what would you suggest?".
Having said that, it would be so much better if MDs would utilize the available standing order sets that address things like meds for headache, pain, fever, indigestion, nausea, vomiting, constipation and diarrhea. ..... Would just make it better for the MDs, nurses, and especially for the pt!
NOVEL concept!!lol
we could also utilize all that hard earned clinical nursing judgement we were told about once, some time ago...
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?
So you think the doctor, who is brilliant enough to do neurosurgery but can't remember to order med for heartburn, should not be awakened? S
o you think the patient should have to endure for 3 hours or so? I'd be on the phone to the Nursing Supervisor about you.
Don't you guys have house staff?
Don't you have someone who should have noticed hours ago that Dr. Idiot didn't order all the various PRN's he should have ordered? That someone should have nursemaided the doctor and gotten orders hours ago for Tylenol, Maalox, diarrhea, constipation, pain, insomnia, etc.
Or, you should have an understanding, some written protocols/standing orders with your surgeons that they will cover you for giving these OTC meds in the middle of the night.
Take initiative here and get each of your regular surgeons to write out orders that would apply to all of his or her patients. That way, every time they are writing post-op orders, they can just check off the ones, like Maalox or Mylanta or TUMS, that should apply to a particular patient.
A nurse or a permanent clerk who takes off these orders should make sure that everything is checked. Or not, but the doctor should have to be given a chance to definitely, actively indicate "No" about, for example, heartburn med if he doesn't want it ordered for a certain patient. Make calls to doctors early, preferably office hours end, or ask them on their last Rounds each evening about any orders that seem incomplete. It will save patients suffering and docs being awakened by the poor night nurses.
I have started asking pts that I admit, "What do you take when you have heartburn? What do you take if you can't sleep? What do you take if you have a sore throat? What do you take if you're constipated/have diarrhea?" "Is there ANYTHING that you can think of that you take OTC for any reason?" I put every single one of these things on their home med list as a prn and hope that the doc checks off to continue it while in the hospital, so when they decide to get obsessed about their bowels at 2330 I can just give the meds.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i'd rather write the order as a telephone order than call the doc in the middle of the night! has anyone dealt with a neurosurgeon at 3 am? it's not pretty.
furthermore, since this is turning in to a more serious discussion than originally intended, what are some nursing interventions you all would do in this situation. instead of fixing with meds what are some other things you would do?
i kind of thought this was going to be a humor thread. i can't believe how many people are bent out of shape over tums!
in the realm of the sort of discussion i had hoped this was going to be, a patient once asked me to call his surgeon at 10 am (surgeon was in the or) to ask him to tell his girlfriend it would be bad for his (the patient's health) to ever see her again. i told him that he could break up with his girlfriend all by himself. the surgeon thought it was hysterically funny when told . . . and thanked me for taking care of that one without involving him.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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?
so you wake him up for two minutes to give an order for an antacid . . . no need to try crackers or anything else. just go straight for the neurosurgeon who has a 7am case scheduled. then your colleague calls him to wake him up for two minutes to give an order for tylenol for a backache. hey it's a neuro unit -- it could be something really serious, right? and then someone else wakes him up for two minutes with an order for a laxative that really can't wait for morning because the patient is really uncomfortable. and then the charge has to wake him up for two minutes to report a k+ of 3.5 because it's a bit low.
at what point is he sleep deprived enough to affect his performance in the or? at what point would you not want him operating on your loved one? i know heartburn is uncomfortable, and it sucks to have to live with it. but unless you're thinking it's a cardiac event, i fail to see why it couldn't wait until 5 or 6 when the surgeon would be waking up anyway.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
so you wake him up for two minutes to give an order for an antacid . . . no need to try crackers or anything else. just go straight for the neurosurgeon who has a 7am case scheduled. then your colleague calls him to wake him up for two minutes to give an order for tylenol for a backache. hey it's a neuro unit -- it could be something really serious, right? and then someone else wakes him up for two minutes with an order for a laxative that really can't wait for morning because the patient is really uncomfortable. and then the charge has to wake him up for two minutes to report a k+ of 3.5 because it's a bit low.
at what point is he sleep deprived enough to affect his performance in the or? at what point would you not want him operating on your loved one? i know heartburn is uncomfortable, and it sucks to have to live with it. but unless you're thinking it's a cardiac event, i fail to see why it couldn't wait until 5 or 6 when the surgeon would be waking up anyway.
*** look he is a professional and an adult. none of the things you mentioned are things a nurse whould be waking a physician up for. that is exactly why we have stratagy to prevent such things. if the physician refuses to make use of the normal stratagy, like his fellow physicians do, then it is on them, not nurses.
it is the physicians duty to get enough sleep to preform safely. they can do this easily, most do. if you have one who is a control freak, or simply imcompetent and didn't learn how to write a proper set of orders when they were residents it's not nurses fault or problem. we are our patient's advocate. we must advocate for our patients even when their physician doesn't know what he / she is doing, or chooses not to do the normak, proper thing.
so you wake him up for two minutes to give an order for an antacid . . . no need to try crackers or anything else. just go straight for the neurosurgeon who has a 7am case scheduled. then your colleague calls him to wake him up for two minutes to give an order for tylenol for a backache. hey it's a neuro unit -- it could be something really serious, right? and then someone else wakes him up for two minutes with an order for a laxative that really can't wait for morning because the patient is really uncomfortable. and then the charge has to wake him up for two minutes to report a k+ of 3.5 because it's a bit low.
at what point is he sleep deprived enough to affect his performance in the or? at what point would you not want him operating on your loved one? i know heartburn is uncomfortable, and it sucks to have to live with it. but unless you're thinking it's a cardiac event, i fail to see why it couldn't wait until 5 or 6 when the surgeon would be waking up anyway.
while this is all true... perhaps calling him in the wee hours with these petty concerns would make him think twice about not ordering things like tums and tylenol on his post op patients.
Advance practice nurses have the ability to write for all manner of Rxs, that is consistant with thier training. I have never understood why an RN with our education in meds couldn't get OTC meds for our patients. Honestly- if it was 9-5 the guy could have strolled down to the gift shop and bought a roll of tums, but in the middle of the night we can't offer this simple relief without the blessing of the allmighty MD. How about a line on the admission order sheet that says "OTC meds at nurses discression" and a checkbox( or better yet- a hospital policy that says we can order OTC meds unless denied by a specific order)? The pharmacy could have a list of RN orderable meds.
While this is all true... Perhaps calling him in the wee hours with these petty concerns would make him think twice about not ordering things like Tums and Tylenol on his post op patients.
Where I work the residents on surgery services that take call at home are most of the time NOT THE ONES who admitted/operated on the patient, just the one on call that night , who will be in at 5-6 am for the OR. another mockery of nursing some of these posts represent.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
or better yet- a hospital policy that says we can order OTC meds unless denied by a specific order)? The pharmacy could have a list of RN orderable meds.
*** I guess I didn't realize so many hospital still are not doing this.
Where I work the residents on surgery services that take call at home are most of the time NOT THE ONES who admitted/operated on the patient, just the one on call that night , who will be in at 5-6 am for the OR. another mockery of nursing some of these posts represent.
A mockery of nursing these posts represent? What does that have to do with what I said?
Perhaps the system needs some tweaking if a doctor who needs to be in the OR at 5am is also taking call in a hospital that doesn't have standing orders for common complaints. It's not the nurse nor the patient's fault.
PMFB-RN, RN
5,351 Posts
*** Gee, wouldn't that be great? It would be great to call a physician, present my assessment findings and pertinant information and recieve an order. Wow! I can hardly imagine it. Better than what I get about 9/10 times, "well what do you usually do?", or "just tell me what you want me to order", or "golly gee I am not sure, what would you suggest?".