911-ing a resident out, requires an order?

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Howdy,

Nurse Lynwood here. Forgive me if this question has been asked before, I am new to the forums.

I work 11-7 at a LTC facility. I get a call from my unit manager today saying it is urgent that I come up to the nursing home (LTC facility) where I work and write an order for Friday night (the last day I worked). That was a really chaotic night. To make a very long story short...I had to call 911 because a resident was a full code, (usually A&Ox3) and became unresponsive on me. And was hypotensive BP 80/40. I immediately called 911 to have him transported to the ER. The situation was critical and I didn't feel there was time to call the doc, and wait an hour for the on call doc to give me the order to "send to ER for eval and tx" (it was 3am). So I get a call today (Monday morning, I was off all weekend) and my unit manager says "you must come up here immediately and write the order for sending Mr. X to the ER for Friday night". Huh? I never got any such order or talked to any doc. I straight 911'd him out because the situation was so critical. In my years of experience, I have never had to write an order to "Send to ER for eval" unless I got that order straight from the doc before sending the patient out. As I understand it, if you "911 em out" you don't need an order from the doc to send them. Correct?

I think she just wants me up there because "the administrators" are in the building and they are short staffed & she is using this phoney excuse to get me up there so she can put me to work (they are short staffed today) and once I clock in (to write a 30 second order), they'd hold me there for a 16 hour shift and call it "abandonment" if I left. Yeah, that's they way they roll. I'm getting ready to quit this place because they've done nothing but abuse me with situations like this over the past 10 months.

So, my question is, YOU DO NOT NEED AN ORDER FROM THE MD TO SEND SOMEONE OUT TO THE ER if you used 911 to send them out in an emergency, CORRECT?

Thanks in advance for your time and response. I have already asked another nurse who works with me and they were unsure?:confused:

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Specializes in Trauma Surgical ICU.

I don't work LTC so please take what I say with a grain of salt.. From my understanding and what I have seen, yes, you need a order to send to the ED.

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My experience for a 911 is that you do not immediately need the order, but as soon as the patient is safely out the door you have to call the MD, explain what happened and get an order.

You always, always must get an order when you send the patient out. No matter what the circumstances. In theory you are supposed to send a copy of the order with the transer packet. But in a 911 that's of course not always possible.

Was there a supervisor in the building at the time? In a situation like that you can ask the supervisor to get the order while you are getting the patient out.

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Specializes in wound care.

if you afraid of working just show up in shorts and sandals with a cut off tee

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No supervisor was in the building at the time. Just me and 44 patients, and oh, 1 CNA (the other CNA was a no call no show). I did call the doc and explain the situation and that I had already 911ed the resident out. By that time he was already en route to the hospital. I did call and give the nurse at the ER a heads up on the situation. Also sent copies of the resident's MAR/TAR, H&P, Face Sheet, Advance Directives, etc. I just did not WRITE an order to send to ER for eval, because I never obtained such an order from the doc, as the situation was emergent and the patient wouldn't have survived long enough for the on-call doc to call me back and I always run the risk of the half-asleep on-call doc saying "just wait and call his regular doc in the AM and have him make the decision to send him out or not" (has happened to me before). Again, this was 3am. I did call his regular doc at 7am right before I got off and informed him of the situation. The hospital admitted him of course. I'll be surprised if he makes it back to us, he was in rough shape.

Thanks for the replies guys.

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I used to work for AL and there I never called the doc before 911, if it warrents 911 I don't have time to call a doc first. The doc was then notified. This was our policy.

Where I work now, NH in an extreme emergency where there is no time to wait you can call 911 before the doc, but you need to get the order. Otherwise you have to call the doc first because we are skilled care we can take care of many situations in house.

I guess what I'm saying is it depends on the P&P of where you work.

I agree that you should go in wearing street clothes then they can't force you to work. :)

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if you afraid of working just show up in shorts and sandals with a cut off tee

ha, they keep extra sets of clean scrubs available at all times, in all sizes :o

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Specializes in LTC.
ha, they keep extra sets of clean scrubs available at all times, in all sizes :o

Just say no you can't work. They cant force you to work on your day off.

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Specializes in Emergency Medicine.

Wow! ...just Wow!

You need an order for an acute medical emergency???

So much for critical thinking skills. Time = Tissue...

Fire me. I'm calling 911 and we can discuss

it later. I would rather that than be "under-fire"

for failing to act.

Sorry for you. You did well and I hope you would

do it again. Somebody needs to advocate for the patient.

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You need an order but you can get it after the patient goes out. The OP should have written an order before leaving for the day; however, since she talked to the doc at the time, all she needs to do now is write a late entry order to tie up all the lose ends.

She did everything right, she just didn't write the order for the doc to sign off on. It's really just a documentation issue, not that big of a deal.

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Specializes in Geriatric.

Unresponsive + Full Code? No second thought...911 then will call MD for the order.

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Specializes in LTC.

You do need an order to send a resident out to the hospital.

But..

with those circumstances(or any emergency situation on a resident that is not a DNH).. 911 first..get the resident out.. then call the MD for the order and to tell them the situation.

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