Is it okay to call the doctor for a script in the middle of the night?

roser13, ASN, RN · Sep 4, 2017

Well, let's think this through....

If you were an MD, would you appreciate being awakened in the middle of the night for a prescription for diarrhea medicine? Or for a narcotic even, if it wasn't an emergent issue?

Or would you expect that routine scripts/refills should be handled during normal business hours?

amoLucia · Sep 4, 2017

Why didn't the 3-11 shift call themselves? That's where the problem should be directed. Usually it's not an extreme nuisance if the call is made before 10 or 11 pm. I figure the doc is up until the late TV news before bedtime, so it'll be OK to call.

And yes, I support the rally call that "phone calls are part of the doc' job". But it's not nec to become a nuisance, esp if it's something that could have been handled in a more timely manner.

I WILL make that phone call on NOC if I have to for something important.

I NEVER want to be the Nuisance Nancy Nurse that docs don't return phone calls to.

Sour Lemon · Sep 4, 2017

I wouldn't call for that unless the patient needed it at that very moment. I also tend to ask doctors what their ideal non-emergency hours are with regard to being called. If someone stays up until 2AM every night, I might give them a call. If they tell me they go to bed at 8PM and wake up at 4AM, I might call at 5 or 6 before I leave.

When an issue is urgent, I'll call any time of day or night, of course.

brownbook · Sep 4, 2017

Just to clarify. The evening shift nurse told you the patient was in pain (needing narcotic pain meds), and was having diarrhea (imodium). We don't know why the evening shift nurse didn't take care of it....I hope the patient wasn't having pain and diarrhea all night?

So you assumed it was something to pass on to the day shift nurse instead of call the doctor yourself?

This is a SNAFU in long term nursing facilities. This really stinks.

IF the patient was having significant pain and diarrhea all night then you should have called the doctor. After you have done your own assessment of the patient. Don't take the previous nurses word for what is going on with the patient. Re-read that sentence. I am not saying you should have called the doctor.

If the patient was stable enough, not having significant pain, the diarrhea wasn't constant or severe, the day shift nurse needs to deal with it. No sane nurse thinks it is okay to call a doctor on the 11 - 7 shift for something that is not urgent.

Actually this all started with the evening shift nurse. She should have dealt with it.

You should take a minute to talk to your supervisor, simply ask for her advice, guidelines, on calling the doctor, on your shift. You don't need to go into any details about this specific incident. Whatever she tells you ask for it in writing. If she implies you can, should, call the doctor anytime for anything on your shift be sure to get it in writing and when you get an irate doctor complaining about your call you have in writing what you were told to do.

I repeat, unless the patient was in distress all night, you did the right thing.

This was not your question, but when you call a doctor have the patient's chart in front of you. Recent vital signs, medications they are currently on, allergies, etc. You should problem solve before you call. Why was the patient suddenly needing narcotic pain meds, why was the patient having diarrhea? Were their pervious pain meds not working? Did they have an injury? Any idea about the diarrhea? How much, how often. A side effect of a new medication they were on? A fever? Bad food from the kitchen?

Know what medications are available in your med supply. If the doctor kindly orders Percocet, you take the order, (after slowly and carefully reading back to the doctor exactly what the order says), then find out you don't stock Percocet, the second call to the doctor might not go so well.

Kooky Korky, BSN, RN · Sep 5, 2017

So, OP, where do things stand?

Do you understand now? Reasons to wake a doctor up include but are not limited to are:

serious bleeding

serious respiratory status

apparent or suspected injury (like after a fall or other trauma)

your gut telling you that your patient's condition seems unstable and is likely to deteriorate if you don't

call the doctor right away

high temperature that doesn't respond to anti-pyretic

serious vomiting that threatens to de-stabilize the patient's chemistry

serious pain

terrible itching

On Night shift, I do not call a doctor for a cough (unless bad, keeping the pt up/miserable, and/or accompanied

by significant fever, bad ear pain or bad throat pain, or other serious symptom/sign), sore throat, low-grade

temp, or other annoying matters that don't seem like they will worsen or become dangerous before morning.

In your scenario, how come the 3-11 nurse didn't call a doc? There could be acceptable reasons, but I just

wonder why the call wasn't made. It is not acceptable to make a patient wait through 3-11 and 11-7 shifts

while having diarrhea and pain requiring narcotics.

You would not exactly have been wrong to call a doctor early on your shift or at the end of your shift to get

treatment for those reasons, especially since the patient was suffering for too long, IMO, based on what you

have said.

It's not really possible to tell you every reason to call or not to call a doctor on Night shift, but your supervisor

should be able to give you some guidelines.

My view is written from the standpoint of a long-term care setting, not acute care, not ICU.

lindseylpn · Sep 5, 2017

Does your facility have standing orders? When I've worked SNF/LTC we've had standing orders and stock meds for things like: nausea, diarrhea, fever, cough, headache etc. One unit had a stock and emergency med box in their med room. The standing orders books were at every unit and incase of something like diarrhea we'd look up the patients Dr and there where their orders. Dr. A's orders may be too give Imodium but, Dr. B's orders might be the call the on call service. If there was an order for meds, we'd transcibe it into the mar and go to the stock med box for the med. You may want to look to see if there are some standing orders, they really make situations like this so much easier. Not all facilities have them though.

I personally wouldn't have called at night unless the diarrhea was excessive and the pain was intense, unusual etc. We'd routinely send in med requests to the Drs though at night by fax and then dayshift would receive the orders back in the morning. I would fax something like: pt has 24 hours of diarrhea with pain, standing dose of Imodium given, further orders for diarrhea/pain meds? The Drs/nurse would fax back like: continue with standing orders, an order for more meds or say call for Drs appt. Every facilities procedures are different though.

Even if you'd called the Dr would you have the meds to cover for the order or does your pharmacy deliver emergency meds at night? Not all facilities have access to the pharmacy at night so, even if you got an order dayshift would still have to get the meds.

The facility I work at now (group home) doesn't have standing orders and we have no access to the pharmacy at night. OTC meds are Incorporated into our Mars though incase we need them. The nurses in the home don't contact Drs at all either, only our office nurses do. If a pt really needs something at night, then a trip to the ER is the only option. For something like diarrhea we'd probably wait till dayshift for orders if possible.

The 3-11 nurse should've really addressed it though (unless it started at the end of the shift or something).