IV's- nursing or medical decision?

[canoehead, BSN, RN]

I'm having issues with a doc. She does not want IV's started on her patients-not even saline locks-unless she gives the OK. Most of our docs have no problem with it if someone is orthostatic, or if they just look sick, if we put in a lock and draw blood while awaiting orders. If I wait for her to finish with what she's doing it can take up to 20 minutes, and in the meantime the patient could be treated, and feel like they are being taken care of, even if no meds are given.

The last ER I worked in they had no problem with RN's starting a line, and in most cases if the patient needed one the MD would be annoyed if it wasn't already in and running when he/she got there.

If anyone has a link to ENA material that states their position I'd love to see it. I have their triage manual and it doesn't address the issue.

[SouthernLPN2RN, MSN, RN, APRN, NP]

I've always considered an IV to be an invasive procedure and I don't place one without an order. However, I do understand that the ER is a whole nother world!

[suzanne4, RN]

You still need an order.

Most Emergency Depts have standing orders, and you are covered under those for stasting IVs. . But if the doctor states that she does not want those followed under her care, then she is the one taking responsibility for it. You cannot go around that.

[carachel2]

Do you have any type of standard protocols that would cover IV insertion ? We go ahead and start a line if the patient falls under these protocols (abdominal pain, chest pain, syncopal episode, cva protocol,etc.). If I have a doubt, I don't do it and wait for an order.

We do have one doc who doesn't like us to do hardly anything until he sees them. His charts stack up pretty quick.

[scrmblr]

We have a doc who has a fit if you put an IV in a pt without an order. He thinks we are "too quick on the draw" to start lines in ER pt's.

We do have a protocol for IV starts. I usually give the doc a quick run-down of the pt and ask..."Do you want a line and labs drawn before you see this pt?" He is appreciative of this.

[Katnip, RN]

Wow. In the ER I just left nurses were allowed to decide when to put an IV in. Heck, half the time we'd have blood down to the lab before a doc came in. Of course, we also had some protocols, but they didn't cover everything.

If we had an orthostatic patient or anything else we darn well knew needed a line, who didn't have an fluids going by the time a doc got in there, the doc would wonder what the heck was wrong with us.

[canoehead, BSN, RN]

Nope, we are working on protocols and they should be completed ...ahhh....sometime in the next 5-6 years. So don't hold your breath. I was hoping the ENA standards might have something that would back me up on the obvious cases.

The doc in question refuses to put her personal protocols in writing. So I suppose that means no order, no IV.

[beautifulb]

Has anything happened, besides a delay in treatment, because the pt. didn't have a lock?

It's too bad because you know what needs to be done to help the pt but per her "personal protocol" you have to wait.

I haven' heard of the ENA standard.

Good luck in what happens.

[Darlene K.]

We have standing orders and protocols. We get a line and labs on anyone whos CC falls under one of our protocols. It saves a lot of time.

[rjflyn, ASN, RN]

Ah the delema, with my experence I have been in several different ER's. They run the gammet from the one where basicly nothing could happen to a patient to what do you mean that chest pain patient hasnt been lined, labbed, xrayed, given MONA and all but admitted.

Anyway I think your fall back here is going to be the standards of care that every hospital is now getting graded on. As an example a MI patient is suppose to have his EKG done within 15 mins of arrival. That same patient is suppose to have documented that he was given ASA or why not. That same patient is suppose to be in the cath lab in less than 60 mins. Does said MD meet those standards. If not then maybe your facility needs to consider another doctor.

Rj

[Darlene K.]

Ah the delema, with my experence I have been in several different ER's. They run the gammet from the one where basicly nothing could happen to a patient to what do you mean that chest pain patient hasnt been lined, labbed, xrayed, given MONA and all but admitted.

Anyway I think your fall back here is going to be the standards of care that every hospital is now getting graded on. As an example a MI patient is suppose to have his EKG done within 15 mins of arrival. That same patient is suppose to have documented that he was given ASA or why not. That same patient is suppose to be in the cath lab in less than 60 mins. Does said MD meet those standards. If not then maybe your facility needs to consider another doctor.

Rj

I agree completely!

[traumaRUs, MSN, APRN]

We have extensive protocols that we run off of. We do IV's, labs, EKGs, xrays, some meds (asa, NTG, albuterol, atrovent, application of LMX to pediatric patients). In our ER we'd be dead in the water if we had to wait for the MD.