I received a patient with a low potassium level of 2.6. During report, the ER nurse stated that he had called the MD, informed the MD of the potassium level, and that no new orders were given. So I get the patient on the floor, and about 5 hours later my boss hears of the level with no new orders and tells me that I HAVE to call the doctor now. So I did, and from the way he was talking, it sounded like he didn't even know, but he ended up ordering a few things. Anyway, my question is, I'm not sure how to handle future situations like this. If, during report, the nurse says that he/she has already called the physician and has made them aware of whatever the problem is, are we supposed to accept that? Are we supposed to believe they are full of it and call the doctor again to make sure? I'm just not sure...
I received a patient with a low potassium level of 2.6. During report, the ER nurse stated that he had called the MD, informed the MD of the potassium level, and that no new orders were given. So I get the patient on the floor, and about 5 hours later my boss hears of the level with no new orders and tells me that I HAVE to call the doctor now. So I did, and from the way he was talking, it sounded like he didn't even know, but he ended up ordering a few things. Anyway, my question is, I'm not sure how to handle future situations like this. If, during report, the nurse says that he/she has already called the physician and has made them aware of whatever the problem is, are we supposed to accept that? Are we supposed to believe they are full of it and call the doctor again to make sure? I'm just not sure...
I think I would have been puzzled enough by a doctor choosing not to treat a K level that low that I would have done some digging through the chart, then I would have called. Sometimes the ED doc will only write holding orders, then the admitting physician will come see them and write the admitting orders. If that is the case, I would have waited for the admitting to come and then pointed the K level out.
Specializes in Breast Cancer, Arterial, General Surgery.
Personally I think that I would have rung the doc and asked him if there was anything that he wanted to do as the patients K was 2.6. He could then say that he knew about it or not, but I would rather be shouted at than leave a problem that serious for five hours.
Document, document, document. Communication is key when passing on information in report. I agree that I also would've called the doc anyway. They would've had to of given you admitting orders anyway, correct? Also, you could've gotten your charge nurse involved - that could've been made an event report for an inappropriate admit. A K of 2.6 is scary.
Specializes in CNA, Surgical, Pediatrics, SDS, ER.
I work in the ER and I have not called an admitting doc concerning issues w/ my pt. The ER doc is usually updated and he also speaks to the admitting doc on the phone b4 admitting the pt. Usually they will write futher orders per doc so & so which is the admitting doc.
We also have the critical lab notification system so at least you know it's been addressed & to whom it was addressed w/. A K of 2.6 is low and I would have spoken w/ a coworker or the charge as to what to do about it. I would also clarify w/ the ER nurse next time which doc was notified.
I absolutely would have called someone. Even if the doc treating the pt in the ED was aware and gave no orders, someone has to. The pt's K+ was 2.6. If someone griped that you called to get that covered, too bad. I would have said that "Dr. Soandso was aware and didn't think it was necessary to supplement a hypokalemic patient. I think we should, don't you?" and gotten orders.
Even if I was told the MD was aware and that there were no orders, I would be calling the MD anyways. No orders for a K of 2.6 sounds out of the ordinary to me.
If you feel uneasy about calling a doc because they supposedly have been made aware of the situation, use language such as, "I just received Mr. Smith from the ED and I noticed that his K was 2.6, so I'm just calling for orders for a K replacement." I wouldn't feel bad, or hesitate, about calling the MD until I had an order to replace that potassium. If their response was that they were aware of the low K level, I would respond with the question, "What do we plan on doing to fix it?"
Even if I was told the MD was aware and that there were no orders, I would be calling the MD anyways. No orders for a K of 2.6 sounds out of the ordinary to me.
If you feel uneasy about calling a doc because they supposedly have been made aware of the situation, use language such as, "I just received Mr. Smith from the ED and I noticed that his K was 2.6, so I'm just calling for orders for a K replacement." I wouldn't feel bad, or hesitate, about calling the MD until I had an order to replace that potassium. If their response was that they were aware of the low K level, I would respond with the question, "What do we plan on doing to fix it?"
I agree - I would follow up with this within a very short time of getting report if I didn't hear from the doc.
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Virgo_RN, BSN, RN
3,543 Posts
R on T is where a PVC occurs early in the cardiac cycle, falling on the preceding T wave. This can be a precursor to V Tach or V Fib.