MD AWARE

I know exactly what you mean.

the other week on an ortho surgical ward my friend discharged a patient with a prescription of amoxycillin, containing penicillin.

the patient was allergic to penycillin.

how ever the doctor had prescribed the amoxycillin on the patients drug chart where it clearly states the allergy, the pharmacist then confirmed the order.

my friend had only just come off of holiday and didnt know much about the patient. in fairness she should have realised this error.

the patient then went home and had a severe allergic reaction to the drug, not life threatening although it could have been.

now the nurse is the one being disciplined due to the incident however the doctor has not had a single action against him for prescribing it.

Hee!

Would he care to make that statemen- that he would make up something- in front of a witness?

Well I'm old and sneaky, and I would write up the incident as harassment, and quote him on that particular sentence, and get a coworker to sign as well. You'd have no more trouble from that particular doc!

yes i have been yelled at by a doc for my charting... to bad for him.. i was told by a doc my charting made him look bad... lol.... a md cannot tell you what to chart .. to bad if they don't like it... never change your charting because a doc tells you to... the docs are nothing to you , they are not family or friends they are co workers and you need to CYA.... i had a doc call me up and say read your charting today and you made me sound bad... i said " i write what happens" and i will not change it... she slammed the.phone in my ear...lol... to bad....if they don't want bad things written about them they better do the right thing...

My favorite charting phrase as of late is "Pt experiencing so-and-so, stat call made to M.D. So and So regarding this information, no new orders received. Will continue to monitor." That way whenever Doc Do-Nothing wants to know why his patient crashed in the middle of the night he, his colleagues, my bosses, and the as-yet-unappointed-invisible jury can read it right there for themselves. :nuke:

I have to agree with the other posters. If a patient complains of pain and does not have an order for anything to relieve it (and if the pain cannot be relieved in a non-pharmacologic manner), good judgment and nursing practice would dictate that you would call the treating physician to make them aware of their patient's condition and the need for some pain medication.

More than once I have received a glib response or an outright refusal. I chart the doctor's response objectively, using the basic facts and direct quotes. I will be very detailed if I feel the situation warrants it.

I most certainly will chart "Spoke w/MD @ 0300, MD aware that patient is experiencing stabbing pain in right temple, duration 30 minutes, rating it as an 8 on a 0-10 pain scale. Attempted repositioning, additional pillow, dimming of the lights and cool compress to temple area without relief of pain. No new orders received." or "I'm not giving you an order for anything right now. She can wait until I see her in the morning."

When push comes to shove (as the old saying goes), I want to be able to show that I tried to do right by my patient. Doctors should be well aware that they're going to be held accountable for their actions (or inaction) in the nurse's notes.

oldladyRN

I always chart "MD made aware, no new orders", if that is the case. I would not have said "No nursing interventions at this time" because that makes you look bad. You should always chart whatever you did to make the pt more comfortable--repositioned, ice pack applied, or whatever. We have things we can do that the doctor doesn't need to order.

There are times when you have to go beyond "MD aware."

If the situation is dangerous for the patient or there are ethical considerations you have to report it to the charge nurse and perhaps go beyond that to the supervisor. On to the medical director, if warranted.

I've been involved in situations where we went beyond the attending right on up to the medical director and the ethics committee. And no, I did not suffer any repercussions for doing so. It was well within my scope of practice and responsibility to do so---in fact it might have been construed as negligence/malpractice had I NOT done so.

I've seen nurses scribble "MD aware" and then scurry off with the issue unaddressed, perfectly comfortable that they had covered all their bases, legally. It seemed that all they were worried about was, indeed, the CYA factor.

In truth they were just thinking of themselves, IMHO. And IMHO, that sucks. Spare me and mine from that breed of nurse.

Just writing "MD aware" does not necessarily CYA when the legal crap hits the fan, BTW. The "what would the prudent nurse do" factor enters the picture, with expert testimony.

So be careful out there.

I was working last week and one of the doc's read my nurses note and was extremely mad and ripped me a new one for writing, pt rates pain 5/10 MD aware, no nursing intervention at this time..... I mean I am a relatively new nurse, alittle over a year, but I was always taught to CYA because if it goes to court the doc is going to try to blame everything on the nurse.... has anyone been yelled at by a doctor for their documentation... He tried telling me that what I document means nothing and if it does go to court he would make up something. Sometimes I can't stand doctors!

was there a PRN pain med that was ordered for this pt? If so why wasn't it given. A pain of 5/10 is considerable and could get even worse if no intervention is promtly implemented early. When you said "MD Aware" did you mean you consulted him about the pt's discomfort, and since no intervention was made did the doc NOT order any analgesia?

Wow, these are the kinds of posts that could scare a girl right out of nursing school. I hope all Dr.'s are not this way, because I'm with those of you who would cover my dierriere before worrying about someone else's. I hate to be that way, but nobody's PHD is going to scare me out of doing what's right. Good for you in my opinion. Not that it counts for much since I really am talking as an outsider being only in pre-nursing school, but wow, if it were me he was talking to I just might take his statement as a sign that it's time to look for a new place of employment.

I wouldn't count on ANY doctor covering your butt when it makes them look less than perfect...I've seen way too many nurses thrown under the bus over the years. Always, always, always CYA! Hold your guns...but I do like the suggestion of "No new orders", instead of "no nursing interventions".

Yes, of course you should always chart when you have spoken to a physician about something and what (if any) orders you received, etc., etc. Don't let this person intimidate you - come up with a neutral and straightforward response such as, "It's not my intent to make you look bad. If you have concerns about my charting, you can speak with _______ " (supervisor). End of story. As was mentioned already, if you think that the physician's response to a patient's complaint or change in condition is not appropriate, it is your responsibility to follow that through; speak w/ the physician again and if that doesn't work go up the chain of command starting with your charge nurse. These issues can be really difficult and unnerving especially when newer in the profession. I write telephone orders verbatim, including one once that said, "Do not call me for the rest of the night" (and then right after that I did notify the charge nurse and administrator on duty). You just have to stand your ground. I've found that if you stay kind/neutral but firm, they'll usually look for someone else to try to intimidate. Don't let it get to you

If there was a PRN order written I would have given it to the patient. I think this particular Doc just like to fight with me over the littlest things, to try and make me look stupid in front of my co-workers so we go head to head at the doctors station all the time.... but Yes no PRN orders were written, I explained to him the situation and he did NOTHING... I mean OK if you want to be mean to me and not write what I am asking you for but in the end you are hurting to patient not me... but I am no taking the heat when I told you there was a change in the patients condition and you didn't want o write an order because of personal reasons with a nurse.....I am a new young spunky ER nurse and he is an OLD Doctor who has been in the profession for over 30 years, so I think he doesn't know how to handle that big difference quite yet. I like no new orders at this time, I am going to start documenting that instead. Thank you all for your input.... This is what I love about nursing, you learn something new everyday : )