MD saying I didn’t do something

Specialties Ob/Gyn

Updated:   Published

Specializes in mother baby.

I had a patient who was type 1 diabetic. Patient was on insulin. Blood sugars were elevated.

MD is saying I didn’t administer insulin and the blood sugars were never treated. I have documentation in the MAR that insulin was given several times. MD wrote a note in the patients chart stating that insulin was never administered and that they were never paged. I had paged them several times before I got a response.

What do I do? 

1 Votes
Specializes in retired LTC.

#1 - Make sure you nsg chain of command is aware of this. (Not just a charge nurse - I'm talking nsg admin.)

#2 - Is the pt competent to verify your care delivery? Just to back you up.

#3 - Was there any other staff person who knew you were trying to reach the doc without success?

You realize that the MD could just claim that the MAR is just FALSIFIED. A case of 'he said, YOU said'.

After all the hooey, was the pt OK?

#4 - Check with your admin to see if some type of incident report might be needed?

 

2 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

Did something happen to the patient? May need an incident report.

Documentation is key.

Can the patient  or a staff back you up? If so, get it in writing.

Did you page through the operator? They should have a record of it.

Do you have a union? Call them and let them know.

I agree with amoLucia's points above. Inform your chain of command from manager, supervisor and nursing admin.

Once you have all your facts, get a meeting with the doctor with your nursing admin manager and union rep. That note  that the MD wrote need to be addended as it could have legal ramification if the patient was affected and had a bad outcome.

Moving forward inform manager/ADN if unable to reach someone to avoid a He said/ she said scenario.

All luck!

2 Votes
Specializes in mother baby.

The patient is competent, with every insulin administration I verified the amount I had to give with the patient. Patient was stable throughout my shift. Patient kept telling me that the insulin units was not enough, she even expressed this with the doctors. the patient can definitely tell them how many I gave her insulin throughout the day.

I have documentation in my voalte from work that I paged the doctors many times. 

I communicated with the charge nurse and other staff members that I couldn’t get ahold of the doctors. 

all my coworkers saw me throughout the day and heard me saying that the patients sugars were not doing down and that the insulin amount was not enough. They even got involved when the doctor said I didn’t do anything for the patient. 

my nurse manager saw me throughout the day as well as clinicians struggling to contact the doctors and figure out the insulin. 

in the patients chart it shows all the blood sugars I did and that I treated each one of them  according to the orders that were placed. 

5 Votes
Specializes in retired LTC.

I suggest that you write down a detailed narrative of the whole episode as it occurred with all the 'who, what, when, where and how'. Keep it for your records. (Sad you can't copy documents r/t HIPAA.)

Everything can still all boil down to a nasty case of 'he said, YOU said' with the MD claiming record falsification. He could even claim the pt's LOC was impaired by hyperglycemia!

And PP spotangel's comment re a meeting with you, nsg admin AND the MD is most definitely appropriate for multiple reasons.

I might even suggest that you could contact your carrier for any suggestions. They prob would tell you much like we have and to also avoid social media.

Just know, as per your explanations, you did nothing wrong. But doctors do carry some significant clout, and it's inappropriate for him to wage a campaign to impugn your professionalism. And by extension, that of nurses. You and nsg will still have to work with him in the future.

Get this all settled out. Good luck to you!

3 Votes
Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.

I think your nursing management team needs to get involved if the MD is trying to throw you under the bus. This should not be tolerated and the MD needs to be confronted with the evidence. Next time ,any verbal orders from that MD or team should be verified by a fellow RN on speaker phone and both document (verified verbal order along with RN Backmeup!).If you don't take a stand now (think iron fist in a velvet glove), it's just a matter of time before another he said/ she said with this provider. All luck nurse! Chin up and don't back down when you are right! Put them in their place politely but firmly!

3 Votes
Specializes in L&D, Trauma, Ortho, Med/Surg.

Did you chart that you notified the provider each time you did notify? Did the MD notify you and complain or just write a note? If there is only a note I would call the MD and ask for clarification. I would assume it is a mistake on the MDs part before believing that s/he was throwing me under the bus about it because well 1 - I'm a positive person like that, 2 - because I know I took the correct nursing actions and 3 - because people make mistakes and this doc could have been looking at another chart or thinking it was a different patient and thought s/he was not notified. So I would talk to the doc and ask for clarification. Tell him/her that you saw the note and wanted to see if they had made a mistake. Remind them that of what happened, what you did, and that it is charted, etc. I have been sitting next to  providers where they are charting a note and looking at another fetal heart strip when I hear them say "Oh that is not the right patient!"  They have LOTS of patient's. I have charted on the wrong patient before too. Clarify first. ? 

2 Votes
Specializes in retired LTC.

I remember one doctor ACTUALLY charting in his notes that he was awakened at 2am for a call from nsg (me) re his pt, already being treated.

Well, his pt spiked a sudden 103 or something.  It was a new high. I considered it a significant change.  Yes, Doc had started new ABT (only 1 dose given). But I felt it was enough of a significant new thing for me to call. He declined a CXR when I asked.

I'd have been damned if I didn't call, and was damned when I did.

Nsg admin wasn't concerned. And I just kind of thought it funny. It didn't bother me personally, I'd do the same again. It was just that this Doc usually was more easy going. And he was usually very coop with me on other pt issues.

Go figure!

2 Votes

This is why documentation is so important and why it is stressed in nursing school.  Document everything and just the facts. As long as it's documented and you notify your supervisors of what the doctor said, then it is out of your hands and I would drop it. And now you are forewarned if you should ever have to deal with that doctor again., sounds like he was covering his own a**.

1 Votes
Specializes in L&D, Trauma, Ortho, Med/Surg.
1 hour ago, Camillemm said:

This is why documentation is so important and why it is stressed in nursing school.  Document everything and just the facts. As long as it's documented and you notify your supervisors of what the doctor said, then it is out of your hands and I would drop it. And now you are forewarned if you should ever have to deal with that doctor again., sounds like he was covering his own a**.

I totally agree with you here. Like I mentioned before - we all make mistakes. They have a lot of patients and could have something confused. As long as it was all documented I personally wouldn't be worried. However, I do care about my relationship with my provider, and I would want to clarify in person or over the phone just to show them hey - I did all the things I was supposed to...whats up with your charting... to clear the air and so I feel trust them, and if they DID think I did the wrong thing, I would want to correct them so that they know they can trust me.

0 Votes
Specializes in mother baby.

I actually spoke with my manager, she told me the Doctor emailed her to complain. My manager spent hours reviewing my documentation and medication administration as well as my communication log with the MDs and she told me she did not find any mistakes. She congratulated me, gave me a gift card and mentioned me during the weekly bulletin she sends out to the unit. The patient mentioned to my manager how great I was, and that I did everything in my power to help her.  I made no mistakes which is a huge relief. Thanks to everyone for your comments. 

3 Votes

One of the important if not the most important things in nursing is to document,document,document. If you don't document,it wasn't done then the MD has a case. Start at the beginning. What happened? Describe in as much detail as possible. What did you do for the patient? Again describe in detail.What happened when you called the MD? Did he return your call or page? If not,document. Document every time he doesn't call back or answer his page and the times. Meanwhile, document any reactions to what you did for your patient and any symptoms,until the patient stablizes or if not,did you call 911 or a code? Also if the MD calls you back,document everything he says to you,don't worry about what he says or how he says it to you.Also,document your replies as well. I know this sounds like alot,but when you document,you are no only covering your butt,but you are "painting a picture" for the reader as well so that they will "see" what's going on as well. Don't just document in the MAR,document in the patient's chart as well.Also,and this is very important,document that you notified your chain of command. I have been a nurse for almost 30 years and I have found that documentation is one of the most important tools in a nurse's orificenal. Good Luck to you.

 

0 Votes
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