New here and in position...Need advice!!!

[NelliRN06]

Hello! I have been working in L&D and a newborn nursery (level 1) for about 5 1/2 years. Recently, I accepted the position of the unit manager. I have began questioning some things and attempting to improve some of the unit's processes.

One of the things that came up was the nurses liability when it comes to telephone triage for OB patients. We currently do not use log books for this. However, we did have a set of twins that were born non-viable @ 27 weeks after the mother failed to come back in although the nurse advised her to do so.

My questions: 1. Does anyone keep telephone triage logs? 2. Do you give advice (specific) over the phone? 3. If you keep a log, is it specific to your area (OB)?

Information / advice is greatly appreciated!!!

[TrudyRN]

I think you need to get help from the hospital's legal team.

[Jolie, BSN]

The facilities where I've worked have long since stopped doing any kind of telephone triage. When a patient calls OB asking about xyz symptoms, they are advised to contact their physician/CNM or come into the ER. Same for questions about the newborn after discharge.

[crissrn27, RN]

We do not give L and D advice, but we do give newborn advice, if that makes since. We don't keep log books about the newborn advice. and we are pretty quick to tell the moms to call the ped or come in to the ER. We will tell them things like how to tell if baby is nursing enough, how to help engored breast, not to worrry that the cord clamp is still on, etc. If someone calls and says baby is sick we refer them to ER or ped.

[NPinWCH]

We aren't allowed to phone triage anymore, though when we did we had a log book that listed date/time of call, pt name, doc, complaint and what was said. We still get calls and we always ask: What did your doctor tell you? We always do follow up questions, for example:

Pt: This is my first baby I'm due next week and my ucs are 10 minutes apart, should I come to the hospital?

RN: What did your doctor tell you?

Pt: To come when the pains are, 3-5 min for at least an hour or if my water breaks.

RN: Is the baby moving? Are you having any bleeding? Are you leaking any type of fluid?

Pt: Yes, he's moving and no, just the ucs.

RN: Then according to your doc you can stay home, but if you would feel more comfortable being evaluated please come in and we can check you out.

If a pt is told they need to come in (Pretermer with ucs, bleeding, h/a, epigastric sx, PROM...) and they refuse or say they'll just wait til later we usually make a note in their prenatal record AND notify the doc ASAP. Usually, the doc then calls them and tells them to come in or come to the office.

[SmilingBluEyes]

We cant' triage over the phone. They are told either to call their doctors or come in, if they are concerned enough to seek help. Sad but true.

[nurseynightnight]

We do phone triage at my hospital. For the first few years I worked there we had NO record of the calls. We told them what we thought they should do and that was it. Either they showed up or they didn't.

Now we have phone triage records. We write out specifics about the patient: name, age,dob, doctor, g,p, edc, when they called, person calling (patient or other person) and then the problem in their words.

We have a list of canned answers to pick from.

questionable srom-come to the hospital

decreased fetal movement-not 10 movements in 1-2 hours then come to the hospital

it lists signs of active labor, preterm labor and when they should come to the hospital. And things they can do if they have questionable preterm labor/or early labor (lie down, drink fluids, count contractions) then come to the hospital if needed.

We are supposed to check that we discussed the appropriate area with them, they understood and then if we discussed anything else we write it on the bottom. We are also supposed to encourage anyone to feel free to come to the hospital to be checked out at any time. We then fax this sheet to their provider. Currently only our OB docs want this sheet faxed. For the others we siimply place it in the prenatal folder and it ends up in medical records once they deliver.

Now I will admit there have been times I was too busy to fill one out, forgot about it and ended up not doing it. But for the most part we are very good about filling out these phone triage records. It makes me feel better to know I have a record that I told so and so to come in when she hadn't felt fetal movement for 5 hours. She doesn't show until the next morning and has a fetal demise.

Now we still get calls from pp patients and we do not keep a record of these. Nor do we have anything for baby questions.

If a mom/dad calls we can always refer them to their provider via our operator. Or if they call about something like medications and it isn't on our list of approved meds.

I think they are a great tool to get started for a nursing staff that must do phone triage.