No orders?

Where I work in ICU if there is a direct admit from the dr office the patient most of the time comes with orders, if it is a direct admit from a different hospital then most of the time they don't and then we have to call to get orders. Pissy dr's is common where I work and don't like to be called for anything. you did the right thing by calling its your job and the doc will have to get over it. :)

The doc shouldn't have been pissy with you. You were doing your job. You deffinately needed more than protonix orders with a direct admit. In most cases I have had in the past they have sent orders with the patient.

I am a new RN, fresh out of school. I recieved an admit straight from the doctors office, no problem, but she had chest pain. I look at the physicians admission orders and all there was to give was protonix. I was floored. Is this normal? I had to call the doctor to get orders for nitro, 02, etc...dr was kinda pissy with me. I do not understand this.....shouldnt there have been cardiac orders?

clueless!

I think though that if the doctor believed that the chest pain was cardiac in nature he would have admitted the patient to CCU or through the ER first.

I think though that if the doctor believed that the chest pain was cardiac in nature he would have admitted the patient to CCU or through the ER first.

true, but then why didnt the doc adm with"epigastric pain"

since that is what he was treating........

We get patients with a diagnosis of CP which is epigastric in nature but the doctor uses CP as a diagnosis to satisfy the insurance company that the admission is warranted. The Games We Play...

Dont feel bad for calling, I wouldnt. You have to cover yourself.

And if all the pt needed was protonix, why are they even being admitted??

When I worked on tele, we got lots of direct admits and it was typical to have to call the admitting physician for admission orders. Always check when a new patient arrives and get orders as soon as possible. We had standing tele orders on my floor, so we could call the doc and we an order for standing tele orders, and verbally go over the standing med orders (nitro, morphine, etc....). Then, we they came to see the pt, they could add to the orders.

I'm thinking if the docs felt the patient was sick enough to be admitted they were sick enough to warrent orders-Diet? Activity? PRNs for pain, sleep, nausia...? How about IV access? Labs? Radiology? Gosh - even a consult to an appropriate service for diagnostic work-up. Sounds to me as if the doctor was going to be "pissy" no mater what - but I wasn't there. Could you have conveyed a feeling of mistrust in his admitting diagnosis by asking about cardiac work up?- You were right in your concern, but this conversation needs to be handled with kid gloves. The last thing an attending doc wants to hear is some nurse that just met his patient deciding he dosen't know an MI from heart burn and sounding like they are busting his chopps about it. Is there an admitting resident service that is supposed to handle routine admitting orders? Did the patient follow instructions? I've had patients show up in admitting when the doctors instructions were "go to the ER- you need to be checked out right away" I've had the opposite- patients that were told " if this keeps up we may have to admit you to get to the bottom of it" who show up in ER with the story " my doctor told me to come" . There are lots of angles to this picture we don't have. He still should have been polite and professional- he would expect no less from you.

Do you not have protocols in place for things like this? Where I work, no matter where you are if a pt has cp,.IV,O2,Nitro Q5 X3, EKG, page the doc. It would be very frustrating to stand around and do nothing until you could reach a doc. I am assuming that in this case the doc as already seen the pt and thinks this CP is not cardiac related,.but I agree he could have communicated his thoughts a bit better.

Hi,

I work on a Tele unit, and we frequently get direct admits that come straight from the MD office. Most of the time we get orders with the admission paperwork, but occasionally we don't. If the admitting Doc is also the attending, it often just takes a phone call to say that we need orders, which they will then enter into our system (we are on a computer system) once they know the pt has been admitted.

Direct admits are a little more complicated than ED admits, since we are the ones doing the first assessment, and carrying out any orders, and we often do not get a warning that they are coming, they just show up.

Amy

I don't know of any hospital that does NOT have standing orders for nitro, o2, etc. for chest pain.

If you believe that someone has cardiac related chest pain, do not wait for the doc to call you back before you do something. Standing orders are there for a reason - to allow you to treat someone in a timely manner for situations that are life threatening. Saying that you are "new" and didn't know about the orders will not protect you. Your facility should have gone over standing emergency protocols with you. If not - find them yourself, make copies, and keep with you at all times.

gosh - even a consult to an appropriate service for diagnostic work-up. sounds to me as if the doctor was going to be "pissy" no mater what - but i wasn't there. could you have conveyed a feeling of mistrust in his admitting diagnosis by asking about cardiac work up?- you were right in your concern, but this conversation needs to be handled with kid gloves. the last thing an attending doc wants to hear is some nurse that just met his patient deciding he dosen't know an mi from heart burn and sounding like they are busting his chopps about it. is there an admitting resident service that is supposed to handle routine admitting orders? did the patient follow instructions? i've had patients show up in admitting when the doctors instructions were "go to the er- you need to be checked out right away" i've had the opposite- patients that were told " if this keeps up we may have to admit you to get to the bottom of it" who show up in er with the story " my doctor told me to come" . there are lots of angles to this picture we don't have. he still should have been polite and professional- he would expect no less from you.

did we read the same post? i think not! when the op asked if the patient should have come with cardiac orders, i did not get the impression that she was slighting the doctor's ability to determine who needs to be admitted; rather, she wanted a full set of admitting orders. no "chop busting" involved. also, i believe you are assuming a great deal in how the conversation with the physician went. and, i hate to be flippant, but when it comes to patient safety and doing my job, i know for a fact that i do not give a flying cupcake about what the "last thing" an attending wants.

and about the patient following instructions, it sounds to me that the er was not involved, and that the patient was right in coming directly from the office (considering there was an order...physicians don't tend to write inpatient orders on patients who are not going to be admitted!)

correct me if i am wrong, but i believe the issue is lack of admitting orders. therefore, "angles" to the story aren't really needed.

~jess