Published Jul 17, 2009
"I don't know why he hasn't written for a PICC line yet! I left him a note on the chart three days ago!"
I guess I am just anal retentive, but sometimes I am astounded that people think notes like this (mind you I photoshopped the coffee rings on this fictitious note!) will get ANYONE's attention, let alone a zooming doc.
So I type my notes, 14pt font, half sheet of 8.5 X11 paper and tape it directly to the front of the chart. (I used to put my notes in by the progress notes, but then got worried that they might wind up in medical records and be in with the permanent chart >.
Mind you I work nights, so chatting up docs during the day isn't something I get the luxury of, so I tend to leave a lot of notes to express my specific concerns. I always put my name on them too! That way if they want to complain about bossy nurses and too many requests they know who to look for!
Anyway, just a vent :)
PS. I had one particular nurse who is infamous for torn sheets of unreadable scrawl point out that I should highlight the docs name on the note to get their attention...lol.
I like your idea Tait...would probably get more attention than the post-it notes I leave in the progress notes.
It's hard sometimes to say what works since I only leave a note if I'm not going to be there the next day (I'm a day shifter)...and since I'm not going to be there, I most likely won't be able to follow up.
In my experience, verbal pass-ons to the next shift are the least reliable way to get a hint/suggestion to the doc.
We use large 8.5 x 11 inch sheets of paper, paper clipped or taped to the front of the chart to leave notes. One nurse even writes it on our yellow blank progress note paper in big black marker. Seems to work nicely.
Tait, MSN, RN
My first job had a communication log. We would write the request and then the doc was supposed to initial it when they had read it.
It worked well, however it was a small hospital and we didn't have more than one doc per patient for the most part. Where I work now it seems there are so many specialists that they just keep passing the buck around on issues.
I found that writing a note attached to the binder with a rubber band, so that you could not open the binder without first reading the note was effective. I am a day shifter and the doc's seem to come and go without me noticing, so rather than paging them numerous unanswered times this worked for me.
We have a communication log that is kept to the front of Dr order section. When the note is written, there is a section for date, time, who writing, who being written to, and the comment. The page is then folded across like a new order so that the docs don't miss. Some of our patients have mult docs, and we've not had anything missed yet......
I think I'm more offended by 1)the idea of leaving the note as a question and 2)allowing the issue to go three days unresolved. If the doc doesn't respond the very next day, then give him or her a call for goodness sake!
Ruby Vee, BSN
we just text page them.
A nurse I worked with wrote notes (rather lengthy) in tiny little writing. I was amazed that her notes were always read by the doctors. I think they saw it as a challenge. What works for me: Paperclipping the note to the progress notes in such a way that the doctor has to use two hands to get to his or her progress notes. Writing the Dr.'s name on the top in big letters. And I have been known to hide the chart in the nurses' station so he or she can't sneak in and write a progress note without my being called and getting a crack at them with something vital.
It was a false scenario...for the most part, and I generally never phrase my requests as a question, more as a here is is what we might need, and here are my reasons for requesting it.
My hospital has brightly colored paper with "Physician Messages" written at the top. We are required to write pt identifying info and the date on the message, and we leave it in the progress notes. Seems to work pretty well..But sometimes I see notes for things that should really be called for--especially when it's something that pops up on dayshift. Nights have more leeway for notes than days, IMO. (And I'm a dayshifter..)
NurseKitten, MSN, RN
I'm famous (or infamous, as the case may be) for my missives to physicians.
Most of them have learned to just give me what I want for the patient and we're all happy: the patient has what they need, and I don't bug them to death trying to address the issue.
I see it as a "win-win". :)
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