Nurse Proxy/Patient Advocate and Physician Removal

[deweydecimal13501]

Hello,

Not sure where to place this, so please move to appropriate area if necessary. One of my nurses at the hospital asked me to research this question (which I have) and also get more information from nurses from other hospitals if possible. I hope you can help.

The question is: Has anyone been a nurse proxy/Patient Advocate for a patient in a hospital setting and the patient's primary care provider did not do in-patient. The patient's family did not feel comfortable with the provider that did cover his admissions/care and asked for a hospitalist. Hospital policy requires that the patient or their proxy call the physician themselves to notify the provider that they are being removed. and request a a consult for a new physician to take over. The policy prevents prevents the patient's nurse (the patient's nurse/advocate) from making the call even if they request that is is done so. If the patient's proxy had confronted the physician, this may impact her future dealing with the physician.

My question to you all:

Has anyone had this kind of situation? What would you do? Do you have any policy or procedures you would be willing to share?

Thank-you so much in advance,

Deweydecimal13501

[email protected]

[KatieMI, BSN, MSN, RN]

So, what your policy says if patient is unable to make his own decisions, proxy is not available and his PCP does not have privileges in hospital?

(sweet memory of mine: reaction of a deep and committed policy lover to a patient with both UEs amputated eons ago, s/p radical mastectomy in impending DKA coma. No upper body IVs including centrals due to risk of lymphedema, no IV in legs due to diabetes, per hospital policies. MD saw big juicy leg veins and refused to do femoral central line after he was physically blocked from throwing IJ in. The policy-lover's whole world suddenly crushed into non-existence:roflmao:)

Where I am, things like this happen almost daily. Patient from LTC coming from ICU, comatose/sedated/vented/terminally demented, PCP does not cover hospital, family is nowhere near. Either the admission coordinator (during the day) or shift leader RN (any other time) calls hospitalist service and asks them to consult. Alternatively, PCP is called by the same person and asked either apply for privileges on emergency basis (done in 24 hours if needed) or switch care to to whoever he or she prefers. Only one case when patient or proxy has to call physician is when they want second opinion.