occurrence report=doctor hates me

LovingLife123 · Nov 12, 2018

Pt was an observation from a minor surgery that needed rapid response and later died from possible sepsis within three days. No medical doctor following? It was simple occurrence report complication from a surgery that needed to make facility aware. Are facilities not to report a complication? This is a small hospital where I work with not even a compliance line set up. There is more to it because something was used for the surgery that was not normal, an "off label use" which they changed a policy to okay for off label use. It was set up for failure due to that! Manager said that device was normal...not in my 18 years..

So the patient was on your unit with no doctor following, just the surgeon? Am I understanding correctly? That happens all the time, you don't have to have an internal med doc following. You should have had orders from the surgeon though and a way to get a hold of the surgeon the same way you get ahold of a hospitalist.

I work in a surgical icu and sometimes, we don't have icu following, just the surgeon. But they give us our orders and numbers to page.

And just because you haven't seen something used off label in your practice doesn't mean it doesn't happen.

Does this hospital not have a rapid response team that took the patient off your hands to icu when it occurred? Was the surgeon not available when paged during the rapid response?

KatieMI, BSN, MSN, RN · Nov 12, 2018

So the patient was on your unit with no doctor following, just the surgeon? Am I understanding correctly?

So, surgeons are not "doctors" any more? Another thing to remember

:roflmao:

psu_213, BSN, RN · Nov 12, 2018

I worked someplace where all RRTs were entered as an incident report by the operator who called the team. The report was basically "[Room number] Smith, John MRN 12345678." There was a committee that then looked at all RRs to see if anything could have been handled better.

Without knowing the specifics of this case (i.e., exactly what was done, exactly what was off label, etc.) it is impossible to determine if the doctor and/or your NM is in the wrong. This was a patient you were treating on the floor after surgery, correct? Unless you actually witnessed something that lead to the sepsis, it is not your place to report what may have happened in surgery. If there was something specific that did or did not happen once the pt was under your care (for instance, many unanswered pages), then you can write up an incident report for that.

Ruby Vee, BSN · Nov 12, 2018

Well,
This has been bugging me. I wrote an occurrence report for a rapid response and then patient died within a short time frame after a procedure. My manager told me that I was in the wrong for writing it and that MD doesn't want me to take care of his patients and also somehow another surgeon chimed in about "my conduct" during this review! Its a long story, but is that a JUST culture? Feels like retaliation to me for something our unit and MD could learn from? Does it make them look bad at higher up? A policy was changed to make me look bad too. I am trying to see if union can help me but doesn't look promising. PS our "manager" never been in this position before so she is trying to "make peace" for "my error" of reporting.UGH!

I'm not encouraging anyone to provide details of an incident because that can come back and bite you in the posterior, but since I don't know for sure what exactly happened, I don't know whether you're in the wrong for writing an "occurance report" or not. (By the way -- what is an occurance report? Is it anything like an incident report?)

Because it's a long story that I don't know, I cannot answer your question of whether this is a just culture. But I sincerely hope you did not write up a physician without having all of your ducks lined up in a row, your written policies verified and an opinion from your charge nurse (or, if you were in charge, from the most senior nurse there besides yourself) that a write-up was warranted. MDs tend not to learn from write-ups from nursing staff unless there's something truly egregious happening. (And even then sometimes . . .) And yes, write-ups make them look bad and are truly annoying. Your first step should have been talking to the physician involved.

A policy being changed to "make you look bad" sounds a little bogus to me. And if the union cannot help, you're kinda out of luck here. Plus you've made yourself difficult to work with. If the providers don't want to work with you, that's a problem.

avado, BSN · Nov 12, 2018

Manager knew of device, the OCR was simple, pt came in for observation status, had a rapid response, transfer to ICU then DNR within 3 days.

avado, BSN · Nov 12, 2018

It was guessed as sepsis. i was not present for RR but was told my manager the day out of surgery something was amissed and two other people verified what I was seeing. I just come back to find out and RR was not reported as we have new one year grads as charge nurse now. Our manager is a temporary who has never been this position before. Yes, I should of questioned the doctor but gave a report to oncoming rn that this is a different device and best I could explain how to assess it and use it and left that message to my manager about it. It was just not ordinary device that could mistaken for other things but placed differently. I can't say much, it just bothers me why i am feeling the heat. Because of this device, it was added to an old policy in another department since we do not have one. So this manager threw this in my face that its been in this other department policy for over 7 years. Yes, policies have rarely been updated that one hasn't been updated over 7 years! I really enjoyed the different font when I looked it up...

Daisy4RN · Nov 12, 2018

It was guessed as sepsis. i was not present for RR but was told my manager the day out of surgery something was amissed and two other people verified was I was seeing. I just come back to find out and it was not reported as we have new one year grads as charge nurse now. Our manager is a temporary who has never been this position before.

then why were you the one to write the incident/occurrence report?

Daisy4RN · Nov 12, 2018

Manager knew of device, the OCR was simple, pt came in for observation status, had a rapid response, transfer to ICU then DNR within 3 days.

If manager knew something was amiss and you did nothing wrong then why didn't the manager or charge write the incident report if it was warrented

avado, BSN · Nov 12, 2018

Good question.. not to make waves I guess. Why can't it be simple and used as a study? It shouldn't deter anyone. Its just sad.

avado, BSN · Nov 12, 2018

Seriously, we had no policy except another department policy that is over 7 years old. That is how messed up it is where I work. Yes, I have taken my lumps from my annoying write up. I usually write up on process problems like med reconcillation or safety issues. Union is pretty deep with the manager they are best friends, trust me they talk. Its a flash back high school. All I requested from the union is who changed the policy and an apology from my manager. I shouldn't be discouraged now for fear of retaliation.

Daisy4RN · Nov 12, 2018

Good question.. not to make waves I guess. Why can't it be simple and used as a study? It shouldn't deter anyone. Its just sad.

Again, without knowing all the info it is hard to say. But based on what you have said it should have been either the Charge or Manager who wrote the report prn. So in you quest to "not make waves" you did indeed make waves. Take this as a live and learn moment. It is not a matter of it deterring anyone, just needs to be the right person, (and for the right reason/info) to fill out the incident report. Most nurses hate filling those out and don't do it unless it really needs to be done. Next time ask your Charge or NM if you are not sure, it doesn't matter how long they have been there, if they hold the position it is up to them.

Daisy4RN · Nov 12, 2018

Seriously, we had no policy except another department policy that is over 7 years old. That is how messed up it is where I work. Yes, I have taken my lumps from my annoying write up. I usually write up on process problems like med reconcillation or safety issues. Union is pretty deep with the manager they are best friends, trust me they talk. Its a flash back high school. All I requested from the union is who changed the policy and an apology from my manager. I shouldn't be discouraged now for fear of retaliation.

It sounds like an unsafe place to work and that management is playing CYA after the fact (falsifying documents/policies?). I think I would start charting very carefully and look else where. Good luck!