is it ok to call a dr even if not your patient

[mary78910]

Ok i have a question. I've only been a nurse for a little over a year. But in a situation where i know something is not right with a patient, and i continually tell the patients nurse and she doesn't listen, and this patient keeps declining is it ok for me to step on her and call a dr????

Ok another thing, surgeon on call doesn't return phone calls, who do we call then, my theory was call our supervisor her supervisor someone, we needed a damn surgeon. Anyway, no returned phone calls, nurse not paying attention. Patient actively bleeding, very low output, long story short hypovolemic shock and death. I can't sleep, keep thinking i should have threw a fit, i should have this i should have called the freakin ceo if thats what it would have took. But no one would listen to me. I guess i'm going to answer my own question and say should have picked the phone up myself. This is driving me nuts. Yes this is the first death i've dealt with. I guess the first one i've taken care of and been there whed died.

Anyway is it ok to take over???? This other nurse been a nurse for 30+ years

[Jolie, BSN]

When you see a colleague fail to respond appropriately to an emergent situation, you have a moral and ethical obligation to get help, whether or not that help is welcomed by your colleague, and whether or not you feel like you are stepping on anyone's toes. Think about it for one minute, if that was your spouse or child who was actively bleeding, and his/her caregiver was not responding, what would you want the other nurses to do?

Go up the chain of command. Get the charge nurse involved. If s/he isn't successful in turning things around, call the nursing supervisor. If more help is needed, and the attending physician isn't responding, call the chief of service. If the chief of service isn't helpful, call the medical director of the hospital. Alternatively, many hospitals now have rapid response teams that can be activated by family members or staff members to respond to patients who are not yet coding, but whose conditions are deteriorating.

For a hospitalized patient to die of an observed, but untreated complication is unacceptable and unconscionable.

[CritterLover, BSN, RN]

it sounds like there is more than one issue here.

always follow the chain of command. if you are not the nurse's supervisor, then i wouldn't initially call the doctor. first, i'd talk to the charge nurse.

if she is the charge, or the charge isn't listening, then i'd go to the nsg supervisor. let him/her come and assess the patient.

as far as doctors not returning calls, there is also a chain of command for that. usually, you have to go through the nsg supervisor, but for attending physicians, it involves calling first the chief of that discipline (in this case, surgery). if that doesn't get you anywhere, then the chief medical officer.

other options would be to call other consultants on the case, letting them know that you can't get in touch with the surgeon, but things aren't looking good.

depending on the situation (ie, not returning calls vs. returning calls but not treating/downplaying the situation), you can also try to get in touch with one of the surgeon's partners.

another option would be a medical response team, if you have one. ours rounds every few hours, and if you are concerned about a patient, you can always tell them "it's not my patient, but i hear that suzie's patient in rm 1111 is having some blood pressure and uop issues. maybe you want to check on him?"

[XB9S, BSN, MSN, EdD, RN, APN]

I have to agree with the above posters, if your patient has an ABC problem then the doc needs to be called, if the nurse responsible is not taking action then you need to do it, also go to your superior let them know what is going on and get some support from her as well.

THis is the type of patient that really benefits from a MET / ART or what ever your hospital call your medical emergency team.

[RN1989]

You facility is required to have a policy on chain of command, including the names of the docs that hold the positions of authority over the surgeon not calling back. Find that policy, make a copy so you have the info handy and can reference it when a charge nurse or other person does not step in as needed.

[wooh, BSN, RN]

You've got 2 issues. If you think another nurse isn't responding in an appropriate manner to a declining patient, discretely go up the chain of command. Fact is, there may be things going on that you don't know about. Let the people in charge take care of it, that's their job.

If you have an MD not responding to pages, there should be a policy in place for who to call, how to deal with it. Find it. Use it.

[Tweety, BSN, RN]

Basically, I agree with the above. Use the chain of command, charge nurse, manager, supervisor, etc.

Then document on an incident report.

[barbyann]

Remember, the emergency room is only a few hallways away. I have brought inpatients there when no one would return phone calls. (that was before rapid response teams, things are much better now).

[Sunflowerinsc, ADN, RN]

Any one call call a code for the rapid response team,including the pt (if able) or a family member who can see a decline in their family member. Of course I would go to nurse and ask if she needed help and get the charge nurse. There should be a policy for who to go to but I would never hesitate to call a Code White (rapid response team) and get started before you have a full blown code blue and /or death. Rapid response team can get the pt right to ICU and get all sorts of Dr's .

Part of our admission information now for the family includes information about calling a "Code White" if they feel something is "not right" with pt and staff is not responding. I believe this is one of the newer Joint Commission's safety goals.

[november17, ASN, RN]

I've done it before. Not because of a patient declining though. The only times I've ever done it were when I've had coworkers need a physician's approval to discharge their patient. If they are waffling to make the call and the discharge planner is backed up I have stepped in and made the necessary call and written the order. Our floor is really busy and generally they are appreciative, even though you could call it going over their heads.

[mary78910]

Ok, i went and checked the patient myself. Was shocked when i saw her. I had this patient two days before hand and shipped her to ICU when i had her, well then she came back out on that floor. Ok i just went to see her Just to say hi basically. And found this. I went straight to the charge nurse. She said the nurse is handling this she's contacted the dr. I said ok, well i had issues with my patient so i was taking care of that. When that charge nurse left at 7 i immediately told the new charge nurse. She went in. She called dr after dr. I kept telling them the dr they were calling was not on call. Everyone insisted he was. I knew he wasn't because he was my patients surgeon and he left for vacation that day. SO i call switch board myself they say same dr i said no it's not get me a surgeon now. Well they weren't successful. So i have the supervisor come up. She did absolutely nothing. When my patients dr came in i had her go in there. She checked her said you need a surgeon now this i can't fix. she ordered a few things then left. Still hour after hour no surgeon. Mind you the patients nurse is a complete idiot. We are talking about a woman who swears the ice machine is talking to her. Not to mention she runs out after assessing a patient and asks if te tele monitor is showing pvc, pjc etc because she heard them on her assessment. anyway i tell her to get this patien something to do something. SO the charge nurse was calling everyone , it's 3am i'm clocking out, because god for bid if i have any overtime. I clock out and i stay and ask what this patients out put is, ok post surgery patient, and his nurse says "i don't know" i said go look. itwas less than 80, ok she was running a 250bolus, had been having fluids running, 5 hours and less than 80. I said what was it for 2nd shift no one knew. I was shocked i couldnt believe what i was hearing. Finally her dr comes in at 6 and flips out, sends her to the unit wants a surgeon she couldn't get a surgeon on the phone. Ok i need to back up, this nurse also was hiding what was going on for several hours she told us so calmly when she came out the room, i can't get a bp, can one of the aides go try. I about had a fit, I also said someone needs to call "our boss" no one would listen. When i would try to help the supervisor kept saying your not on the clock, at which i responded who gives a S**T someone needs to call someone. But they ignored me. This woman was in hypovolemic shock and her nurse said i keep checking her surger i know she's hypoglycemic but it's reading 200. I said hello she's in shock. IT was a big mess, it's eating me alive. And the patients dr wrote it up as a sentinal event, which it was, but this isn't the first time this same nurse has done something this stupid. hell this woman had been bleeding out like this sine she got back from surgery. Her first nurse was a charge nurse on first shift, who would have been able to get assistance way faster than thirds, but she didn't either. THis patients nurse had us in a meeting two months ago re: another patient, we were told she would be sent to first shift to re orient and be re trained and it was never done. Over and over she's keeps doing this stuff and over and over they do nothing. I'm fed up, i can't keep working with her. So i very calmly called my boss today and said look, i'm done, i will not work with her anymore, if i have to switch shifts i will but i'm done.

[Sunflowerinsc, ADN, RN]

Is this a hospital setting ? Do you not have a rapid response team? How do you generally contact the Dr's? Someone has to be on call ,right? Don't they have beepers or cell phones?

And the more details you are writing seems like to much. This sounds like a lawsuit in the making.