phone protocols

babyktchr, BSN, RN · Feb 28, 2006

I used both of those books when we were researching our telephone triage stuff. I also did a lot of online research and found that it is more complicated than what the books or any other resources say. After putting together a triage form, our hospital lawyer nixed it and said the ONLY advice we can give over the phone is call your doctor or come to the hospital. We document the calls and what we told them and that is it.

SmilingBluEyes · Feb 28, 2006

Be sure you check with your risk management department to see if telephone triage is even allowed/recommended by them before you go to a great amount of effort to put this together. Like the wise poster above me said, you can't be too careful and some risk management depts no longer allow this except the advice to see or call a doctor if a person is unsure. Be sure you are aware of all legal ramifications when taking on tele triage. Many places have discontinued their "nurse advice" or "ask-a-nurse" hotlines due to these very concerns.

That said, those books listed above are GREAT. I have one of them myself.

Good luck.

SC RN, RN · Mar 1, 2006

What do most hospitals do in their OB departments with these types of calls? Our most common call is: Hi, I think I'm in labor. No, my water hasn't broken. Yes, the pain is unbearable. Definitely 10/10. Yes, I'm having one right now (still speaking clearly with a happy tone). They are about 10-20 minutes apart. Yes, I can feel the baby moving in between UCs. No, no bloody show. Yes, it's my first baby. (And so on). How does your hospital (speaking to all in this forum) handle these calls? We give the standard "UC's q 3-5 minutes X 1-2 hours, then come in" line .... is this putting us at risk? (Yes, I realize it is indeed but we can't possible have all primips come in each and every time they feel a single UC). What do you all do? Do you have a log book? Do you have a standard line of questions? Of course, most of these calls are coming in when the docs offices are not open (altho sometimes they are open and they call us but then we refer them to their doc if it seems appropriate). I'd like to see it streamlined where I work but the management seems almost afraid to tackle this problem!

rpbear · Mar 1, 2006

We do not do telephone triage either. We simply give them the answering service number of thier CNM or MD and have them talk to the pt. It is the easiest way to avoid any problems.

jrring1019 · Mar 1, 2006

Always just refer them to their doctor/CNM. I always say you need to contact your doctor, even when a patient is pushing me for advise. Legally you have no other choice. YOU know the answers and know that she does not need to be seen, but let the doc's take the responsibilty.

During my BRIEF time in the ER pts ALWAYS called for advise. They were usually told to come in because you can't tell them not to. One time a pt called to find out her DATE OF CONCEPTION!!! No lie. Yup, called the ER. She knew that there would be a "wheel thing" and we could tell her an appox. date. Then she didn't like the date provided and tried to see if it was possible to be a different date because she would like the daddy to be someone else........ Sorry I really got off track there.. Anyhow the nurse taking the call referred her to her OB/GYN.

LandDRN · Mar 2, 2006

I've gotten the weirdest phone triage calls. Quite literally...

" I just peed in the toilet and there was bubbles. Did my water break?":lol2:

"I think I may be in labor but I don't know how to tell.":uhoh3:

" my boygriend said if I give him oral sex, my labor could start. How long do I do it for?":uhoh3:

Or the always infamous spanish-speaking-only phone call. I feel so totally helpless there.

But to answer the original question, we can only offer that they call there md or come in to be evaluated.

nodi0603 · Apr 15, 2006

I am the Director for a L&D/PP/Nursery unit and I tell my staff this:

When you start asking questions of these patients you are essentially performing an assessment and you can not assess over the phone. They are only allowed to instruct them to call their Physician or come in to be seen. Even if you document what you tell them (we do not keep a telephone call log) it is your word against theirs. I worked at another facility 6 years ago( i was not the Director at that time) and a patient called and said she thought her "water had broke". The nurse said she told the patient to come in to be seen. The patient did not come in for over 8 hours. This was a full term patient and when she arrived and was placed on the monitor, initially the heart rate was 140, but then it took a nose dive and failed to recover. The baby lived for 3 years but from birth until death he was on a ventilator with home care. The patient says she was told to shower, wait until contractions are 5 minutes apart and then come in. Of course it was her word against the nurses. The jury believed the patient and she was awarded an undisclosed amount of money. I tell this story to all my staff and I also insist they chart as if a lawyer will be reviewing their chart. We have an excellent labor flow record we use but I still insist they chart narrative notes. I realize it is "double charting" but in the long run it is what is best for them. It is hard to remember what happend 2 weeks ago, let alone 5 years from now.

SmilingBluEyes · Apr 15, 2006

Well unfortunately it will always be our word against theirs. That is why tele triage is being discontinued in so many places. My standard line has become:

"we can't assess you over the phone. I can't see how you are your baby are doing. if you have any question at all, you should come in and let us assess you to be sure everything is ok". I don't advise them more beyond this.

But it still comes down to our word against theirs in the end.......and yes, charting w/the lawyers in mind is important.

daisybaby, LPN · Apr 16, 2006

Our telephone triage consists of "You need to speak with your on-call OB/GYN provider. The number is xxx-xxxx."

As mentioned above, we are in a hyper-litigious society, and we have to practice as such. Unfortunate, but true.