POE

[RainMom]

My facility just started physician order entry (POE) & still in the "working out the bugs" phase. In the past, RNs would often place a short note for the attending in the chart for non-emergent issues that did not warrant a phone call in the middle of the night. I've left notes for things like requests for stool softeners/laxatives, thrush noted, questions pt/family has, etc.

Now that physicians will be entering their own orders directly in the computer & not writing in the physical chart, I'm wondering how to go about communicating less pressing issues such as these. Some docs would not mind a phone call at the end of shift, 0700-0730, but others would bite your head off. I also don't want to be leaving it to the day shift to follow up all the time either if possible.

For those of you using POE & working nights, do you have a method for leaving FYI type info & minor requests for doc to see when they round or do you call at the end of shift?

[Altra, BSN, RN]

Not sure what type of unit you're on ... in the ICU the RN is generally part of MD rounds.

Do your docs still write a written progress note during/after rounding? If so, then they are still accessing the physical chart, and should still see any notes attached.

What about asking the docs directly as you see them: how would you like to be contacted re: nonurgent matters.

[KelRN215, BSN, RN]

When I worked in the hospital, we would pass things like this off to the day shift. There were Nurse Practitioners who stayed on the floor during the day and who were easy to access. There's no reason to page an MD in the middle of the night to request something like Colace. I would write on our nursing report sheet "needs order for colace" and make a box. For family questions, do your doctors not round every day? If it's a routine question, I'd tell the family to write it down and address it with the team on rounds.

[RainMom]

This is an ortho floor. Docs round every day & normally we can just leave a note for them (usually also mention to the oncoming nurse in report as well). Just not sure now that a note will be seen on the chart since MDs enter their own orders & progress notes directly into the computer. Since this is new for us, I expect many MDs will continue to open up the charts for a while, but may find it unnecessary later on & some of these smaller issues may inadvertently be missed. I know day shift is so busy; I don't want the RNs to feel like they have to be on the lookout for MDs to pass on a message.

Maybe making sure oncoming charge knows as well may work better since they are typically at the desk. I also like the idea of asking the MDs directly how they want us to relay messages.

Ah well, we'll work it out!

[amoLucia]

Don't know if this would work in an acute care setting as I do LTC ---

We had Dear Doctor notebooks. I remember the little old-fashioned hard, black & white marble notebooks and they were in a Dear Doctor wall-mounted rack at the desk area. We all used it for the non-emergent stuff too. Being on 11-7, I relied on those books for communication. I would even ask questions that you might ask of them in person - doctors wrote me their responses/answers back in the books. With all today's hi-tech, they sound rather primitive, but they worked!

I also remember spiral notebooks being used too. Again, simple bu effective.

[RNperdiem, RN]

Sometimes an intern starts "pre-rounding" on patients around 0500. While they are gathering information, there is a chance to mention things to bring up/order during rounds-things like laxatives.

[RNewbie]

Most computer charting systems have a way to leave notes for staff, like nurse to nurse or nurse to doctor that is not a part of pt records but available for staff to communicate.

[jmll1765, ASN, RN]

We also use CPOE at our facility. All of our charting is done on the computer and we can leave "sticky" note in the electronic chart for the MD. It shows up as a yellow sticky note beside the patient's name and once the MD reads it, it goes away.

[RainMom]

I'll have to check into whether our system has a computerized "sticky note" for each pt chart. That would be great!