What do you do when you have a seriously decompensating patient and their physician will not provide appropriate orders? I can't be too specific but we dealt with this situation recently. The physician did come and assess the patient but was pretty irritated that they had to do so, and even after assessing the patient they thought they were not decompensating but that certain symptoms were a normal variation. The patient ended up requiring rapid response intervention soon after this and transferring to ICU, so it was not just that the nurses were coming up with nitpicky problems about the patient out of thin air.
I know this is very very vague, but i don't want to put too many details. How do you provide care for a patient when they need interventions that absolutely require a physician order, I mean something that is extremely obvious and not all that difficult to initiate treatment for, but the physician is simply unwilling to order it. It was quite frustrating. I have dealt with somewhat similar situations in the past, but never one where the patient so blatantly needed intervention and the physician was so stubbornly unwilling to provide it.
I am also worried about what if the patient had had a less experienced nurse caring for them- what the outcome might have been. And thinking I should have done more to help convince the physician that intervention was needed.
Once a RR team is called, until the doc is at the bedside, our RR team has protocols to order pretty much whatever the team leader thinks is necessary: CXR or CT for dyspnea, CT for head for stroke symptoms, labs, certain cardiac meds, etc. The decision on what to order is made by the ICU nurse in conjunction with the nursing supervisor, the ED nurse, the pt's nurse, the unit's charge nurse, the RT, and the pharmacist.
Maybe your RR team is also set up like this but the doc was there, so you couldn't order anything. But even the, when you've got 5-8 people evaluating a situation and suggesting various treatments, it's hard to blow something off. Too many witness and too many years of experience staring you in the face.
BluegrassRN
1,188 Posts
Maybe your RR team needs more protocols.
Once a RR team is called, until the doc is at the bedside, our RR team has protocols to order pretty much whatever the team leader thinks is necessary: CXR or CT for dyspnea, CT for head for stroke symptoms, labs, certain cardiac meds, etc. The decision on what to order is made by the ICU nurse in conjunction with the nursing supervisor, the ED nurse, the pt's nurse, the unit's charge nurse, the RT, and the pharmacist.
Maybe your RR team is also set up like this but the doc was there, so you couldn't order anything. But even the, when you've got 5-8 people evaluating a situation and suggesting various treatments, it's hard to blow something off. Too many witness and too many years of experience staring you in the face.