Question about notifying dr's per request of patient's family

Whispera, MSN, RN · Aug 21, 2012

I would say I will leave a message for the doctor and do it. It hurts nothing to pass on what the family wants passed on. It doesn't indicate you agree with their request. It just means you're doing what they have asked you to do.

About the similar skin problem that Diflucan helped. If it helped before, might it help again? Asking the doctor doesn't mean you agree, but maybe the family member knows something you don't. There's also a placebo effect...

NewbieNeedsHelp · Aug 21, 2012

I almost always notify doc if the pt's family thinks there is a change in condition (even if I know there's a reason for it...medication side effect etc

I sometimes say that I'll put their number in the chart.

Just try to keep the people happy

Nurse ABC · Aug 21, 2012

Ok thanks and another dumb question. How do you all leave messages for your drs? One set of our drs we can leave a message on their computer system but our other drs we have to either page them or pass it on to the next shift to let the dr knows when he/she comes in. That's how they do it where I work and I'm afraid something will get missed. About the skin issue, I agree but it was late so I wasn't sure abt bothering the dr for something that could wait a few more hrs so I did pass it on to the next shift to pass it on. If these things come up during the day and their drs are around I don't mind passing on info but it's when it's evening that I wasn't sure how to handle and how other places handle messages. Thanks!

rn/writer, RN · Aug 21, 2012

You can tell patients that the next time you speak with the doc you will relay their concerns. But along with that, I'd inform them that they can also state their thoughts directly when the doc makes rounds, and that sometimes that kind of personal request is very effective. I actually prefer that they take the direct approach, because, if the answer to their request is no, a good doc will at least try to explain why he or she made that decision. Then it comes straight from the horse's mouth and they know you aren't trying to blow them off. If you're in the room when the doc is there and no one says a word (all too common an occurrence), you can certainly say, "Dr. Smith, Mary's daughter has some questions for you about trying Diflucan." This primes the pump for the patient or the relatives to jump in.

As far as calling the doc during off hours, I'd make it very clear that you reserve that for emergency situations, but that you (or someone else) will call in the morning or you'll leave a note on the chart. If you are in a teaching hospital, you might have resident staff that could address questions or problems on behalf of the attendings during the night hours. Also, make use of your colleagues including the charge nurse, and take advantage of their experience.

At least while you are new, I wouldn't be calling any docs at night without running the idea past the charge nurse first. She can help you decide if the patient's question/request is something worth a phone call. And besides, it's courteous to let the charge know about calls going out to docs. She could very well be the one answering the phone. During off hours, such calls are usually confined to changes of condition that warrant action, critical labs values and other compelling situations.

You may not feel confident in your own ability to decide whether to disturb a doc or not, but you can certainly rely on others to help walk you through the decision. Let this buoy you up and help you speak firmly to the patents and families.

Nurse ABC · Aug 21, 2012

Thank you RN/writer-that helps a lot! I've been asking people I work with but could never get a clear answer. I like what you said and will do that.

PunkBenRN · Aug 21, 2012

I work nights, and I have recieved requests from families like this many times. If it has some ounce of credit, I will follow up sooner than later. If a hospitalist is covering the Pt, I have no problem calling and discussing it. If it is not a hospitalist (i.e., someone I have to wake up), I consider a few factors. Is it life or death? If not, can probably wait. Would the MD find this important/do I find this important? If not, can probably wait. Can the intervention wait until the morning (Or will an MD not even bother to address until rounds)? Then it can definitely wait.

I try to provide education to families as well as the Pt, but if they are really persistent, I will forward it to the MD. Generally, a quick note on a post-it, and place it somewhere the MD will see it (I always put it in Physician Order section, because they will always write orders). The MD will see it, and then either 1) Address it, or 2) throw it away.

At least you can let the family know that you passed it along. If it really bothers them, chances are they will be there for rounds tomorrow and discuss it with the MD in person.

Indy, LPN, LVN · Aug 21, 2012

I second the advice to be careful what you wake the doc up for. I once had a man with abdominal aortic aneurysm and epicarditis. The AAA wasn't urgent or anything, the epicarditis was painful as all heck and he was on some good opiates. Well this dude of course got constipated, and he's on stool softeners to keep him from straining. We all know the heart patients don't need to strain.

Well he also had ducolax and he took that. He got into that awful bowel-obsessed mode where he was gonna be up all night trying to have a BM, no matter what. I got him prune juice and MOM. No go. I walked him around a bit. I made him drink a bunch of water. No go. He told me the dosage of ducolax was off and he needed about six pills or so, plus a fleet's enema, to do the trick, and insisted that I call the doc at one in the morning for this.

All I could think of was that poor man's AAA was gonna bust loose and he'd die on the pot if I got such an order. I finally explained to him that the cardiologist would probably agree to his request out of sheer sleepiness and that I would not put him in the position to do something that would hurt him, the patient. Even if he wanted me to. I told him fluid, fiber and exercise, and time was gonna help. Well I wound up with a thankyou from the doc when the patient complained the next day. He did get a soapsuds enema though, and a different pain med regimen, and managed to live through the experience.

For most of the requests I just say I will put a note on the chart and the doc will see it, they can do with it what they will. That usually works.

Aeterna, BSN, RN · Aug 21, 2012

I'm going to echo what has already been said: if it's urgent, then sure, call the doctor. If it's not, then it can wait until the doctor rounds on the patient. I've had to insist with patients/family that I will not call the doctor for every little concern they have unless it is urgent. I literally had the daughter of a patient tell me, "Why isn't the doctor here? My mother is suffering!" The patient in question was just very constipated and I was already pumping her full of laxatives and giving her the PRN enema that was ordered. When I tried everything in my power, I did call the on-call doctor for another kind of enema, but apparently that wasn't enough and the daughter wanted the doctor to actually come in from home to "save" her mother at the bedside >_> I had to put my foot down very firmly on that request.

I find the vast majority of the time, most requests from patients/families can wait. I'm a little more lenient when it's during regular working day-time hours, but after hours, I only call if it's really urgent. But, as someone already mentioned, it's useful to ask your charge nurse or one of the more senior nurses on your floor if you need help deciding whether to call a doc or not. Some doctors like to micro-manage and want to be called; others do not want to be called unless your patient is actually dying.

How you pass on the messages to the doctors just depends on how things are done on your floor. Where I work, we leave notes on the front of our charts because that's what most doctors who work on our floor seem to prefer/tolerate. I imagine this practice is different depending on each unit's "culture" and norms.

Whispera, MSN, RN · Aug 21, 2012

I missed the part about the requests being off-hours. I wouldn't call the doc for things that can wait for morning...

imintrouble, BSN, RN · Aug 21, 2012

I always encourage family members to speak to the MD directly when they make rounds. If the pt is O x 3, then I tell them to discuss their concerns with the MD. The above is for issues that can wait til the AM.

As a night shift nurse, I have to sift through the demands of pts and their families, when it comes to those after hour phone calls.

Sometimes I think the pt doesn't want to bother the MD with things they suspect are not important, but are not sure. They don't want to look neurotic or stupid. They just want us to.