"No New Orders Received" ..... ?

[RainDreamer]

When you notify the physician of something regarding your patient and receive no new orders, do you document that?

I can just document: "Notified MD of infant's increased work of breathing. Will continue to monitor."

OR

I can document: "Notified MD of infant's increased work of breathing. No new orders received. Will continue to monitor."

What do you do, and why?

[Todd SPN]

Yes, I chart it. When I send a FAX I always ask "Any new orders?" Hopefully I'll get response of yes or no.

[grace90, LPN, LVN]

I would probably say "no new orders" as well. Can't trust those physicians.

When I've reported an issue to a physician and gotten a nasty reply, or no reply or hung up on, I chart what happened. i.e.:

"Dr. HeadinRear notified of pt's increased pain and threat to go AMA without increased pain medication. No new orders received. Dr. HeadinRear's reply was "I don't care if she wants more pain medication. She's not getting any. She can go AMA for all I care. Don't call me on this patient again."

or "Dr. ChronicGrouch paged x3 on pt's high blood pressure. No response received at this time."

[Rnurse4963]

cya recently called a md and forgot to chart it he denied i called him "cover your ass" chart that you called and no orders received he might say he gave you orders because doctors think they can say and do whatever they want

[Xbox Live Addict]

When I've reported an issue to a physician and gotten a nasty reply, or no reply or hung up on, I chart what happened. i.e.:

"Dr. HeadinRear notified of pt's increased pain and threat to go AMA without increased pain medication. No new orders received. Dr. HeadinRear's reply was "I don't care if she wants more pain medication. She's not getting any. She can go AMA for all I care. Don't call me on this patient again."

or "Dr. ChronicGrouch paged x3 on pt's high blood pressure. No response received at this time."

Yes. Document all the juicy four-letter words the doctor may use too. Seriously. And call your supervisor right away. I had a scenario exactly like this years back and charted down two pages of notes when things settled down. The family of the resident fired the doctor from his care.

[elizabells, BSN, RN]

I've started being so much more careful about this recently. My primary at work is most likely terminal, but he's still a partial code (no meds, yes compressions) and his parents still believe he may pull through. The team has pretty much given up, though. So when I go in at night and there are no am labs written (which is almost every night) and I ask the resident or fellow "so, no labs on baby x tonight?" and they say no, I chart "Per MD Docling, no labs to be drawn at this time." Again due to the magic of computer charting, if something changes and they want a lab later, I can go in and erase it.

We also have a problem with some of the, um, less bright residents writing really stupid orders at 0645 and the fellow rarely has time to deal with it. Like the other morning the MD (actually the same one from my earlier post, in re the replogle secretions - god help us, she's back) wrote for an increased kcal formula on a baby who's been having explosive diarrhea and a bleeding diaper rash. Duh. So I call and point this out, and she just did. Not. Get. It. So I documented the conversation and didn't hang the new feed. There was still 4 hours of feeding in the bag (because I like to fill my bags right before change of shift to help out the next nurse) so by the time it ran out, rounds would have happened and they could deal with it then. Ahhhh.

[suespets]

i am in awe of u nurses who can go to another dr. if u don't get needed orders,small town here,iv'e never heard of that ,except call our med director if your page,& calls to dr. don't get answered quckly enough. small town also has good ole boy system. i once torqed a dr. per phone whereas he reported me to my adon. he told me he would too. i calmly said I'm sorry u feel the need too! luckly, adon knew his attitude,but had to say she spoke to me about it i guess,she seem to be trying to appear neutral, never heard more on it, i only once needed to qoute dr in n.n.s requested stronger pain med,per pt. request."give her the xxxxx & i hope she chokes on it" i got the impression he may have thought he knew pt. was addictive personality,or worse.