Vent: Admits and discharges

[oldiebutgoodie]

Hello, all,

I am just so aggravated about admits and discharges.

At our hospital, even if the doc has written orders, we often have to call him/her back because they didn't:

1. Reconcile the home meds

2. They did reconcile the home meds except for the last page

3. Didn't order certain things--labs, test, tele, etc...

This weekend, pt came in with Hx of heart probs. I suggested pt be put on tele. Doc says, "Oh. Okay". Pt has 2nd degree heart block, type 1. I call doc to report, ask if he wants cardio consult. "Oh, I guess so". Geez.

On discharge, doc often sneaks in and writes in orders, "DC home". Of course, he/she has not looked at the home meds to see if pt should continue them. So, I have to call them back to go over the home meds, which, most of the time, have some med that the pt SHOULD NOT be taking. Several times, when I call to discuss home meds, the doc has said, "Oh my God. NO, they can't be taking that". We have the home meds on the computer, and doc can easily look at them, but they don't.

Do your hospitals have any better protocols for admit and discharge orders? I feel like I'm doing a lot of the MD's work.

grumble grumble

Oldiebutgoodie

[Daytonite, BSN, RN]

if a doctor has a complaint about a specific nurse, he/she either tells the nurse directly or goes to the nurses' manager or the director of nursing about the problem. vice versa, if nurses are having a problem with a doctor the appropriate persons to go to are the doctor himself or their supervisor. in the case of a doctor, their immediate supervisor is the chief of staff of the medical service under which they have privileges at your hospital. if you want to make it official so you're sure it gets documented, put the facts in writing in a memo and send them to a specific chief of staff in a sealed envelope. handling complaints about physicians within his/her service is part of the function of the chief of a medical service. just as with any other employee, complaints about a doctor's performance need to be handled confidentially. what i'm trying to tell you very nicely is that you shouldn't be gossiping about this to other employees. you wouldn't want coworkers talking about something you were doing wrong to everyone else on the staff; you need to extend that same courtesy to a doctor, not just because he/she is a doctor, but because it's the professional way to act. if you want further assistance on how to make a complaint about a doctor's performance, talk to one of the people in the medical staff services office. they should be able to help you on how to work on this problem. if they are decent people they will want to make sure the executive medical director knows what is going on as well. they will know how to handle it confidentially. the executive medical director won't know what is going on unless people come forward.