VTach Orders

[CNSnurse]

Hi everyone,

I am wondering if anyone else has received similar orders....One cardiologist I work with in particular ALWAYS writes "Do NOT call unless > 20 beats Vtach." Does anyone else ever get orders like this? My patient happened to have 8 beats Vtach (asymptomatic) and I called the MD and I got yelled at! I originally called because I did not see the original "do not call" order (writing is practically illegible) and was expecting to get a telephone order for "do not call" at that time. While I apologized for not seeing the original order, I got ripped a new one when he came to see the patient a few hours later. In front of other physicians and nurses..... in the middle of the nursing station...... Anyways, How do you feel about these kinds of orders and not being able to document physician notification? thank you!

[Lev, MSN, RN, NP]

Use your nursing judgement. Call someone, a provider - not necessarily cardiology and document away.

[SubSippi]

I've never seen an order like this, but I wouldn't have called the doc. If VT runs were starting to increase in frequency, or if the patient was symptomatic, then I WOULD have called regardless of an order. That doctor needs to be careful writing orders telling a nurse when not to call.

When you're trying to decide if you should call a doctor or not, ask yourself what kind of orders you expect to receive. If there's nothing that you can actually do, then it probably doesn't warrant a phone call.

Still, there's no excuse for pitching a fit, especially in front of other people. I know it made you feel like an idiot, but trust me, getting irate over something like that makes him look unprofessional and immature. Don't let people like that know they've gotten to you, that sort of behavior is often times a power trip and if you don't make them feel powerful, they won't do it.

Good luck!

[CNSnurse]

Thank you for your responses! I will definitely learn from this experience and use my nursing judgement when to call :)

[nursej22, MSN, RN]

Yes, we have routine orders to not call unless >20 beats, or lasting > 1 minute, or patient symptomatic. Of course, if the patient is having increasing frequency or episodes, it doesn't hurt to check oxygen saturation, review latest electrolytes, meds and perhaps the QTc.

[Partly Cloudy]

That's called disinterested and lazy. Yes, there are some docs out there that write orders like that. Irritating. Same thing applies to post PCI pts that have serial Trop's ordered with do not call results ordered. Why bother to get the lab when you know it's going to be elevated and don't want to hear about it. Waste of resources at the very least.

[nursej22, MSN, RN]

That's called disinterested and lazy. Yes, there are some docs out there that write orders like that. Irritating. Same thing applies to post PCI pts that have serial Trop's ordered with do not call results ordered. Why bother to get the lab when you know it's going to be elevated and don't want to hear about it. Waste of resources at the very least.

Ordering serial troops post PCI is not a waste of resources. The cardiologist is most likely watching to see that they begin to trend down and not continue to rise, especially if plaque may broken free or suspicion of a dissection.

[moh.kh]

i think rans of VT , dose not need to call some just monitor and record it ... but he hasn't the right to yelled in u

[UmmIbrahim]

Hmmm...Ive never seen an order like that and dont know if Id agree because well, what if its a new run of VT even IF unsymptomatic its still NEW! What if the pt has occasional runs but suddenly starts having small runs frequently while remaining unsymptomatic. To write such an order sounds off to me.

Personally if the runs are NEW or the pt is symptomatic but occasionally has them I call, even if its like 4 beats but unsymptomatic and new I call OR lets say the pt is new to ME and they had maybe 1-2 shifts ago a few runs and now suddenly having a run even if its say 5 or 6 but unsymptomatic I call and give the MD a heads up then I ask...hey, when should I call? Usually they say...call if the pt is symptomatic OR the runs are becoming frequent OR they have like 10beats or more.

I always ask...I ask, ask, ask, ask...even if the MD is generally rude or mean I still ask as id rather be safe!

So id say...use your discretion and just ask what they would prefer and if this is a safety concern let your director know...

[freyarn]

I would have called if the patient was symptomatic, OR if this was new for the patient. At least to get labs drawn. If it was something the patient had been having, they were there for a GI bleed and had a run, I would have called in a heartbeat! I will always call if I question something rather than not call. I will ALWAYS be my patient's advocated and notifying a physician of a change in condition like that is part of that advocacy. If the patient had been having any sort of VT prior to this 8 VT, I wouldn't have called an 8 VT with that order.

[hotcoffee]

That doc is probably a $&@! all the time don't sweat it.

wide complex tachycardia is ok if the patient isn't symptomatic. If it's sustained I would definitely call. 8 beats isn't worth calling. If you are worried you could always check k and mag.

as long as the patient is happy you are fine. If the patient is symptomatic get help, some pads on, get amio, call the doc and if they Lose consciousness then ZAP em

ps- no amio for torsades