Was this an appropriate order?

[vashtee]

I had a doctor leave something like this on one of my patient's charts during the night shift (I'm on days):

Please have Dr. ________ call me after he makes rounds in the morning.

I'm a new grad, and I don't even know all the doctors yet. Also, we don't necessarily make rounds with the physicians (only one or two will actually seek out the nurse to talk with them).

I knew the odds of me recognizing this physician AND being in the nurses station when he came in were very slim. Trying to increase the liklihood that this message would be delivered, I put a sticky note in the patient's chart drawing attention to the message. Also, the previous night's nurse felt this was more appropriately handled by the ward clerk, who sits in the nursing station all day, so she left a copy of the order with her.

The obvious happened, and the physician came in to make rounds. I was predictably tied up with another patient in another room, and didn't see him until he was heading out of the hospital (another nurse called his name, or I wouldn't have even known it wa him) and I forgot about the message. Who knows if he saw my note? There was no indication that he did - or did not - return the call.

The ward clerk came to me in the afternoon up in arms with the charge nurse in tow. I ended up getting publically chewed out by my charge nurse for not passing the message along. The ward clerk, looking to cover her own butt, was really accusatory in the process. "YOU should have done this! How am I supposed to be able to do extra things like this? I am way too busy!!" (Yeah, no one else is busy. :icon_roll )

I don't place any blame on the ward clerk for not informing the doctor; it was (in my opinion) a stupid order the doctor should never have left. We aren't secretaries, and if the doctors want to talk to each other, they should call each other directly. I guess I was just hoping that instead of everyone standing around pointing fingers at me, someone might have said "Well, it's too bad the doctor may not have seen this order. They should really be better about calling each other. Try to remember to relay the message next time." Even better, I would have loved to see the charge nurse say "well, that's what happens when the doctors try to use us to relay messages".

I guess I am pretty disappointed in the lack of support.

So what do you guys think?

BTW - I have learned my lesson: when I get another dumb order like this one, I will call the doctor's office and leave a message as soon as I see it.

[Ginger's Mom, MSN, RN]

Joint commission requires

New | December 09, 2008

Hand-off communications

Standardized approach

Q. What is meant by "standardizing" an approach to hand-off communication?

A. This means your organization must define, communicate to staff, and implement a process in which information about patient/client/resident care is communicated in a consistent manner. Standardization provides a means to educate staff about the process and helps support consistent implementation throughout the organization. Ideally the handoff process would be similar throughout the organization, but practically the hand-off process may differ from one setting or function to another but not from unit to unit when the unit functions are essentially the same

I would say this violates Joint Commission and National Patient Safety Goals.

No you did not do anything wrong, the doctor did.

[UM Review RN, ASN, RN]

Doctors are extremely busy people. I think the doctor was trying to make good use of other members of the healthcare team. I, also, make requests of unit secretaries, techs, the charge nurse, social service, etc. We are supposed to collaborate for a common goal.

First, stating that doctors are extremely busy people implies that nurses are not, which is absolutely untrue.

Second, collaboration is not equal to fetching a phone number. This doc did not want to "collaborate" with the nurse, he wanted to "collaborate" with another doctor, whose number he could easily have looked up in the computer's directory.

Third, by stating that the doctor was in the right, your posts make it look like the public berating of the nurse by the wc and the cn was not only acceptable, but perfectly logical and permissable.

The doc did not ask. The order was not appropriate. The nurse should not have been made a public spectacle over it.

[diane227, LPN, RN]

As nurses we cannot call consults for the physicians but I would have no problem placing a note on the front of the chart asking the doctor to call the other.