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What if you can't get thru to a drs office??

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So for three days now I've been playing phone tag with a drs office for a pt who is just going to be o&a- but needs a pt eval and pt/inr orders- other than a new med- there's no true nursing skilled service to provide.. When I call for the nurse at the drs office I get put on hold then eventually the receptionist comes back and takes a message- the nurse called back finally yesterday- but I was in the field and didn't have service until after their business hours- then today I called had to leave message- no call back- how do I proceed with admitting a pt when I can't get approval????? Is this kind of the norm in home health? Obviously I know I can't draw a pt/inr without orders so how do I proceed??? Any tips would be greatly appreciated!!

With established extended care patients, there usually is a secondary physician noted on the face sheet of the field chart. Most doctors known to the agency have backup doctors in place or other doctors in the practice will step in (speak with the office nurse). I would contact your case manager or director and find out if they have a listing for this particular doctor's backup or instructions for what to do when this happens.

2 ways.

Send a a fax written clearly asking what you want ie

Patient discharged home on 2/2/15 following hospitalization for pacemaker insertion. Last known INR was 1.8 on 1/30/15, current Coumadin dose is 5 mg QD. When would you SN to draw the next pro time?

or

give that information to the office nurse and ask the md office to call the office and ask for the nurse supervisor.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

How did you get this referral? If the patient came from the hospital, you should have received orders for at least the initial visit. And, as far as I've always been told, cases are supposed to be opened within 48 hours of discharge from the hospital. I've never delayed admitting a patient because I couldn't reach the primary care office. I have a referral from the hospital that has preliminary orders and tells me why the patients needs skilled nursing.

I agree with Libby.

I fax the provider with the information and let them know exactly what I am recommending as the RN managing the care. They can fax back to the office, call me, or preferrably; phone the office.

When I am busy and not always available for phone calls/tag I refer the provider to the office where there is an RN available during regular business hours.

Delegate to the office staff.

I left out something crucial in my example, if you're referring the MD office back to your office nurse/s need the details of your message and what you're looking for. I either give them a copy of my fax or I call/text it in.

MrChicagoRN, RN

Specializes in Leadership, Psych, HomeCare, Amb. Care. Has 30 years experience.

Do you have a cell phone or other confidential voicemail?

The doctor or nurse could always leave a VM with orders in response to your phone call or FAX

Thanks for all of the suggestions!! I faxed the order- and rec'd it back:). Just way different than hospital where everything has to be done immediately- or ten minutes ago- lol!!

Thanks for all of the suggestions!! I faxed the order- and rec'd it back:). Just way different than hospital where everything has to be done immediately- or ten minutes ago- lol!!

Quite right, different from the acute care setting. IF that patient needs something acutely it often means that they need their location of care changed, IMV.

What is important is that you discover how to provide the best possible nursing assessment, teaching, and direct care in as little time as possible so that you can move onto the next patient. Dilly Dallying around playing phone tag with MDs will only frustrate that effort and you. The office is supposed to be there to provide YOU support while in the field. Use them. Of course communication is important...you can't have them speaking to the doc on your behalf if they don't know what your thoughts or opinions were.

Good luck.

I would love to be able to do this but the office would totally freak out. It's sad that Corporate does not see the hassles we face with this. None of those efforts are "productive"