When to call or page the doctor?

Asystole RN · May 17, 2012

When you need orders or when you need to notify the physician.

Changes in condition or unacceptable patient findings (like aberrant labs) require the practitioner to be notified.

Kittypower123, BSN, RN · May 17, 2012

When you're doing your orientation, ask your fellow nurses. Each doctor may have different preferences about when to be called. For example, one of our docs only wants a call for PT/INR if the value is above 3 or under 2, otherwise, simply fax the lab. We have several docs who only want calls for labs if there is a critical value, otherwise, fax it. Some docs want a call for everything. Certain things, such as falls, critical lab values, etc. require a call.

A piece of advice, have the chart in front of you when you call, have your assessment info in front of you (vital signs, info specific to the situation - lung sounds, bowel sounds, whatever), and review current meds and allergies before calling. Another tip - find out if any of the other nurses need the same doc so he/she doesn't get called multiple calls during your shift.

mibrow81 · May 17, 2012

When you're doing your orientation, ask your fellow nurses. Each doctor may have different preferences about when to be called. For example, one of our docs only wants a call for PT/INR if the value is above 3 or under 2, otherwise, simply fax the lab. We have several docs who only want calls for labs if there is a critical value, otherwise, fax it. Some docs want a call for everything. Certain things, such as falls, critical lab values, etc. require a call.
A piece of advice, have the chart in front of you when you call, have your assessment info in front of you (vital signs, info specific to the situation - lung sounds, bowel sounds, whatever), and review current meds and allergies before calling. Another tip - find out if any of the other nurses need the same doc so he/she doesn't get called multiple calls during your shift.

Thanks so much for the tips, i will put this in mind. During my orientation they didn't tell me about it. :)

newrnltc · May 17, 2012

Altered Mental Status! Sometimes its not as dramatic/obvious as it sounds.. if the resident's sleepier than usual or used to be peppy/talkative and now is just staring at the wall giving one words answers don't brush it off.. investigate! Check VS especially temp, recent labs, wounds, elimination, new orders... it could be sepsis or adverse reaction to new med! I would alert the MD to this change. You would be surprised how fast these folks can tank. If you work night shift where most of them are sleeping for hours at a time.. get up close when you're doing rounds. These residents will become like your second family and you will know them well. Just like CNAs are our eyes and ears.. we are the Doc's eyes and ears. If they are annoyed.. remember pt safety first. New onset anything is important to report. Good luck!

rnto? · May 17, 2012

Ditto what kitty said about having your ducks in. Row before you call! You will make the call and your life so much easier! You will learn to use your judgement about when to call. If you are working overnight, you don't really need to call about a skin tear at 1am. But a temp of 104 and low bp? Heck yah! I always try to think about what the doctor will do about the change in condition, and if their possiblebinterventions warrant a call immediately or the next time you talk to them. Most LTC facilities have a plan to make a phone call or fax to each md daily on all patient concerns. Also, if you are calling on a weekend or off shift, coordinate with your charge nurse or the other nurses so you can make one call and address all patient needs. And if you arebstill unsure, ask a senior nurse! I am a new DON and I still call my regional person to bounce stuff of her.

CapeCodMermaid, RN · May 18, 2012

If your facility uses Interact II use it. SBAR is a wonderful tool to quickly organize your thoughts before you call the doc.

onyx77 · May 22, 2012

My motto is "When in doubt- check it out! or call the MD."

Definatley go with your facilities P&P for updating MDs with any COC's. Some only require faxes. If you're unsure, call the MD anyway. They may yell at you (literally) but at least you've done your part. But make sure you have a thorough assessment done before you call. The SBAR form that CapeCodMermaid mentioned is a wonderful tool! You can search it online and print it out for free.

onyx77 · May 22, 2012

Oh... and if you start with something like "I'm really sorry to bother you, but I'm calling regarding your pt Mr. Icantstayoffthefloor....." They might not be so hard on you. I love the caller ID at work because I can tell where a MD is calling from. If its a Sunday morning and I see a local church on the caller ID, I will always apologize for bothering them at church.

And sometimes we need to word things to make them think its really their idea! Don't worry.... You'll get the hang of it quickly!!!

lumbarpain, ADN, RN · May 27, 2012

The facility should have given you a written form on this.....I always remember the A B Cs. Changes in behavior or LOC, medication administration difficulties, which can fall into swallowing problems, continued refusal of meds, vomiting blood, coughing with pain, Temp or BP changes, NOT Only increases but decreases also in temp or BPs. Falls, admissions/discharges/death/drug reactions/side effects.

drastic apetite changes. (this should be monitered) could just be a passing episode. Any acute pain, the list is endless in a way......talk with your facility on proper protocols in regard to calling the md.