I work in a small hospital, we have hospitalists, and we also have a few general practitioners who admit their own patients, and are usually easily accessible. However, last week, one of the practitioners admitted a patient through the ED and after I assessed her, I realized she was having severe exacerbation of CHF. I paged him SIX times, and he never called back. There was no diuretic ordered. Her bp was through the roof because she hadn't taken her ACE inhibitor that morning, none was ordered. The admitting doc does not have any partners, the hospitalists aren't allowed to write orders for his patients, I was stuck just trying to get her O2 saturation above 82 (the ED sent her up WITHOUT O2!) and her BP down. What do you do in this situation? I gave report to the oncoming nurse (this all started about an hour prior to shift change), documented every page I sent, and clocked out. I did call back the next day to check on the patient, and I informed my charge of every step, but it was infuriating. WWYD?
At my hospital there is a chain of command. If you don't get a response in a half hour you go above that person then you go above that person if it doesn't work and so on. It works and the first person usually calls right back because they don't want you going above their head.
The really difficult time is if you go up the chain to the Medical Director (or designee) but they're not responding either. And they were the attending physicians!!! Nowhere to go after them!
In LTC, if things were that bad, I'd be sending pt out.
RT are the first responders in my facility's rapid response. I called them, he assessed the patient and asked if she was being diuresed. That prompted my first page to the MD. The patient's weight was 10 k more than it had been a month prior, second call to the md. BP meds weren't ordered, had the operator connect me to his cell; voicemail. I asked my charge what to do, the pt. was stabilizing, sats increasing, I gave a PRN Beta Blocker PO, so bp was coming down. The charge said "keep paging him." So that's what I did. I documented everything. At this point in the day, all administration has gone home. I emailed my nurse manager today, and her boss, she is going to send it u to the admins. I feel bad if I get the physician in hot water, but I feel worse for my patient who went through all of that.
Rapid Response doesn't get you an MD? There are no MDs in the hospital at night? ER? ICU? Hospitalists?
Also, why would you feel bad if you get the MD in hot water? He was on-call for this patient and not responding to his pager, he should get in trouble.
Wait, I was being a nuisance? I've called rapid response before, and yes, it gets you an MD, but if it's not an emergency, it gets you a lot if ****** off nurses and MDs. My patient wasn't in respiratory failure. Her says came up, I needed orders. It's a weird situation, and I don't think I understand all the undercurrents in this hospital. Like every other job, there are politics. Administration was gone, I called the RT, who also does STAT EKGs, and whom I trust very much. Had it been an emergency, RR would have been called. I was just very frustrated that the doctor never called back.
There should be a policy for such situations. It usually goes something like charge nurse tries to call, house supervisor tries to call, if still no response, it goes to medical director.
6 calls would definitely be a situation where you should be following up the chain of your command who can follow up the chain of command on the MD side.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
When all other options have been exhausted, I've heard of the police being sent to the home of physicians who repeatedly fail to answer their pages. They'll do a wellness check to ensure the doctor is okay.
After all, there must be a reason for not calling back. Right?
Advise charge, call RR and/or send pt back to ED if the pt is deteriorating and provider is non-responsive. Remember that the nurse's primary obligation is to the patient, not anyone else.in this case the provider may not have responded for any number of reasons but they are the ones responsible for ensuring coverage and therefore they should be reprimanded through the medical staff oversight process. If you are getting grief from nursing admin for advocating for your patient then you may consider looking at another place to work.
Your hospital needs to have protocols in place and I would find out what they are and make sure you know how to use them.
In our facility this is how it works:
1. You page a doctor twice...he has 15 minutes to respond after the first one.
2. If the doc doesn't respond and he has no partner, call the senior resident on call...if your hospital does not have a senior resident, then call the ER physician.
3. If the ER physician cannot help (Let's say, tied up) then you call the Medical Director who finds someone.
Understand that electronics CAN FAIL. Batteries can be unknowingly dead, the doctor can be in a place that is loud leaving him unable to hear the page if he doesn't have it on vibrate.
You need to document when you called and how long you waited and who you called next.
Like Altra said, you do not have to let your patient crash...that is what protocols and rapid response teams are for.
Specializes in Pain, critical care, administration, med.
Most hospitals have policies in place to make sure staff can escalate. In this case if you have a rapid response team you should have activate it. If something happened to the patient you not the doctor would have been hung.
I would also have written a safety report as well.
As for the person who commented about calling the RRT and getting them ****** off....too bad if they don't like it this is their role this is about patients!
kate4rn
15 Posts
Also, thank you all for your thoughtful replies. I'm a relatively new nurse, and feel like I did the best I could in the situation. Nurses rock!