Why do the weekend on call docs not listen to us

[registerednutrn]

Ok I normally don't vent but this weekend was awful for one patient. First of all I cared for this patient earlier in the week and he was doing fairly well post surgery was having some renal issues. So I come back Friday and am assigned the group below this patients group and this patient was quite a bit worse, he was having difficulty keeping his O2 sats up and was placed on 50% venti mask and would still desat. The poor nurse that had him was just a baby nurse and was trying very hard. She sought the advise of the other more experienced nurses when needed. None of this patients doctors were on this weekend and none of the doctors on call would listen when she would call them about the patient. She called when the patient spiked a temp of 101. She called a creatine of 12.7. She called when patient had to be placed on a high concentration mask to keep sat at 90%. In all the on call docs were called no less than 4 times each about this patient. None of them did anything until patient could no longer maintain his Sats on the high con mask and the rapid response had to be called and the patient was I intubated and was in full renal failure. The worse part is not only were these on call docs all called but each one saw the patient with their own eyes. Are they blind how could they not see how bad he was. It did not have to be this way for this patient. Whats worse is one of the docs came in today wanting to know info (I&O labs ect) on the patient I guess trying to cya. Sorry just needed to vent a little

[maelstrom143]

I am a baby nurse. I had a very similar weekend. I voiced concerns to everyone about my Pt on Friday. I came in to start my shift on Saturday and found out my Pt. was in pretty bad shape. Thank goodness for a very supporitve and helpful shift supervisor. It was a very long night, and I was pretty mad that my concerns had been ignored the night before! By the end of my shift my Pt. was in our hospitals ICU.

Thank God you continued to work to his benefit and got him moved to the appropriate care setting

[talaxandra]

Our rapid response protocol has a doctor-delay criteria: any serious concern about the patient. If I've tried getting someone reviewed and I'm concerned I threaten the cover with that and almost always find a change in attitude; if not, they come up with the MET team.

I'm sure my experience has a lot to do with it, but if I rarely need to resort to that. If I ask to have a patient reviewed they get reviewed. If the resident's busy or not interested I go to the reg, the coordinator, the ICU liaison or whoever's covering ICU, depending on the lack of interest and how concerned I am.

If not for that I know three patients who would have died, one from anaphylaxis the resident wasn't worried about, one for tachypnoea of unknown cause (RR 60), and one with pre-clinical sepsis (immunosuppressed, no fever, no change in vital signs).

[maelstrom143]

[...] and one with pre-clinical sepsis (immunosuppressed, no fever, no change in vital signs).

o.O I know, off topic, but you have totally sparked my attention...what s/s did you notice that prompted you to get this patient attended?

Thanks in advance!

[talaxandra]

I don't know - something triggered my intuition that he wasn't right but despite a lot of thought I still don't know what it was. He was a little pale, a little short of breath (but not tachypnoeic or hypoxic), slightly listless and flat, but there was nothing I could point to. Fortunately the resident I called trusted me when I told her I had a bad feeling, and came straight up to review him.

I had a similar experience many years ago, when I came on and a registrar (now consultant) told me he was worried about a patient but had no grounds - 'He's not worse, but he should be better,' was what he greeted me with as I came on. I encouraged him to get and ICU and surg r/v - the patient had fecal peritonitis and the surgeon who took him to theatre seven hours after Marco's intuition kicked him told the family the patient would have been dead by morning.

I don't think there was anything supernatural going on in either case; I think in both cases our subconscious was able to put together information based on years of seeing really sick people in the lead up to them crashing. In both cases the patients were ones we'd known over a period of time, and had cared for recently. The experience certainly made me feel more comfortable about trusting my gut, even though there've been times I've felt worried about patients for no particular reason and they've been fine.

[maelstrom143]

I don't know - something triggered my intuition that he wasn't right but despite a lot of thought I still don't know what it was.[...]

That is so awesome. I think it is times like those that make you glad you became a nurse and reinforces the desire to continue to advocate and fight for what your patients need, regardless how it may be perceived. Awesome catch