Telephone order

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This topic contains 1 reply, has 2 voices, and was last updated by Profile photo of Jason Hautala RN Jason Hautala RN 1 year, 7 months ago.

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    James Hilliard

    At the facility where I worked as an RN we had nurses titled DCDs (Director of Care Delivery). Their sole purpose was to verify that the nurse caring for a patient was justified in calling the MD when a resident’s s/s went bad. If you felt the resident was taking a bad turn you had to call this DCD and not the physician. He/she would then decide and make the call if warranted. This policy was created because the Medical Director was thought to be too quick to transport the resident to the hospital and cost the facility money. I was not allowed to call a physician myself at any time.
    One day I called the DCD to report a very sick resident whom I was sure needed to be transported to the hospital. Having been reprimanded once before for calling the doctor before the DCD I complied with the rule. The DCD received a telephone order to transport. I was not there at the phone as I was upstairs in the rehab giving meds. The DCD apparently told a CNA but did not write the order, document anything or make the call for transport. The very second I learned of the order and verified it with the DCD I called for transport. Though it was not an emergency transport the resident died. No one saw it coming. The DCD lied when she said she had deligated the task to me. If she had, I would have made the call immediately and instructed her to write the order like she was supposed to and chart it. I wanted this resident transported asap. I feel this company policy got in the way of a nurse and his patient so in order for the company to cover their selves their DCD and I were both terminated and disciplined by the Board. I believe the DCD dropped the ball and panicked then as a knee-jerk rxn passed the blame to me.


    Sounds like the DCD is a jerk and threw you under the bus. I would never work in a place in which I could not call the MD whenever I thought it was necessary. You have the legal obligation to inform the doctor of any change in condition you think is significant, regardless of what any other nurse or director says.

    Our hospital uses an RRT (Rapid Response Team, consisting of the house super, an RT, and an ICU RN) who will come and help evaluate any patient in which the nurse feels is taking a turn for the worse, but is unsure of what is going on. This helps to better assess the patient before the call is made, and gets highly trained staff at the bedside ASAP in case things turn south quickly, but calling an RRT is not required to call the MD directly, it is just an extra resource that may be used.

    There is no reason why an RN should ever NOT call the MD about the condition of their patient. Having a policy like that should be illegal, and following a policy like that should get all involved in trouble because it is all about the money and not the patient care.

    Here is a link to a similar topic in the LPN section of the forum: it might provide some additional insight?

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