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 Provided by Clinician 1
How many times per day do we handle situations for patients that we don’t see? The triage calls, medication refills, concerns from other offices, faxes from nursing homes and personal care facilities...the seemingly never-ending stream of information that adds to an already-hectic day of patients.
Wait...what ABOUT those nursing homes and personal care facilities, etc.? THAT is a big frustration for me. I am relying on LPNs and CNAs to dispense information to me about my patients. They are well-meaning; many are very good at their jobs...and some of them, well, not so much.
In my practice, we get about 5 – 10 faxes per day from these places about our patients. Many times, they merely want to notify us that a patient has fallen, needs a medication refill, a signature on a plan-of-care, etc. Many times, the same message is faxed repeatedly, because no one bothers (I think) to check that I have already replied to their original message. Or the response was not passed on between staff members at the facility.
Sometimes, much more concerning messages are conveyed. Such as...”Virginia has been very confused and is ‘making up stories about people.’ She has been more belligerent and is wandering the halls. We would like an order for a psychiatric consultation.” Or the message, “Katherine has been incontinent and more confused recently. We would like an order for Depends.”
I read these two messages recently, and alarm bells immediately went off in my head.
Apparently, the staff had not considered that there may be a REASON behind their recent mental status changes...such as a UTI, electrolyte imbalance, etc. These messages were sent by are well-meaning care-givers who have cared for the elderly for a long time.
In the first case, I refused the order for a psychiatric consult and asked the staff to get labs and a UA C/S first on both women to rule out infection, etc. Turns out that both patients had UTIs, and Katherine ended up admitted with urosepsis. Both patients were treated appropriately with antibiotics and recovered.
Unfortunately, had I taken the staff’s “word” for it, I would have ordered a psych consult and Depends...and who knows what would have happened.
We rely on others every day for input, particularly when we only have a “snapshot” of what goes on. However, I am grateful for my knowledge base, and yes, that “gut instinct,” even when the practice is busy...to stop and think for a moment when reviewing those never-ending faxes...and do the RIGHT thing for our patients. Even those who we DON’T see.
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
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