182: 25.2 Bleep PTSD

I was helping my colleague go through all the ward jobs and answer the incessant bleeps from nurses this weekend. From the scores of bleeps, there were only a handful that were actually urgent. Some were just a plain waste of time. It is expected that the person who bleeps should have enough information at hand for the bleepee to assess the situation appropriately. But alot of the time, it feels like some nurses bleep doctors just to document in the notes that they have escalated it without really addressing the problem at hand.

And if we decide not to assess the patient because there is no clinical need, we would somehow be at fault. It feels like passing on the problem to someone else to deal with it.
This is an example of such bleep:

“Hello doctor, sorry to bother you. But there is a patient who has a syringe driver for her symptoms. But she is agitated. Can you come and review her please?”
“Do you have her drug chart with you now?”
“No, doctor.”
“Do you know if she has PRN (give if required) medications prescribed?”
“No, I dont think so.”
“Well, can you go check?”
“Just a minute. Let me get her drug chart.”
After a minute waiting on the phone, the conversation continues.
“Doctor, I have her drug chart now.”
“Does she have midazolam prescribed in the PRN side?”
“Yes.”
“Have you given it to her?”
“No.”
“Well, please give it to her. I think that would help her symptoms, don’t you think?”
“Ok, thank you doctor.”

I don’t mean to sound abrupt. But sometimes it is, like the midazolam, needed PRN to get your point across.

But as bad as that bleep was, there was one which was even worse.

“Doctor, I have a patient on the ward whose saturations just dropped but she is on oxygen.”
“Did you increase the oxygen?”
“Yes, I did.”
“Is she still desaturating?”
“No. She is on 3L now.”
“Then, what do you want me to do about it?”
“Nothing, I just wanted to let you know.”
Seriously?!?! You are working on a palliative ward, this is the basics of patient care!

Funnily enough, the two bleeps above came from the same ward. It even might have been the same nurse.

*PRN - medications prescribed if required by patient (for example: paracetamol can be given if the patient is in pain)
**drug chart - a list of medications prescribed for the patient