NEED TO BE MORE SPECIFIC

My first night on call was kind of interesting. I was not sure what to expect but I knew I would not be getting a lot of sleep before having to get up the next morning to begin another work day. Week day call is from 1700 to 0800. When on call I am responsible for all of the long-term care facilities in my area. I counted about 25 nursing homes that had the potential of calling me at anytime during the 12 hours of call. I waited in anticipation.

The first call came about 2200 which was a lab result. The patient was on Coumadin and the important result was the INR. Patients with a history of atrial fibrillation are frequently placed on Coumadin to try to avoid throwing a clot into their brains because of the erratic pumping of the right atria in the heart. Usually we liked to keep the INR between 2 and 3. This particular patient’s INR was 2.2. It was just where it needed to be so I made a note and told them no further orders. The nurse calling me already knew what I was going to tell her but knew she needed to call per orders from the NP at the facility.

About 2230 it was time for me to try to get some sleep. I slept on the couch so the sounds of my pager would not wake up the husband. Usually when I slept on the couch I had several cats who also wanted to sleep with their mamma. This made for a tight fit which I was accustomed.

There were other easy calls between 2230 and 0100. The next situation came around 0130. The nurse told me the 62-year-old had a temperature, had oxygen saturations of 77% while on oxygen, and their lungs sounded junky. I knew this patient would need to make a visit to the emergency room. It was probably pneumonia. I told the nurse to “get the paramedics.” She responded, “Ok.”

I made myself comfortable once again on the couch and wedged myself between cats to get comfortable. Twenty minutes later my pager went off. It was the same nursing home I just arranged to get the paramedics to take the patient to the emergency room. I called back. The same nurse answered the phone. “What ambulance are you sending?” she asked me. In a sleepy daze with my mouth open in disbelief I responded, “No, you need to call 911!” She responded, “Ok.”

I once again tried to make myself comfortable on the couch between cats. I was concerned the nurse at the long-term care facility may have not understood me. I called back twenty minutes later to make sure the patient went to the emergency room. She finally did. I was relieved.

I called at 0630 and found out the patient was admitted with pneumonia. A lesson learned my first night of call…BE MORE SPECIFIC. I will learn.