Call responsibilities are an extension of practice for many nurse practitioners. As such, they must be taken just as seriously as in-person patient interactions. Providing care at a distance comes with the potential for misjudgment and miscommunication, so it’s important for nurse practitioners to have best practices in place to guide this aspect of their careers. How do you reduce the liability that comes with taking call and ensure the best possible care for your patients?
1. Answer the phone!
If you are on call, it’s your responsibility to, well, accept calls. Whether the individual on the other line is a patient or another healthcare facility asking for your input, you’re contractually obligated to pick up the phone or respond to pages in a timely manner. In some cases, there can be serious legal consequences if you delay.
The Emergency Medical Treatment and Active Labor Act, commonly known as EMTALA, for example, subjects on-call providers to fines of up to $50,000 for failing or refusing to respond to calls from the emergency department when on duty.
2. Headed to the Beach? Find Vacation Coverage
Before you hit the road for your next vacation, make sure call coverage has been arranged in your absence. If your patients have questions while you’re out of the office, where will they turn? Designate another provider in your practice to cover for you while you’re out. This not only includes taking call, but also checking on other items such as incoming lab results and patient messages that come through your practice’s email or other communication platform. Failing to do so could be deemed patient abandonment. Don’t forget to return the favor for your colleague when he or she takes a Spring Break.
3. See the Process Through
Chances are, if you’ve taken call as a nurse practitioner, you’ve advised a patient to head directly to the emergency department a time or two. Once you let the patient know their condition could be an emergency, you’re off the hook, right? Not so much. If you advise a patient to seek assistance at a hospital, it’s then your obligation to call the facility to give the providers there a head’s up. Handing off a patient without giving report is a big no-no, even if the encounter occurred only over the phone. Wrap up the process by checking in with the patient after the emergency visit to arrange necessary follow up care.
4. Can You Repeat That?
Taking call as a nurse practitioner means that you’ll communicate with patients and those involved in their care at all hours of the night. Have you ever dialed up a specialist for a consult and been convinced they were talking to you in their sleep? Distractions are rife when you’re out of the office whether they come in the form of attempting to get some shut-eye, or as the clamor of a busy home environment. With distractions comes the potential for miscommunication. So, whenever you dole out orders to staff over the phone, or give a patient instructions, ask the individual to repeat what you’ve just shared. This ensures accuracy and that your verbal guidance won’t be misconstrued in the less formal setting. On the flip side, take notes about each call you receive to remain focused on the conversation and ensure the accuracy of your instructions and follow-up.
5. Write it Down
Yes, the never ending healthcare advice is back – document, document, document. You must create a written encounter of interactions you have with patients, staff and other providers while taking call. This may simply be a quick note in the patient’s chart that you advised them to call 911 or go directly to the emergency department and the time you called report to the ED. Be as specific as possible in your documentation. Providing the time events occur is also essential should the encounter be called into question later.
6. Put Down the Booze
When you’re on call, you have just as much responsibility to be present for your patients as you do in the clinic or on the hospital floor. So, sip on a Coke during happy hour and skip that relaxing evening glass of wine. If you’re on duty for your practice, keeping a clear head comes with the territory. It should go without saying that providing patient care of any sort under the influence is a medical malpractice disaster waiting to happen.
7. Listen to the Voice in Your Head
Making decisions about care over the phone, or for a patient with whom you are not familiar is difficult. Seek clarification. Ask plenty of questions. If something isn’t adding up, or you’re hesitant to advise a certain course of action, take note. Listen to the voice of caution in your head. It’s always best to go see the patient yourself, or to send the patient to the emergency department than risk giving unsafe advice. Not only are you legally liable for patient encounters and care that occurs while on call, the potential for malpractice is even greater with at-a-distance care. Proceed with caution, it’s worth it.
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