Assess the patient.
When you're calling the physician, you will need the most recent evidence to present your case. Introducing a blood pressure reading you obtained six hours ago will not give the proper clinical picture. Providers expect the data you are giving to be "real-time." If labs help to support your recommendation, by all means, use them. But, the physician will need evidence (documented issues or patient's history/background) to support the current problem you're calling about. Yes, you are calling about an acute episode, but an investigation is needed for the proper picture to be painted.
Call the RIGHT physician.
Is it nephrology or critical care? If you don't know, ask your charge nurse for direction. Nothing is more annoying than wasting your time paging a doctor, and then you’re told, he or she isn't the person managing that particular aspect of the patient's care. For example, you want to use the patient's hemodialysis catheter to draw blood. You have no other lines, and the patient is hemodynamically unstable. You then call the critical care provider for approval. This action would be in incorrect as the nephrologist is the only specialist who could give you approval for this request.
Know the admitting diagnosis.
The providers you're calling on have multiple patients on various floors. Familiarity is not the standard. Just because the patient has MRSA now, doesn't mean that was the reason for the initial admission. Check the chart and come prepared! A hyperkalemia admission can turn into respiratory failure, with acute renal failure manifesting itself during the shift. Healthcare is tricky, and the transmission of proper information is necessary. Don't assume the current issue is the reason for the patient's admission.
Review the progress notes.
Yes, you're the patient's nurse for that day. But, to get the complete picture, you need to examine the progress notes. Progress notes help you to develop a plan of care or the recommendation needed in the SBAR report. Plus, this will help you to be proactive in finding any problems your patient might soon face. For example, your patient had hip surgery two days ago. You would typically make sure the patient is using an incentive spirometer and possibly call about ordering DVT prophylactic methods. With the knowledge of operation comes standards in care, and you wouldn't know what the standards are unless you have the framework (often in progress notes).
Have resources available.
When you're calling a physician, have a computer next to you (with the electronic chart open), hard-copy chart (if applicable) and any notes in case the physician has any follow-up questions. Yes, the blood pressure was low but were orthostatics previously completed? What is the patient's H&H? Have all aspects of information available at the time of the call. Preparation will keep you calm and allow you to present your evidence in an organized and professional manner.
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