Ask Auntie Aggie: “The doctor wouldn’t let me give the patient enough medication. What now?”

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NewRN asks:

I had to assist with a procedure that took place with conscious sedation. The doctor who performed the procedure wouldn’t let me give enough medication to sedate the patient, saying that she didn’t want the patient to get over-medicated. The patient was in obvious distress during the procedure and ended up with some minor injuries. What do I do? The doctor was absolutely opposed to increasing sedation.

I work in a progressive care unit. We do conscious sedation all the time, and I’ve never had this happen with a procedure before.

The first thing you do in this situation, NewRN, is chart exhaustively, then file an incident/error/event report (whatever your facility calls it). Personally, I wouldn’t mention the doctor’s limit on whatever sedation you used in the chart; I’d save that for the incident report. In the charting, you’re allowed to say things like “distress” and “bleeding noted,” but not “MD refused to give more sedation.” Don’t mention in your note that you filed an incident report; that’s generally frowned upon.

Be sure you file the incident report now, or as soon as possible after something like this happens. Detail the type of procedure, the amount of sedation given, the reaction of the doc when you asked for more sedation and how the patient responded. You mentioned a minor injury to the patient; if there’s a separate form for that, fill it out. If there isn’t, include it in your reporting of the event.

Then send an email to your boss. If your email system has a receipt feature, and most do, request a receipt when it’s been read. Be as detailed as you can be in the email, quote as much as you can remember accurately of what was said and include times. Keep a copy for yourself somewhere other than your work email archive.

Your boss might decide to get whoever does risk management involved in the case. If so, you’ll need to keep records of everything that happens with them, and all correspondence you exchange with them.

You did the right thing by asking for more meds; it was the doctor’s decision that led to the patient’s being uncomfortable and hurt. What your documentation does is establish that you took the necessary steps to try to protect your patient, and that you took the correct actions when that failed.

I’ve never been in this kind of situation before, but I can imagine how much it must suck. I wish you good luck.