It is so easy to become like a robot, taking one call after another and going through the motions...reciting protocol after protocol. There are, however, a select group of calls that should stand out as high risk.
Extremes of age: The very young, as in newborns, and the old (those above age 65) are at higher risk of developing complications. They are also physically less tolerant of symptoms such as fevers.
Comorbidities: Those with diabetes, post-op patients, immunosuppressed.
Repeat Callers: (Repeat calls for the same problems) Maybe the caller is not understanding instructions given? Are the patient's symptoms worsening, and the caller does not understand how to communicate this? Is there a high level of anxiety?
Frequent Flyers: Are they anxious? Is there a lack of caregiving in the home? Is the caller difficult to educate?
Patients with Multiple Complaints or Poor Historians: Multiple complaints makes it more difficult to determine what the call is actually regarding, and it is difficult to give accurate advice if you cannot make a complete assessment based upon what information the caller is giving you.
These types of calls deserve extra attention to the protocol and follow through. If there is any question about level of understanding, concerns about adequate caregiver availability, risk of the caregiver and/or patient not following advice given, or any risk to the patient's well being, the physician on call should be contacted to lessen the responsibility of the nurse, and possibly even referred to the ED for further evaluation and care.