Policy A312- Situations in which the chain of command process should be used include the

following:
 Instances when the provider has not responded in a timely manner to a deteriorating or critical patient
condition.
 When there is reasonable cause to question a provider’s written order or care being rendered.
 Situations where the clinical staff identifies gaps in care or issue resolution that may present an
immediate risk to the patient.
 Individual professional assessment differs significantly from the provider’s assessment and/or
documented awareness of the patient’s clinical condition.
 Unprofessional behavior that jeopardizes patient care.

Step 1
Step 6 •Discuss with
•If the concern remains Colleagues
unresolved and/or a •Did you attempt to
solution is not contact the physican
obtained, the campus- or LIP? Esp during the
based leader will day .
contact the clinical •Did you contact the
chief for that specialty Consulted physicians ?
of the attending. Is it a cardiac issue, is
it a ID issue...etc...

Examples:

1. Critical result called to the LIP but

Step 5 no return call-Escalate up
•Nursing related 2. The nurse calls the IOC or the
concern—campus- based
Chief Nursing Officer Resident and told NOT to call the
(CNO) RRT or Sepsis /Stroke Alert...nurse Step 2
Non-nursing related •Discuss with Charge
concern—campus- based does not want to create conflict
Nurse
Chief Administrative with the physician or have the
Officer (CAO) •If NO repsonse from
After normal business
Attending question, why didn't you physician or LIP
hours (for nursing and call the resident? Please follow
non-nursing related
concerns) – Chain of Command policy to further
Administrator on Call advocate for the patient
3. Patient and/or family state
something is “wrong”, your gut is
telling you something is “wrong”.
Get help!

Step 4
•Discuss with Nursing Step 3
Supervisor •Discuss with Nurse
•He/She is there to Manger if available
help!