I dont mean to offend anybody. I may look like a dumbo after this post but I'm just trying to learn about my pt's and how I could have handled this scenario differently. Anyways, a pt was ordered Depakote tablet and Imitrex SC for her migraine h/a's. Of course pharmacy is giving me a hard time on the Imitrex so that prompted me to call the PA. I was told that the pt could not 'swallow'. I'm thinking, 'what?!', those DEpakote pills are horse pills.. and she went to say why the pt is on SC not tablets but I didnt bother to listen intently because I was just flipping out on the orders. The PA went mad as soon as I called on her 'absurd' orders. I do want whats best for the pt and I have no prblems following orders, even if I have to give my arm to get that order done. But the order has to make sense, especially if I risk neglecting my other patients for that order. The same PA oredered her PCA changed because she apparently "dry heaved" 1 time on another floor but wasnt documented. I had given her Anzemet and had no issues at all the rest of the time I had her. I think the order was unecessary since the pt said she was feeling much better. So basically I spent a lot of time obtaining meds and changing tubings for this pt for reasons I dont understand and agree and especially on a day that I have 4 post op pts and 1 bleeding pt. Those are the days I think I was gonna go nuts.
Sep 17, '06
If the word 'absurd' came out of your mouth in regard to the actions of another provider, I think that's a potential area where things could have been handled a little differently. 'Concerned' - yes, 'confused' - okay, 'absurd' - no.
Sep 17, '06
Could the tabs have been crushed and put in pudding or apple sauce. I know the SC could not, but what about the depakote???
Sep 17, '06
I guess I am just not getting it.
1) why was pharmacy "flipping out"?
2)What was your problems with the order?
3) maybe this patient conveyed to the PA that they would prefer another pca med? In my experience just because no one charted the patient having nausea or vomiting doesn't mean they did not have it.
Just wishing for a little clarification
Sep 17, '06
The pt takes Depakote at home, for some odd reason she told the PA that she has a hard time swallowing, when she's taking these big arse pills!. I guess the PA just didnt realize how large those pills are compared to Imitrex pills. I would think that the Imitrex injections cost more than the pills. Most patients dont know anything about PCA unless they had several surgeries. I guess I've seen too many patients over react to their illness and demand unecessarily, worse practitioners that give in to their demands and leave it all up to the nurse to deal with! Most days the patient load is heavy that I am reduced to providing just what is necessary or else I risk neglecting my other patients, or I drop dead. Its frustrating that patients, even some practitioners behave like they have a private nurse on duty.
Sep 18, '06
Depending on if your patient is on extended release or ER Depakote, sometimes you can check the the prescriber and pharmacy and offer a liquid dose of the same drug... only thing, if its not ER, they just will have to give more doses with the liquid form, to get the same dosing in the patient. ??? if that helps. also depakote comes IV.
Sep 18, '06
I believe I understand your logic on the issue of the "difficulty swallowing" -- if the patient was able to swallow large Depakote pills without difficulty, he/she *should* be able to tolerate smaller Imitrex pills.
However, I would have addressed this with the patient before calling the PA ... is it the total number of pills that she's taking at one time that's bothering her, the taste of that particular med, etc.?
What was the difficulty with Pharmacy? Did they only have Imitrex p.o. available?
Maybe I'm reading things into your post that aren't there, but I think I sense some underlying conflict between you & the PA? (BTW -- if a patient c/o nausea to a medical clinician, they're logically going to order an anti-emetic. Yes, it's possible that the nausea may resolve without med administration, but it's nice that the order is there if you need it.)
I certainly wasn't present when you called the PA, but I agree with EricEnfermero - if someone told me my order was "absurd" ... there's very little room left for the conversation to go before taking an unpleasant turn.
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