[happyloser]

So they closed my unit because of low census throughout the hospital and they wanted to finish painting the rooms... so I was floated to PACU...

Our last case was at 9:30PM and in comes Dr. Blah and adds on another case fine no problem except she was having Blood Sugars of 500+ in the pre-op holding... they brought it down to the 200's and cleared her for OR.

When she came back to us the Dr. Blah left and did not write Glucose monitoring orders/insulin coverage orders. Then patient's T waves were inverted and there was no baseline EKG to compare....

MD was called at 11 to get orders and clarify T wave problem.... He did not call back and Anastesiologist (sp) said we could transfer patient to a telemetry unit which we did at midnight... patient arrived in PACU at 10:30PM and MD was paged twice..... I was super annoyed and upset, and I probably have to go back tomorrow....

BTW Dr.Blah is not the real name.

[Faeriewand]

Originally Posted by happyloser

BTW Dr.Blah is not the real name.

Thanks for the laugh.

If I knew anything I would post more but as you can see I just graduated.

[PACUJennifer]

I can sympathize with you -it does add stress when it's hard to get hold of a resident or an attending. In my PACU,the EKG problems would be handled by the Anesthesia staff before the pt would be discharged from our care. Generally in the PACU setting,Anesthesia has responsibility for the patient until they have recovered from anesthesia and are transferred either to the Post Recovery Lounge (Day pts) or to their in-patient unit.

Did the PACU resident or attending not order a 12 lead plus blood levels of troponin and cardiac enzymes? In our unit that would not have been the responsibility of whichever surgical service the pt was under,but anesthesia's.

Sliding scale Insulin orders and the frequency of the chemstrips while the pt is on the floor are the responsibility of whichever surgical service is caring for the pt - or sure,and we usually try to have the service write their orders before we release the pt (primarily for continuity of pt care) - and sometimes that is a royal pain if we have ORs on hold, and all hell's breaking loose - But in an unstable pt such as this -we'd hold 'em.

Did the anesthetic service allow the pt to be discharged from PACU with no Insulin orders for the floor? In a pinch,I should think the anesthetic resident/Attending could write orders for the floor to follow until the floor tracked down their doctor - but that's not the ideal situation,is it?

jen

P.S. Kudos to you,btw, for floating to PACU...you know how we nurses love to float...

[BlueHenRN]

Originally Posted by PACUJennifer

Kudos to you,btw, for floating to PACU...you know how we nurses love to float...

Happyloser - are you an ICU nurse? If not, I don't see why they would float you to PACU.
I'm sorry that you had to deal with this. It stinks when you're doing the hospital a favor and you get crapped on a bit!
Jess

[happyloser]

lol No I am not an RN, I am a patient care tech finishing up nursing school and being a tech means I float anywhere and everywhere.

As for labs and such there was one order and that was "Admit to renal floor under Dr. Blah service. Call Dr. Blah for medical orders"

That was it, no lab orders or glucose/insulin orders. I was surprised nothing was done, Oh and when we called anastesia about all this they said " If patient has no chest pain put them on a tele monitor."

Yup I fload to PACU once in a blue moon and when I do, I feel like a chicken without a head.

[BlueHenRN]

Originally Posted by happyloser

lol No I am not an RN, I am a patient care tech finishing up nursing school and being a tech means I float anywhere and everywhere.

As for labs and such there was one order and that was "Admit to renal floor under Dr. Blah service. Call Dr. Blah for medical orders"

That was it, no lab orders or glucose/insulin orders. I was surprised nothing was done, Oh and when we called anastesia about all this they said " If patient has no chest pain put them on a tele monitor."

Yup I fload to PACU once in a blue moon and when I do, I feel like a chicken without a head.

You know what's funny? When I was a tech, I worked in PACU...and being on any floor made me feel like a chicken without a head!
Jess