bolus w/o order....yes or no? - page 2

greetings all!! bolusing without an order....yes or no? background story to the question: i work same day surgery and we had a patient, male, late 30's, in phase 2 recovery s/p knee scope.... Read More

  1. by   sapphire18
    Quote from SionainnRN

    When I worked in ICU we would often order labs, X-rays, etc and let the md know afterwards. But that's once they knew and trusted us.
    Yup. This. We often know what the patients need and what the MD is going to order. If they are unavailable, or it's the middle of the night, we do what we need to do and let them know after. This is limited to labs, EKGs, CXRs, if it's a more emergent situation, maybe some fluid. I'd rather use common sense than let a pt decompensate. Again- this is only with certain MDs who know us. They usually just thank us. However, every workplace, every situation is different.
  2. by   anotherone
    I wouldnt have done it . i have seen drs through major temper tantrums for nurses doing ekgs without an order on pts having chest pain
  3. by   eatmysoxRN
    I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  4. by   limaRN
    Quote from anotherone
    I wouldnt have done it . i have seen drs through major temper tantrums for nurses doing ekgs without an order on pts having chest pain
    Seriously?? They're angry because an EKG was done on a patient with chest pain? Get over yourself!
  5. by   sarahbeth2006
    she is relatively new to the area....perhaps about 4 months there vs myself and everyone there being there for a year or so.....and this isn't something the MD would have ordered. can almost guarantee it.
  6. by   emtb2rn
    Quote from eatmysoxRN
    I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
    The "nursing bolus". Do them all the time in the er, get the doc to put in the order so everything matches up. It's all about critical thinking. The environment counts a lot too.
  7. by   anotherone
    Quote from limaRN
    Seriously?? They're angry because an EKG was done on a patient with chest pain? Get over yourself!
    Yes, It was pathetic. This doctor always threw ( i typed "through" instead of throw before lol) temper tantrums for everything. It was pretty comical. As this pt was pretty old and had a ton of cardiac problems.
  8. by   tewdles
    Nurses practicing in a specialty area for a period of time often practice in ways that "cut corners"...as in this instance, give the bolus then get the order. There is some jeopardy in this practice but some nurses feel comfortable enough with the physicians affiliated with the care that they are willing to walk the edge.

    Dependent upon the size and condition of a patient, a 500ml IV bolus shouldn't be too dangerous...but there are exceptions to that generalization.

    As others have said, many nurses practice in areas that have well developed treatment protocols and standing orders for medical and nursing care.
  9. by   CC Wisconsin
    On the Surg/Ortho floor, we give a 1,000 mL bolus for orthostatic hypotension (drop of >15 systolic). That order comes up with each surgical patient as a protocol. If the systolic drops, we give the bolus, then call the MD and notify him/her. Granted, we technically have an order in this situation, but we also prioritize.

    A patient saying that he is dizzy is not objective. Dizzy to me may mean passing out whereas dizzy to someone else may mean feeling a little light-headed. She should have at least checked his BP before deciding it was okay to bolus him.
  10. by   BelgianRN
    What's wrong with speaking to the RN herself? Why run to management. If you felt the need to spy on her patient care at least have the courtesy to go head on with her as well. There is too little direct communication nowadays.
  11. by   martymoose
    This happened to me when I had a knee scope/bad reaction to dilaudid. The nurse called the anesthesiologist and got the order to bolus 500ml. It took her less than 2 minutes to get the order.
    I don't know why a nurse would want to take the chance of giving something without an order- especially when it shouldn't take that long in post op to get the order.It may be a different story if someone is vagal-ing, but there should be protocols in place.
  12. by   wooh
    Quote from netglow
    Maybe a call had been made, or will be made and the surgeon will sign without any hoopla... I've seen PACU and ICU nurses (especially) get and give first, let MD know after often. Again, you don't probably know this nurse...
    Yep. Textbook answer to OP: No. Don't do it.
    Real life answer: It happens.
  13. by   sarahbeth2006
    It really isn't spying on her patient care at all when you work in an area as small as we do. I assisted her in bringing her patient back to the chair after using the restroom and then went back to my charting about 25 feet away. I fully understand and appreciate your comment that communication is definitely key but dislike the assumption that I was spying on her patient care.

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