Orders from hell...

Nurses General Nursing

Published

From time to time I run into real gems of medical writing.

Levaquin 750 gm P.O. q. 48 hours for 2 more days

the trick is to find how many pills this will be

Can you?

Specializes in Med/Surg, Gyn, Pospartum & Psych.

Co-Ed Behavioral Health Unit. All patients were involuntary admits. Two patients were found having sex in a room on rounding (early 20 year olds)....glad I wasn't working that shift. MD orders were that the two patients were not allowed to be in the same hall at the same time or must be sat on opposite sides of the dining room/group room. It was funny to watch them try to meet in the hall not visible by the nurses station. I guess they didn't "get" that we could monitor every public area on the floor via video cameras. When I finally went out and confronted them and threatened to become the male patient's "best friend & shadow", he announced that I couldn't keep them apart. I told him I had explicit doctor's order's from the chief psych doc that said they couldn't be in the same hall at the same time ... and he looked at me and said "okay"...and they suddenly complied. Maybe he was thinking of hoping to meet criteria for discharge (he was actually sent to the state long term facility) but I have never been so happy for strange doctor's orders.

For the record, they're trying to get you/really the physician to DOCUMENT in plain English the "why". They know why. But in order for all of us to get a pay check we have to be able to charge for the care we provide. And since we won't get paid unless all the boxes are sufficiently filled out the way CMS dictates, those QI people come by and cover everyone's ass. And CMS states no inferences can be made. It must be plainly stated. No I don't work in quality but I know how reimbursement works. Next time tell them thank you for making sure you get a paycheck.

Specializes in Med/Surg, Gyn, Pospartum & Psych.

Not a order, but after a friend of mine called the surgeon who placed a stent in her patient went home without talking to the patient and the patient was freaking out because she had blood in her leg bag but not in her urine. She said that she was "fine" and tell her he would talk to her in the morning. My friend put her note in. "Contacted doctor with patient's concerns. Doctor said that it could wait until morning. Patient informed." Strangely enough, that doctor was in the patient's room 30 minutes later around midnight.

Specializes in Oncology.
I had a surgeon write an order that the nursing staff had to go and sing happy birthday to a patient :)

Hoping he joined in

These are great.

'lady partsl douche once weekly as needed for fishy odor or discharge'

and nurses were actually assessing and documenting 'fishy odor' every shift.

Specializes in NICU, Infection Control.
I worked with a CT surgeon who always whipped out his own nasty looking scissors to remove chest tubes. I'd always pad down the bed and the floor with chucks, and lay a sterile suture removal kit next to it. When he was ready I'd peel back the top and leave it near him … he'd always ignore it, pull out his funk covered scissors from his lab coat pocket, snip, snip - yank out the chest tube (insert patient screaming here) blood flying, and fling it to a section of floor without any chucks. Zip - he'd pull the sutures closed like purse strings (the patient still yelling in agony, trying desperately to find themselves through the haze of pain) spin on his heel and walk out - leaving me to comfort a writhing patient, and a nasty mess to clean up while cursing under my breath. :mad:

One day he left his fancy surgery telescope glasses sitting on the counter and left … I tried them on, played with them a bit, then ran a saliva covered finger down each lenses before putting them snuggly back into the padded case. Let him chew on that for a while as he obsessively polished them while wondering what happened to them. :smug:

I would have written up a 'quality variance' report (or whatever it's called in your facility) every. dang. time. for lack of pain control, and break in sterile technique! That is just plane rude. If enough people did that, eventually, it would have gotten to some higher authority, and gotten a behavior change. I probably would have TOLD him I was going to do it, too. You know better, Doc!

:devil:

Specializes in Emergency.

An ER doc I've worked with will sometimes write orders like "Gown" when the patient is complaining of an ankle or elbow injury, etc. Or "Move to Minor Procedure Room", when the room is already occupied by something more serious and/or I can easily bring suture supplies to wherever the patient is. Really??

Specializes in Community, OB, Nursery.

Man, one of the worst orders I've ever read was my very first nursing job what feels like a hundred years ago (it was 16), on a general surgery floor. Back in the Dark Ages when we gave Demerol like it was water, one doc wrote for 10mg Demerol IV q1h for a hip or knee replacement (can't remember which). Not only was it an enormous pain in the butt to run in that room every hour, 10mg of Demerol was like spitting in the wind.

Specializes in NICU, Infection Control.
Man, one of the worst orders I've ever read was my very first nursing job what feels like a hundred years ago (it was 16), on a general surgery floor. Back in the Dark Ages when we gave Demerol like it was water, one doc wrote for 10mg Demerol IV q1h for a hip or knee replacement (can't remember which). Not only was it an enormous pain in the butt to run in that room every hour, 10mg of Demerol was like spitting in the wind.

Congratulations, Dr. Elvish. ;)

Specializes in NICU, Infection Control.

Keep in mind that most of my experience is NICU.

A frequently used IV solution is D10 ISO-P. The "P" is for, duh, pediatric. I told a med student that's what order I needed; he wrote: D10 ISOPee. :sarcastic:

Attending asked me how baby X was eating; I said, she's trying to nipple, but not quite there yet, so, we were still gavaging most feedings. He wrote "encourage baby to p.o. feed". I read the order out loud, looked @ him, and said, Well, now! There's a novel concept! We never would have thought of that on our own!! He started laughing.

"Allow family to call for codes" (family was known to push blue button or disconnect vent if they needed a cup of ice and insisting that it was their right to do so).

Well THAT makes my blood boil. Gawd.

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