Unusual physician order

[sweetnurse63, BSN, RN]

I just had to know what all nurses think about this order. Long story short. I work in long term care and as you know, there will always be offensive odors whether in the halls or patient rooms. Anyway, one of our physicians go into a patient room to assess or examine and noticed a foul urine smell. This particular patient urinates on herself inspite of nursing staff assisting her to the toilet; she is ambulatory with some dementia and she is not incontinent so she can urinate at anytime with out us even knowing. So, I am checking physician orders and the physician writes an order stating: "make sure patient room is cleaned twice a week, there is a foul odor and increase her baths. First of all, as a healthcare professional, this order was insulting to me as a nurse who is use to seeing medications, PT or etc written on legitimate physician order sheets, not this mess. The doctor could have mentioned the odor to nurse manager or supervisor but why write it as an order. Also, the rooms are carpeted which harbors foul smells, this was not a good choice to make so far as the floors. My final thought is that if you can not take the foul odors as a doctor, then maybe you need to find another career.

[classicdame, MSN, EdD]

be glad he mentioned it before someone turns the facility in to the health dept.

Management needs to get a grip on this. I have worked in LTC where there were NO odors. It CAN BE DONE

[virgo,student nurse, CNA]

I know at the nursing home that I do per diem at they are always trying to keep odors down, especially in "common/residential areas".

[caliotter3]

Have yet to find a pristine smelling LTC facility.

[canesdukegirl, BSN, RN]

Febreeze 2 squirts TID

Febreeze 3 squirts for breakthrough odor.

[sweetnurse63, BSN, RN]

be glad he mentioned it before someone turns the facility in to the health dept.

Management needs to get a grip on this. I have worked in LTC where there were NO odors. It CAN BE DONE

I think the first thing that should be done is to get rid of the carpeted floors. House keeping is not going to shampoo the carpet every day and our facility usually is odor free except when someone has just been changed during rounds. I still disagree with cleaning a room as a physician order when it can be communicated in another professional way. Just my opinion.

[Cuddleswithpuddles]

I like this guy actually.

Yes, it is strange to put that note in a MD order. We are advocates for patients but not every single complaint has to go through us. He would have had better luck bringing it up to the management directly.

But I am actually really impressed that this doctor cares about how his patient smells.

I, like classicdame, have been to two LTC facilities that were odor free other than what the patient, uh, contributes on a transient basis. I do believe it can be done but it may require massive upgrades and renovations (ripping out old carpet, hard flooring, more ventilation etc.) that no doctor or nurse can undertake on their own.

[sweetnurse63, BSN, RN]

Febreeze 2 squirts TID

Febreeze 3 squirts for breakthrough odor.

Believe me, there are two rooms that i go into that definitely requires febreeze and I do not hesitate to use it. The carpet is the culprit in this situation.

[sweetnurse63, BSN, RN]

I like this guy actually.

Yes, it is strange to put that note in a MD order. We are advocates for patients but not every single complaint has to go through us. He would have had better luck bringing it up to the management directly.

But I am actually really impressed that this doctor cares about how his patient smells.

I, like classicdame, have been to two LTC facilities that were odor free other than what the patient, uh, contributes on a transient basis. I do believe it can be done but it may require massive upgrades and renovations (ripping out old carpet, hard flooring, more ventilation etc.) that no doctor or nurse can undertake on their own.

Impressed that this doctor cares about patient smell ? Wow thats really something considering that most physicians are only in the room for two minutes once or twice a month. How do they think the nurse assistants feel as they change smelly diapers filled with poop almost daily and nurses who spend more time with the patients. We all care, but it is up to management to make the necessary changes not us.

[RaineyRN]

Maybe this is a case of "CYB" for the Doc? If it's something he knows is difficult to change (lets face it, the facility probably isn't ripping out carpets on Dr's orders!), and relatives could be asking about quality of care, maybe it's his way of showing he is attempting to address the issue.... JMHO

[military spouse]

Doctors do crazy things :) We had a physician that would always write for a clean, quiet, private room for her patients. All but two of our rooms were semi-private, so she had to know it wasn't happening for they types of patients she admitted. We used those rooms for peds, dying, infection control. She was a gyn surgeon. Sometimes you just have to laugh and roll your eyes when nobody is looking!!

[seizetheday]

I think this is a great order. Shows a doctor who is thinking a little outside the box to support this resident's health and hygiene. It is likely if he just suggested more baths or room cleanings than normal - you would say you can't just do that. So by writing it as an order you can access the required supports to do it as you have to follow doctor's orders. If you have done as you said everything you can to keep this woman clean and there is still a foul smell of urine then I think more baths and more room cleaning is a good next step.