What is the most incompetent thing you seen a fellow nurse do? - page 8
There were two patients in a double room on a 38 bed tele floor. One was an old fart with a sick heart an the other was a 35 year old male who was in an MVA being observed for a myocardial contusion. The old fart coded and... Read More
- 0This is from personal experience...My husband was admitted w/ A-fib and was ordered Dig 0.5mg IVP x2 as a loading dose. He did not get up till his room until late and was asleep when the night nurse came in to give his meds (she hadn't bothered to assess him first). His normal resting heart rate is high 30's to low 40's. This nurse was about to push the dig when I asked her "Aren't you going to check his apical pulse first?"She replied "Well, he's on tele anyway." My husband was 24 and this is the first time he had ever had this med. Isn't there a litttle thing called ASSESSMENT?
- 0Jun 13, '02 by Amy ER NurseMy hubby was admitted with new onset a-fib last summer (33 years old). The night nurse came in when we finally got to the floor at 3am and did his assessment. She asked alot of questions, but never put a stethascope to his chest, or even checked a radial pulse for that matter. Later the med nurse came in and told my husband "I have your blood pressure medicine". My husband told her that he does't take any meds, and his B/P was low in the ER. (My husband said the way she worded it made it sound like it was a routine med for him, and that is why he said that he doesn't take any meds, meaning ROUTINE meds). Before I had a chance to say anything she snapped "well, you can REFUSE the medicine if you want too!" I called down to the ER (I worked in that hosp. ER at the time) and asked the nurse taking care of him there if the doc ordered B/P meds, and he said NO! the B/P was low. Then said, oh, he did order Lopressor, but more for the rhythm. When the cardiologist came in, I told him that my husband was not trying to be difficult or refuse meds, but the nurse didn't attempt to see what the med was prescribed for. The doc said, "well, half these nurses around here don't know what they are giving or why!"
- 0Jun 13, '02 by Amy ER NurseSo true! Just last night in the ER where I work now the ER doc said she called the pts pvt MD and he ordered TRIAVIL 3cc, but she was not sure how he wanted that administered, so call the pharmacy. I called, and THANK GOD the hospital did not have TRIAVIL in cc's, only PO. About that time the pvt MD came down, and I asked him about the order. He said he ordered TRIDIL (Nitro drip) to be run at 3cchr via pump!!! I thought the ER MD would have been clear on the order the pvt MD gave!!!
- 0Jun 13, '02 by Brownms46Originally posted by Amy ER Nurse
So true! Just last night in the ER where I work now the ER doc said she called the pts pvt MD and he ordered TRIAVIL 3cc, but she was not sure how he wanted that administered, so call the pharmacy. I called, and THANK GOD the hospital did not have TRIAVIL in cc's, only PO. About that time the pvt MD came down, and I asked him about the order. He said he ordered TRIDIL (Nitro drip) to be run at 3cchr via pump!!! I thought the ER MD would have been clear on the order the pvt MD gave!!!
- 0Jun 15, '02 by NotReady4PrimeTime, RN Senior ModeratorSome of the blame for incidents like the Triavil/Tridil one must lie with the drug companies. New drugs coming on the market are being given proprietary names that are too similar in both spelling and sound to already existing drugs. One way around this potentially disastrous little conundrum is to create a policy whereby physicians must order all meds by the generic name, although this isn't totally without risk either. Fluoxetine/fluvoxamine is just one example of a possible mix-up there. Physicians are notorious for illegible handwriting, so maybe computerized charting will reduce some of these errors. I just thank God that nurses are the questioning sort and don't hesitate to clarify seemingly incongruous orders! Think of all the folks who never know they had a close call.
- 0Jun 15, '02 by eagleRNOriginally posted by mario_ragucci
I've only worked in a hospital as a cna now for almost 2 months. I went two months before coming to the worst I've seen. My mouth activaed, and I started bad feelings on nurses part, and nurse wound up bad mouthing me and ??.
Pt is young guy recovering from rollover auto accident, head trauma+ body. I am a sitter, and the night before he pulled out his trach. Then his foley was removed. He's a nice young guy, his mom spent time with him, but the nurse rarely came in, said they just got back from vacation, and the sentences were broken when she spoke. by days end, the poor guy scratched his head wound (lil blood) and keeps trying to stand up to urinate (like a male would) after having the foley removed.
In CNA school, and in nursing school so far, the use of restraints is mentioned often as a last resort. They say you need a DR's order every time. So I am conditioned to believe yewd need a dr. to come in and say put them on. They really emphasize restraints are last resort.
Nurse makes a cameo appearance in the room, sees a little blood on his hand, and over reacts. She starts drilling me about not noticing it. Pt tried to stand up (he can't too well) and the nurse starts barking about putting him in restraints. Her voice and demenour were bad. I just said one word, "threat" and she left the room in a tizzy angry at me.
I think if your gonna use restraints, for a patients own good, you should just puttem on and not talk about it. And not threaten their use. The nurse had no empathy for this patient at all.
All these stories are very interesting, and I learn much from reading them. The vocabulary I reap is what I am thanking you for, and the introduction of various scenarios as well. I can not feign to understand all the drug names and proceedural descriptions, but I am loving to imagine.
If you use restraints you have to have a dr.s order, always. The order has to read the reason for the restraint, and that you loosen it Q 2 hrs and at meal times, and a restraint order is only good for 24 hours. But it can be written the same way the next day. It's ALWAYS prudent to check with the family before the restraint order, it could save you and the facility alot of headaches and possible law suits.
- 0Jun 15, '02 by Brownms46First of all....I have thought about this since I posted...and what the post referred to should not, have really resulted in a problem. As I'm sure it would have become evident...for many reasons. One when the drug arrived...I'm very sure...all would have known it was the incorrect durg..whether it came in cc's or not. Because any pt needing Nitro, was there for something cardiac, and would have been IV and not PO. I'm sure the ER MD would not have been calling the PMD for anything requiring a po med.....especially one needing nitro! And upon receiving a po med..the confusion would have been clear. Or.... upon receiving something odd from pharmacy. I think pharmacy would have become suspect also if they received an order for such a med from the ER. JMHO
I agree that similar sounding drugs can be confusing...but all the more need to repeat an order back to the person ordering it. I once wasn't sure what a MD was ordering over the phone...so I had him spell it! If I'm not sure what a med is..either generic or brand name...I look it up! These are the best ways to keep confusion down. And yes.... nurses and doctors need to have questioning minds. Never just think you heard someone correctly...KNOW!