What should I do?

[charles zhou]

What should I do if I find that certain drugs in doctor's orders are not suitable for the patient, esp. when in emergency? The medicine ordered by the doctor will not yield desired effects and another one may be better used, yet without 100% certainty of success. Most important, you have no time or way to consult the doctor. What should you do then? Which medicine should you administer?

[SmilingBluEyes]

This is a question I can't possibly answer; too many variables. Each situation is so different. What do your colleagues do?

[suzanne4, RN]

I answered the pm that you sent me. As a nurse, you cannot order medications for your patient, only the physician can....and especially in China.

It is best to discuss medications when they are first ordered, when possible.

You can make suggestions to the physician, but ultimately it is the Dr.'s responsibility. If it is detrimental to the patient,, then of course you do not have to give it............but you cannot choose your own med to substitute for it... :)

[markjrn]

but you cannot choose your own med to substitute for it...

I'm hoping that all nurses know this, right? Or maybe not... :uhoh21:

[hollyster]

Is there a house MD or on-call MD? I do not know how medical care in China is but it is rare for a pt here to only have one MD, some have five or six consulting MDs (surgeon,internist,pulmonologist,cardiologist,etc.) Call the MD of the system most effected by the medication and work your way down the list until you can make contact. With all the specialization going on and all the new drugs coming out so rapidly I have noticed that some MDs are not aware of the possible interactions or adverse effects. This is one of the reasons that I like intensivests so much. They are much better rounded and see the big picture not just one system.

I apologise for getting off the subject. But do not change or give a medication unless you have an order for it or a standing protocol(ACLS,OHP,PALS.)

[stidget99]

Many times, a doctor will not order a medication for the usual indications that it is for. Rather, they may be wanting the side effects or be giving it for some other reason that you are not aware of. For example....my lesson learned....when I first started in hospital nursing...a patient was ordered to receive lactulose. I've always thought that that med was used as a cathartic and I held it once because the pt was complaining of loose stools. The doctor, in a not-so-nice manner informed me that he ordered it because of an elevated ammonia level. Example #2 - carbamazepine is generally given as an antiepileptic. However, a less common use for it is to help manage a person's behaviors. You can always question the doc why he is ordering it. "Hey doc, I've always thought that this med was given for this purpose and it seems to me that this med might be detrimental." It's a learning experience. Hopefully the doc will understand your desire to become a better nurse and better understand why you are giving a particular med.

[suzanne4, RN]

You need to take into account that he is speaking about nursing in China, not the US. Things are quite different ovre there, as well as most other countries. Nurses do not get the same recognition that we do over here. And definitely not the same acceptance as being part of the health care team.

[NurseFirst]

Many times, a doctor will not order a medication for the usual indications that it is for. Rather, they may be wanting the side effects or be giving it for some other reason that you are not aware of. For example....my lesson learned....when I first started in hospital nursing...a patient was ordered to receive lactulose. I've always thought that that med was used as a cathartic and I held it once because the pt was complaining of loose stools. The doctor, in a not-so-nice manner informed me that he ordered it because of an elevated ammonia level. Example #2 - carbamazepine is generally given as an antiepileptic. However, a less common use for it is to help manage a person's behaviors. You can always question the doc why he is ordering it. "Hey doc, I've always thought that this med was given for this purpose and it seems to me that this med might be detrimental." It's a learning experience. Hopefully the doc will understand your desire to become a better nurse and better understand why you are giving a particular med.

A great reason why all MARs should include the REASON why a medication is being given. Of course, the docs have to cooperate :) But even if the person has a prn drug order, you are not legally allowed to give it for any but the prn reason.

NurseFirst