Give now orders for a patient that is "circling the drain"

  1. If you received a "give now " order for a critical patient (codes under the belt times 2) in MSOF. What would be a reasonable/ prudent amount of time to execute that order. I am not talking about bloods or any type of infusion that needs to be specially mixed. A drug such as dig or solucortef, for example?
    Thanks
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  2. 7 Comments

  3. by   gonzo1
    You haven't given a very clear picture of the situation, but if I had a critical pt I would expect to execute the order right away.
  4. by   JenSICU_CCRN
    I 2nd what the above poster has said...that is why in the unit that I work that we have specialty drugs and items in our procedure carts, omnicell, stock rooms, etc. Plus we have nurse servers in each room at the bedside for frequently used items.

    Jenny
  5. by   gonzo1
    After much soul searching I decided to remove the phrase circling the drain from my vocabulary. When I worked med/surg we had a woman who we coded more than 12 times over one year. Non-verbal, no spontaneous movement, feeding tube, but breathing on her own. Family wanted full resuscitation. So you see, she was circling the drain for a very long time and if we hadn't coded her, her familyl would have lost this time with her.
    I personally do not believe in this and my/my dh family are all DNRs, but we must act as if all patients are viable and give our best effort. Only God knows if the pt is truly circling the drain, and he ain't telling. I have gone home many times and told my husband "I saved a life tonight, but for what I don't know". He pats me on the back and says "Good job"
    Hope this helps.
  6. by   TopherSRN
    waaay too many variables. I always understood 'now' orders to be given in < 1hr. As to its importence it depends. If they're in msof then odds are they're being consulted by every service in the hospital. If a code in eminent and the nephrology R2 writes for the diaylsate to be changed form 4 KCL to 2 KCL now then I wouldn't be as concerned about it than if the cardiology attending wrote for Corvert now in a pt. w/ afib w/ a vent response of 170s. Just my 2 cents take it for what you will. It all comes down to your nursing judgement, thats why they are in a unit in the first place.
  7. by   criticalHP
    I agree with the above respondant. It depends on how critical the situation. For 'now' orders for non-critical drugs such as solucortef I would expect up to one hour. But for vasoactive drugs such as levo or epi the situation implies more urgency and the drugs should be administered asap. You could try looking at your hospital policy on this as well.
  8. by   maolin
    The rule of thumb I was taught was:

    stat=stop whatever you are currently doing, get the med and give immediately.
    now=finish whatever you are currently doing, get the med and give ASAP
    no label=give when pharmacy delivers med, can be prioritized based on nrsg judgment, can be given based on routine times (a daily MV ordered at 1800 could be given with other dailies at 0900 next AM)
  9. by   Maine Critical Care
    First off, is the patient allowed to circle the drain? Would that patient really want the whole 9 yards treatment? SHOULD the patient die now? Has the code status been adressed realistically?

    If its NOT OK for the patient to die now an it is really a big fat emergency, then now means NOW and not in 5 minutes. We have a lot of stock drugs in a Pyxis machine and can get them out in seconds.

    Our pharmacy even loaded a bunch of common antibiotics for our sepsis patients since antibiotics are to them what nitro is for the patient with chest pain.

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