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Discussion

what would you do?

Ok, I work in a very fast paced sameday surgery center. We have a good bit of autonomy in this area, but I still like to have doc orders for d/cing meds etc. Well, here is what happened today and is totally not a big deal, but just kind of made me feel like a dummy...well a little. Was d/c'ing a pt and giving her instructions and scripts,etc. There was a script for macrobid and she was already on bactrim at home, so she wants to know if she should stop that. I told her I am sure the doc would want you to stop that and just take the macrobid, but I wanted to check with the doc to be sure. So, while she is getting dressed I go to the phone to call back to the OR to ask the doc this. Just at that moment he went thru our area as he had just finished the case and was on his way to the back again. So, I catch him and ask him, just for clarification. So, he says, 'well, yeah', cause the C&S on the chart shows the organism resistant to the bactrim. I said I just wanted to clarify. I really hadn't thought to check the sensitivity, and that is what made me feel like a doofus. But, still, I would want to have clarified. I mean, I can't order the meds and I can't d/c them. Anyway, input????

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    You did the right thing. I had to call a doctor the other day to let him know a urine culture came back as MRSA, but was susceptible to Rocephin, which she was already on. But its still our policy to report anything like that, telling her to stop taking a medication without the doctors okay would be practicing outside of your scope.

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    You're not the prescriber, it's your job to understand, not interpret the need for a particular med based on assessment findings or labs. Your call was wise, as in my experience, there often are things overlooked by MDs when it comes to addressing home meds when writing new orders. 20/20 hindsight now tells you that this was the rationale for this drug being prescribed, but perhaps there was additional rationale for the use of both or one versus the other that you were unaware of that the prescriber alone knew. No way for you to know based on labs alone. Again, it's the prescriber's job to clarify.

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    And besides that, lots of people take macrobid qday indefinitely. It would not be unheard of to instruct someone to complete the bactim therapy and continue on macrobid for weeks, month, years.

    Doc was being an ass trying to make you feel dumb when it was his failure to be clear.

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    You did the right thing so in no way should you feel dumb. When he responded to you sarcastically you should have told him "Well as a nurse I'm not licensed to treat illnesses or dispense medications while you are as a doctor. Thank you." Does he not get paid enough to pay attention to his patients?

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    What a jackwagon. He just feels dumb because you had to point it out to him. HIS fault, not YOURS.

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    clarifying an order does not mean you do not know about the medication. It just means you understand you do not have prescriptive powers and need an order clarified. You did the right thing!

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    Thanks for the input everyone. That was exactly what I thought, and as I even told the pt. I was 99.99% sure he wanted the macrobid to replace the bactrim, but, since I am not the doc, I HAD to verify. I am all about CYA!

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    Doc should do THEIR jobs and check and double check meds they are ordering and meds the patient takes at home and they should clarify them.

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