Another time mgmt question......

Pediatric Critical Care Columnist · Oct 15, 2008

Does your unit have some way of flagging charts that have new orders on them so that you actually know orders have been written? I can't understand why doctors think that we have ESP that tells us when they've written new orders and don't bother to mention them to anyone. It happens to me often enough that I get mad about it... I usually have only one patient and I'm right there at the bedside, unless I'm helping someone else or am covering a break and the other nurse's patient needs something. But they write new orders, close the chart and walk off. GRRR. So in your shoes, having only found the order at 7 pm, I'd have told the night nurse, "Sorry, I didn't see this order. Maybe Jane can help you. See you tomorrow." Nursing care is an around the clock arrangement and there is no reason why things like that have to be done by the day shift... in these circumstances.

WindyhillBSN · Oct 16, 2008

Unfortunately, we don't have mgmt. at this time, so all of us are "self-governing," no one flags our charts. :sniff:

Kymmi · Oct 16, 2008

I understand that you are very new to this and I can only suggest that with time you will become more organized and develop your own routine of doing things proficiently.

On another note and I sure hope you take this as constructive critizism I do not think I'd have left a patient with a K+ of 2.1 go 6-8 hours without being treated. I'd have been calling that MD every 30 minutes if necessary or insisting that I speak to the MD now. Electrolyte imbalances can reek havoc if not treated esp when they are extremely low or high so you got lucky that shift because imagine how late you would have been getting finished if that patient would have coded.

Pediatric Critical Care Columnist · Oct 16, 2008

Kymmi, people rarely code because of LOW K+, although they are more prone to certain dysrhythmias... and people with a normal ADH secretion/response will be mildly hypokalemic at night because ADH encourages K+ to move into the cells. I work on a cardiac unit and we don't even start treating hypokalemia until it's

southernbelle08 · Oct 16, 2008

Yeah -- we have a page in the front of every chart so new orders and things can be flagged. I have only been at this 5 months, but I find everything starts happening at the end of a shift. Doesn't matter if things have been peaceful all night, something is going crazy about 6AM. People I work with kinda pick on me about my lists for everything -- but when I come on my shift I make a list of all the things I need to get done (assessment charting, pain charting, careplan, 24-hr chart check, etc) and I just go through my list, most important to least, so when I am between giving meds and doing patient care I know where I am in my night and I can pick back up no problem. I don't yet have a full patient load (4-5 pts is what I take now), but I rarely am there late. There is always that occasional crazy night though and I know there always will be. :)

Kymmi · Oct 17, 2008

Kymmi, people rarely code because of LOW K+, although they are more prone to certain dysrhythmias... and people with a normal ADH secretion/response will be mildly hypokalemic at night because ADH encourages K+ to move into the cells. I work on a cardiac unit and we don't even start treating hypokalemia until it's
A K+ of 2.1 is extremely low and could cause alot of serious complications and if left untreated and continues to decrease could potentially cause severe problems. If someones K+ is that low you'd have to ask yourself what else is going on with that patient to cause such a low potassium. If the patient has a extensive cardiac history and is already compromised cardiac wise then it would be potentially likely that a lethal rhythm could occur. We begin treating K+'s in our unit anytime they are less than 4 even though normal is 3.5. I work CVICU where are patients are cardiac compromised. All I was trying to point out is when it comes to critical labs the MD should be notified and the labs should be dealt with before something happens that will end up taking alot longer to treat than simply replacing K+.

WindyhillBSN · Oct 17, 2008

The good thing is that there was already an order for 2 K-riders over 2H, so when he finally did call and the other 4, then 2 more were given, it got her K+ up to 4.0.:typing