Antibiotics and Cultures

[EarthwormRN]

Wondering what you all would do in this scenario. A patient came from an outside hospital on ceftriaxone for "suspected UTI", as well as urinary retention and acute kidney injury. He had been on it for about a week. I couldn't find any old culture results at the prior hospital. Most often UTIs are caused by e.coli so ceftriaxone would normally be adequate. We redid a UA and culture anyway and the culture ended up being positive for an enterococcus species. I was training a new nurse and instructed her to let the doctor know that the culture came back and ask if she would like to change the antibiotic. The doctor responded dismissively and said something along the lines of "thanks, I can take care of my own patient". The new nurse was embarassed to have been spoken to that way. I questioned whether or not my instructions for her to notify the doctor were necessary. My thought was, it was kind of late in the evening (1530ish) and sometimes the docs finish up and go home between 1600 and 1700, then stay on call until 1900 if needed. I figured it would be better for the patient to get the proper antibiotics as soon as possible instead of waiting until morning in the event the doctor didn't see the new result until the next day.

 

What are your thoughts? Did we do the right thing or overstep?

[delrionurse]

Not sure how the message was worded, but yes you did the right thing. A culture came back, you tried to verify the info. But really, that's the doctor's responsibility anyway. I probably would have just let the doctor know that the new culture results were ready.

[JKL33]

EarthwormRN said:

The new nurse was embarassed to have been spoken to that way.

A good lesson for new nurses and everyone everywhere is to learn not to feel embarrassed or take personal offense solely as a result of someone else's ridiculous behavior. Their behavior is their problem and only says something about themselves, no one else. 

Unless there is more to the story, no, of course there is nothing wrong with reporting that a new result has been received and asking if it necessitates any changes in the plan of care.

[Wuzzie]

JKL33 said:

Unless there is more to the story, no, of course there is nothing wrong with reporting that a new result has been received and asking if it necessitates any changes in the plan of care.

Totally agree but I've found that with some of them the way it's worded can make a difference especially if they don't know you well. For example in the same situation I would have worded it "Hi Dr. Snippy-Pants, Mr. UTI's culture came back positive for E Coli. Are there any changes you would like to make?” That way no egos are bruised and you can go about your day. Yeah, it's stupid to have to do it but anything to make your day go more smoothly without completely capitulating to uppity co-workers is a win for me. 
FTR-this was a skill that took me a long time to figure out and master.