ED protocols that include zofran?

[kmoonshine]

Does anyone have standing orders/protocols for nausea and vomiting that includes giving zofran ODT? Our ED has been swamped with nausea/vomiting patients; and I didn't know if there was anyone out there with standing orders which include giving zofran ODT prior to the patient seeing the doc. I feel so bad for the patients that are actively vomiting when our ED is completely backed up, because they have to wait longer. This would be for healthy 15-40 year olds, with main c/o nausea/vomiting (for those patients that most likely have gastroenteritis).

[luckylucyrn]

We have a list of protocols that are initiated prior to the MD seeing the patient. If the patient is in an ER room, on abd pain/n/v, we start an IV and give Zofran 4 mg IV x 1 dose, and phlebotomy draws labs. If they are in the waiting room, we just draw the labs and give the Zofran IV when they get to the back....can't have a bunch of people LWBS with IV's in!

[LeesieBug]

It's been the same here - hundreds of young healthy adults coming to the ER for vomiting x 1-2 days. People have absolutely no tolerance for short-term illness.

Ditto. I am so sick of puking people.

That said, we just started stocking the zofran ODT in our unit a couple months ago and I LOVE THEM! Especially for kids...I have noticed more of our docs trying the oral zofran and PO challenge rather than jumping straight to a line. Also, I read a recent study that discussed the benefit of the oral zofran in preventing the need for IV fluids in peds pts.

Anything that has me poking kids less is the best thing since sliced bread! We do not have standing orders either, have just been getting a VO when needed.

[ZippyGBR, BSN, RN]

ondansetron has come off patentnow , suddenly it;s started appearing as a stock drug here i nthe uk rather than something that you had to order from hospitla pharmacy for a named patient or sell you soul to snaffle some from PACU or haematology ward...

[workingforskies]

The only potential problem I see with this idea is that the patient's symptoms will be resolved with the ODT zofran and then they will leave without being seen by a doc or PA. It only takes one person to do this, go home and die of sepsis from a burst appendix before the media and lawyers start accusing triage nurses of practicing medicine without a license. (Even if the person left on their own - it doesn't matter).

Blee

If there is a protocol to give it, it is my understanding that is the same as a written medical order. In the sense of being accused of practicing medicine without a license, you would be covered as long as everything was appropriately documented.

As far as someone leaving, they are free to come in, they are free to go unless they verbalize or show objective evidence that they are clearly, a threat to themselves or others. What is the alternative? "Sorry sir, even though you now feel better and want to leave, I am going to tie you to this chair until you are seen by the doctor"? Imagine the law suits coming from that.

The family can sue all they want. Does not mean they are going to win.

[ZippyGBR, BSN, RN]

as for 'practicing medicine without a licence' traige drugs are going to be subject to a legal mechanism to allow the RN to supply and adminster them ...

in the uk we have Patient Group Directives which is a legally recognsied way for a workplace/ employer to allow none prescribers to autonmously supply and adminster prescription meds ...

[MAISY, RN-ER, BSN, RN]

Zofran tabs are part of standing orders in triage for nausea and vomiting. It recently came off US patent and is now very cheap to administer iv and by tablet. The only high cost zofran is now the sub lingual which we only give to children. It is a very rare occasion that an adult will get it, and that is with a physician order due to cost!

Maisy