bolus w/o order....yes or no?

[sarahbeth2006]

greetings all!!

bolusing without an order....yes or no?

background story to the question:

i work same day surgery and we had a patient, male, late 30's, in phase 2 recovery s/p knee scope. he got 5 of versed and 200 of fentanyl total, on top of gen anesthesia. c/o being slightly dizzy during most of his stay, not unusual. after he got up to go to the bathroom and came back to sit, he was still c/o dizziness but no nausea. the RN taking care of him decided that on top of the 2L of LR he had already gotten, that she was going to bolus him. so that is exactly what she did. 500 mL LR bolus in 10 minutes...without an MD order.

i feel like this shouldn't have happened or was even necessary....thoughts? opinions? reasoning either way?

thanks!

[wooh, BSN, RN]

Maybe a call had been made, or will be made and the surgeon will sign without any hoopla... I've seen PACU and ICU nurses (especially) get and give first, let MD know after often. Again, you don't probably know this nurse...

Yep. Textbook answer to OP: No. Don't do it.

Real life answer: It happens.

[sarahbeth2006]

It really isn't spying on her patient care at all when you work in an area as small as we do. I assisted her in bringing her patient back to the chair after using the restroom and then went back to my charting about 25 feet away. I fully understand and appreciate your comment that communication is definitely key but dislike the assumption that I was spying on her patient care.

[DedHedRN]

I agree with the comment about approaching the nurse first. You could say something like.."Giving IV fluids without an order is outside the nursing scope of practice, without the order you leave yourself open to malpractice lawsuits if anything went wrong." and see what she says. She has lots of exp. its possible the last unit like yours she worked on had standing orders or something like that, its possible she just is not aware the yours does not. Its possible she used to work ICU where nurse often act first then get orders later.

At any rate you will remind her that she does not work alone and that doing things like that will be noticed by others. Maybe she will clean up her act.

Write an incident report if it really bothers you. Its a medication error at any rate.

[squatmunkie_RN]

Out of her scope. I'm sorry but I won't risk my job or license doing something I "anticipate" a doctor doing no matter how sick the pt is. If the MD won't answer call a rapid response or keep paging until he answers.