Don't you just love it when the docs compliment you for a job well done? The example I have happened this evening. I worked just a few hours at the end of a 12 hour shift. An admit had come in earlier during the day and I was figuring out what meds she still needed. Coumadin was a home med for her, and she had not had today's dose. I looked at her labs. The INR was 3.73 and the PT was like 38.5. I held the Coumadin. I had the on-call doc paged. I told him the labs results and what the patient's Coumadin dosage schedule was. I also informed him that I had not given today's dose because I wanted to see what he advised. When I told him I had not given today's dose his comment was: "That was smooth thinking." He ordered the Coumadin held for the weekend and to recheck her INR/PT on Monday. To me, holding the Coumadin in light of the labs was just common nursing sense. But it still made me feel good that the doctor noticed I was paying attention.
Now, if the stupid ER doc would have looked at the pt's labs before he wrote the admission orders, he would have seen the elevated PT/INR and ordered the Coumadin held. But that is whole other thread.