Some of our residents scare me. . . . .

[kcalohagirl]

So. . . .two days ago I float off my happy little unit to a medical telemetry unit. No sooner do I take report on my patients than I get a phone call from Pharmacy.

"About that fentanyl order for Ms Smith in Room 4. . . . ."

"Hang on," I say, "Let me grab her chart, I just got report and haven't taken a close look at it yet."

I grab the chart, flip through to the last order written (about 10 minutes before shift change) and say, "You mean that order that Doctor Jones wrote for 2 MILLIGRAMS of fentanyl?"

The pharmacist says, yes, that was exactly the order she was talking about.

I told her that I would contact the doctor immediately and get a clarification.

So I call the doc. . . . . . . . .

"Hi, Doctor Jones, this is KC from unit **. I'm taking care of Miss Smith, and I wanted to talk to you about the 2mg order you wrote for fentanyl."

"Yeah, what's wrong with it?" (This said in a very surly, belligerent tone of voice.)

At this point, I thought I had heard wrong. "I'm sorry, what did you say?"

"I *asked* you what was wrong with the order??!!" the doctor replied.

"Well, since the usual range of a fentanyl dose is 25-50 MICROGRAMS in this type of situation we may want to re-write your previous order for 2 MILLIGRAMS."

"Why would I want to do that? I was just up on the floor and wrote you an order!!" The doctor is sounding very angry at this point.

At this point, I'm afraid I quit being nice.

"Well Doctor, since the dose you wrote would kill the patient, I thought you might want to give me a different one."

And July was months and months ago. . . . . . . .

I'm sure she was probably sleep deprived and was thinking morphine instead of fentanyl when she wrote the order, but still. . . . . . . . .

This is why I love floating. It makes me so very appreciative of my home floor's patient population, our PAs, our Residents, and our Attendings.

[EmmaG, RN]

i dealt w/a resident who wanted my pt's fentanyl and dilaudid, quadrupled.

when he saw my reaction, he carefully explained his rationale:

"well, she's dying anyway".

:stone:stone:stone

And then there are the ones who won't so much as order a tylenol.

Sheesh

[leslie :-D]

And then there are the ones who won't so much as order a tylenol.

Sheesh

oh gawd, don't get me started on those doctors.

leslie

[Elvish, BSN, DNP, RN, NP]

One night I had a hyperemesis pt that was vomiting and taking Phenergan but it wasn't touching her. I asked the res if I could give her some Reglan...."Uh, ok. It's not really indicated for nausea and vomiting." [we give it all the time for that very thing...] Finally I convinced him to at least give it a try and then heard, "Uh, how much do you guys usually give and how often?" Not that I would have, but I could've told him anything & he might not've known the difference. Poor guy. He's usually really nice, but started out flippin' clueless.

[harley007]

Years ago I worked in a 12 bed ICU. The ONLY residents we had were family practice Docs. Many of them attended med. school in Mexico, as they were not accepted into any schools in the US. Because of their out of the US schooling they were required to do an extra "intern" year called a "5th pathway". Many turned into great Docs but a number were washouts. That first year was oh so scary for nursing. My favorite order was for 40mEq KLC IV push - he couldn't understand why I refused to give it until I explained it was a quick way to forever asystole. I also had to call this peanut brain one night for a patient with lots of post MI ectopy in need of a Lido drip. He refused my request for the drip but told me to give the alert patient two precoridal thumps and he would be up to the ICU in 1/2 an hour. He never did find his "pathway" and was gone by September.

[leslie :-D]

He refused my request for the drip but told me to give the alert patient two precoridal thumps and he would be up to the ICU in 1/2 an hour.

ahhhhhh yes.

those life-saving precordial thumps.

well, harley, i hope you had the good sense to give the k+ 40meq ivp FAST in the interim.

leslie

[BlearnRN]

On my floor we have had a resident say that a subarachnoid hemmorrage was not a stroke and she didn't understand why the pt was under the stroke service.....

[Nightcrawler, BSN, RN]

I have had the same argument with our current overnight residents twice in the last week. The patient presents to the ER in afib with RVR, isn't really responding to the diliazem gtt, and they want to send them up anyway. Their solution is to start the patient on amiodarone, and when I say that this is not an appropriate drug for a patient with a fib of unknown duration their answer is; " She was seen in the clinic 5 days ago, and the note says that she had a regular rhythm then". OKAY, no ECG was done, and I wouldn't want my future determined by anyones physical assessment.

When I calmly explain that to risk conversion to sinus rhythm in a patient that may have been in the rhythm for more than 72 hours without anticoagulation, they get huffy and say, "Well, she's not responding to the dilt" and " Well the dilt can convert her to sinus too"

Okay, yes, but it is much less likely than the amio.

You would think that having this conversation once would be enough, but no dice. They came up last night and wrote a order for Amio 800 mg daily for a patient in aflutter with a rate in the 80's. Once again there was a unknown duration, the patient was not anticoaged, and she had a history of fib and flutter in the past.

Once again, we explain that we should wait for the TEE that is planned for day shift, and explain that the 800 mg daily is usually given in divided doses. We finally convinced him that she currently didn't really need anything as her rate was controlled.

Sigh

O Brother.