What would you have done???

[babynurselsa, RN]

Left wrok with yet another big ole hunk of my butt missing......

Last night when I recieved report for m a new orientee, I was told that my baby had an rder for 2 doses of Lasix. She had given the first. The order was to give it IM. I grinched about the route. I can't remember ever having had to give Lasix IM. Well when it came time for the dose I noted that she had recorded a dose of 6mg. The normal dose is 1mg/kg. I double checked the Dr. order, it did in fact read 6mg, IM. This baby weighs 1975g. I double checked the Neofax. which read: 1mg/kg, slow IVP, IM,PO. may increase to 2 mg/kg IV. Up to 6 mg/Kg PO. I called our Moonlighter told him what my order read. His reaction was the same as mine. (What in the world!?!?!?) He told me to give 6mg but to give it PO. I carried out the order as clarified by my Moonlighter.

The next morning I weent and told the Neo what I had done, that I questioned the order becausee it was a dose that was higher than I could ever remeber having given. He immediately went into a tirade about how he wrote the order and that was exactly what he wanted done. I was out of line for questioning his order. He was sick and tired of "people" going behind him and changing his orders.

I tried to reiterate that our accepted Pharm. resource did not state that the order was approprtiate. That I had called the physician to clarify the order when I had a question, and that was why I was asking him about it that am to get clarification straight from him. Essentially his response was that no matter what the Neofax had said I shoulld have just given it because that is the way HE wrote it, so obvioulsy that is what he wanted done.

I just wonder what anyone else waould have done.

[thisnurse]

i would have done the same thing you did. i would also check with your manager to see what the policy is for your unit regarding the administration of lasix. you may well have a policy that forbids you to give that dose IM. i cant tell you how many times ive had docs throw tantrums because i questioned their order. too bad. im not going to do anything that might jepordize my patients. ive also had docs thank me for questioning their orders because they had made a mistake. you did the right thing.

[P_RN, ADN, RN]

I wonder how big a hunk would have been missing from DrDoofus' backside if HE had made an "error" leading to a tragedy ? I know some malpractice atty's who have such as him for breakfast!

If he had a problem with the clarification he needed to go to the clarifier. You did exactly what you should have. You are not the bad guy here....you watched over your tiny angel just fine!

I have also been known to tell docs that if they want such and such given they can do it themselves.

P

[NicuGal, MSN, RN]

You did nothing wrong...as a matter of fact, did you write an incident report on the other one? I would have. As far as docs throwing fits..who cares. I work at a big Level III nursery and we always just say that it isn't in the guideline, and if they want it given they have to do it themselves. So..either they do it or they change their minds. Why on earth was this kid getting that much Lasix? I'd hate to see the electrolytes on that kid this AM!

[babynurselsa, RN]

Nicugal, I have worked NICU for 6 years and have never given a dose of Lasix like that. The electrolytes was one of my first thoughts when I saw the order and knew that it had already been administered once that day as written.

When I foound the order it just blew my mind. My first thought when I found the med card was that the orientee who had written it had made an error. Then I checked the order, that had been written by our Neo himself.

This kiddo had not had an enormous wgt gain over the proceeding days. She is 59 days old and I have been taking care of her all along. She was not markedly edematous.

she is a chronic BPD kid.

His response bothered me as much as anything. "I wrote the order that way and that was what I wanted done." I informed him that I could not find that to be an acceptable dose per the Neofax, and that was why I called the Moonlighter for clarification, but if he preferred next time I would be happy to call him at home so he could personally clarify this order to give a baby 3x the reccomended dosage of the med.

I am there to take the best possible care of my babies that I possibly can and will not blindly execute and order that I cannot substantiate.

This is just another day in paradise with this man, I keep telling the other girls on my shift a little Haldol in that first morning pot of coffee in the morning would make him a whole new man:D

[-jt]

>

And if its not an approved dose by the instructions that come with it, but he insists, then he can come in and give it himself.

You did the right thing. What would have happened if he had made a mistake & you didnt question it but just gave it? Youd be fired and reported to your BON & be fighting for your license.

At one time we had neurosurgical PAs in our ICU covering the neurosurgical pts.

A PA ordered phenobarb 300 mg via NGT for a pt. The nurse questioned it by bringing the order to the attention of the PA who wrote it. The PA confirmed yes - phenobarb 300mg. So the RN crushed up a ton of 15mg phenobarb pills & gave it to the pt. A short time later the PA asked if the pt had gotten the DILANTIN yet. The nurse said "what dilantin? You ordered PHENOBARB. I specifically asked you & you said again yes phenobarb".

The PA denied it & when the nurse went to check the order again, the order for phenobarb that she had signed off was no longer there but a new order for Dilantin 300mg via NGT was. The pt had to be lavaged & put on NG suction to get rid of all that phenobarb & the RN was investigated...... then fired.... because she should have known that crushing up all those pills had to be a mistake & should have called the MD in charge of the PA. The PA lied about ever writing an order for phenobarb & got to keep her job because there was no prooof that she did. She maintained that the RN gave the wrong drug and never asked her anything about a phenobarb order because there never was a phenobarb order.

The hospital had the nerve to ask the RN for a witness to her questioning the PA about the order. But there was none. Who ever thought to bring another nurse with you to witness you asking an MD or PA to clarify an order? The nurse was accused of making the mistake herself & was fired. She was so mortified she didnt fight it and just left, but we demanded that PAs be removed form our unit & they were. Now only residents care for all ICU pts

and we usually have someone around listening when we ask for a clarification on an order.

[Teshiee]

You did the right thing! I notice when I go for interviews that is one of the questions the managers ask you. I would clarify clarify. I had one incident where a MD wrote an order for an anitbiotic I couldn't read it very well but found the word in a PDR so since I wasn't familiar with the med nor its use I called the MD to make sure that was what it was! The sphincter muscle yelled at me since I didn't ask the pharmacist. I told him who wrote the order? Shut him down real fast. Needless to say I wasn't welcome back on that floor but I don't care. I am never going to put my license on the line for any facility or MD.

You did the right thing! Don't ever stop clarifying! :D

[purplemania, BSN, RN]

From another Pedi nurse: I keep a diary of every "incident", no matter how small. Just a few sentences, dated, on a floppy reserved for that purpose. This is excellent reference material later if ever there comes a time when your word or actions are questioned. Learned this while working for atty. Also helps me to blow off steam w/out confrontations. Have had to use it only once in 20+ years, but it saved my hinny.

P.S. Write up the bully.

[NicuGal, MSN, RN]

Nurselsa...your attending must be the twin of one that we have As for that Lasix order..holy moly..in 15 years I have never given that much lasix...if they need a diuretic that badly and that much then we give Bumex!

I would tell your CNS and the UM about this..it sounds like this guy needs a talking to from some higher up nurses! Our CNS is a big nag and our attendings hate it when we sic her on them

[prmenrs, RN]

Who's license would have been on the line if something had gone wrong and you DIDN'T ?? the order? Not his!! YOU are responsible for your actions, too.

YOU DID THE RIGHT THING!!

You go, girl!! , way !

[RyanRN]

This guy should be bringing candy and flowers because you saved HIS as s!!! Next time you see him, give him a great big "you're welcome!!!"

If he were man enough to admit it I'd bet you'd respect him more. If these John Wayne types only knew!!!! I thought we were in this together?!?!?!

[hoolahan, ASN, RN]

I would have done the same thing you did. Today I had a doctor tell me he "don't have time for the $hit" when I called form a pt's home to clarify meds.

Sphincters! Protect yourself, no one else will. We handles docs like that on nights in the hospital by calling them in the middle of the night directly, that shuts them up!