Given NS Bolus order

[berhaelee]

I am RN working in a local hospital taking care of one pt that will be doing CT with contrast. When I drew Creatinine level per protocol, lab tech called me about the GFR being high and needs 1L NS infusion pre and post procedure. Thats when my predicament started. I called MD for an order for NS infusion. I ordered what needs to be ordered but I failed to clarify if it will be given as bolus or plain infusion and the rate. I was stupid to think that it should be bolus because of the time and urgency of the case. I ordered 1L NS Bolus at 250 ml/hr. The pt has hx of CAD, HTN and the admitting dx is post ADB anuerysm repair. The pt was able to have CT done. Other MD called me prior the procedure that he ordered Lasix bid because of the fluid I gave. (This happened few hours before shift change.)

During my report to the oncoming nurse, she made a lot of comments about the order - NS bolus pre and post infusion.She question why I did not have post NS infusion when the lab tech recommend it. I realized what I did after that and I am troubled since then. I don't want to lose my job since I am fairly new to the hospital. I badly want experience.

This are my realizations on that day:

1. Clarify orders including pre/post infusion, bolus or plain, rate and recommendation.

2. Better understanding of the pt's situation and hx.

3. Give detailed report to the oncoming nurse.

4. Be calm.

Please give me more advices about this. I need help.

[Rose_Queen, BSN, MSN, RN]

Is there a standing order or protocol for patients going to CT? Surely this isn't the first time and won't be the last time that a patient has labs requiring action in regards to having a CT. Look into that as well as your facility protocol.

Other than that, always make sure you are clear on orders being given over the phone- this is why all physicians at my facility have remote access. They can place orders from home without having to worry about the order not being entered by someone else.