I Hate Surg!!!

[ChristineN, BSN, RN]

I work on a pediatric medical floor. Today I was taking care of a 4 year old sug pt that was overflow. He had a lap appy the day before, and had only been ordered Tylenol for pain. Mom thought Tylenol was not cutting the pain, and I agreed that it didn't seem to be helping. I called the surgery team for an order for Morphine. They told me that they would love to give the boy Morphine, but there was a kicker. Surgeon asked me if I knew what a safe dose of Morphine was for a 4 year old. I did not off the top of my head, I normally work with teenagers, and know their dosages better. The surgeon then told me Welll, why don't you just guess a safe dose, and put it in as a verbal order under my name." I was furious someone would even consider guessing a med dose for a 4 year old!!! Not to mention, at my facility, nurses are not allowed to take verbal orders for narcotics. What an idiot.

[freedom22]

What an idiot!!

[ChristineN, BSN, RN]

I should add that obviously I didn't guess a dose, and ended up getting a hold of another member of the surgical team, which wrote for a safe dose to be given.

[Riseupandnurse]

Doctors seem to be getting lazier and lazier. I am getting more orders for "Medication X---have the pharmacy dose it." On the other hand, this is probably safer for the patient.

[ChristineN, BSN, RN]

Doctors seem to be getting lazier and lazier. I am getting more orders for "Medication X---have the pharmacy dose it." On the other hand, this is probably safer for the patient.

How is that legal?

[RN BSN 2009]

Wow - I can see where that would be a BIG problem!

[RN BSN 2009]

Talk about passing along the buck.

[CABG patch kid, BSN, RN]

How is that legal?

A wee bit off topic but it is legal for a pharmicist to dose a medication based on numerous factors such as pt age, ht/wt, renal function and peak/trough levels. We see this most with antibiotics because the pharmacists know the med doses based on the peak/trough way better than the docs do. Also, we see docs writing orders for Lovenox but then pharm changes the dose based on the pt's creatinine clearance. It really is safer for the pt.

[chicookie, BSN, RN]

Well gee thanks Dr. So-and-So.

LAST TIME I CALL YOU!!

Next thing you know he will be wanting you to perform surgery or something!

[sunray12]

How is that legal?

That's what they're trained for. I think they have doctoral degrees in it - DPharm.

What's the proper role of the RN in this? Obviously it s/he should never guess - that's one crazy doctor for suggesting it but what is with the heavy emphasis on drug dosage calculations in nursing school if not for these type of situations?

[eriksoln, BSN, RN]

What an idiot!!

While frustrating (and where was he coming from, what was his point he was trying to make, or does he always act that way), its not that hard of a situation to deal with. He did give you permission to write a verbal order. From there, just let your nursing skill take over.

Check allergies. If none, get out your book and call pharmacy. If you want, you can even write a pharmacy consult. I would suggest that actually. Write a pharmacy consult for "management of morphine dose/pain control". Nothing wrong with it, its kosher.

Let pharmacy run its checks, check them against your book and there you have it, morphine safe to give.

[netglow, ASN, RN]

"Let pharmacy run its checks, check them against your book and there you have it, morphine safe to give." -ericksoln

Wouldn't you rather facilitate the pharm and the surgeon, or anesthesia to figure out? I'd want a completed order in the end from that doc before I give, even if it's verbal again...