I Hate Surg!!!

[ChristineN]

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.

[Magsulfate, BSN, RN]

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.

I totally agree with this. :)

[eriksoln, BSN, RN]

I've often seen doctors order a medication, with "Pharmacy to dose". I think that's a fairly acceptable practice.

Next time perhaps you can prompt the physician to order it this way.

Yeah, thats where my suggestions come from. They can do it with narcs. too. One hospital I was at had standard orders for PCAs that were made by pharmacy. All sorts of things doctors never think of in them. It was really nice. If pt. claimed pain was not controlled, there were predetermined steps for everything: Give boluses, then lower lockout by this much, then raise demand dose this much etc etc. It was so efficient. I rarely had people unhappy about pain management at that hospital.

[FireStarterRN, BSN, RN]

Yes, Surgeons like to order things "pharmacy to dose". They understand that pharmacists are the experts. They like to concentrate on surgery. I don't think they are being idiots. I think they are using a smart team approach to healthcare, where everyone does what they do best for the common good.

Yes, I've seen narcotics dosed by pharmacy. The doctor is asking that the pharmacist do what he/she does best. In this case he was trusting the nurse to do this for him. I would have asked him to write it "pharmacy to dose" to accomplish his goal without putting the burden on my license.

I agree Erik, where I work now has a PCA protocol as you describe. It's a wonderful tool!

[eriksoln, BSN, RN]

I hate surge

Surge hates me

We're a dysfunctional family

And a court case rang out

Took money from the hospital

No more nasty MD to roam

[Riseupandnurse]

I think it's great when the pharmacy is officially ordered to dose Lovenox and Vanco, etc. I think it crosses the line a little when they mention a more standard drug and tell the nurse to have the pharmacist look it up and then leave it to the nurse to write the order. That's a conversation they should be having with the pharmacist themselves. It doesn't happen very often, just when the form is changing because the nurse says the patient needs it (pills to liquid, etc.) or it's something the nurse has suggested and wants. They know we'll be motivated. But it is what I call a bit lazy.

[ChristineN, BSN, RN]

I think it's great when the pharmacy is officially ordered to dose Lovenox and Vanco, etc. I think it crosses the line a little when they mention a more standard drug and tell the nurse to have the pharmacist look it up and then leave it to the nurse to write the order. That's a conversation they should be having with the pharmacist themselves. It doesn't happen very often, just when the form is changing because the nurse says the patient needs it (pills to liquid, etc.) or it's something the nurse has suggested and wants. They know we'll be motivated. But it is what I call a bit lazy.

I agree. Looking back, I regret not reporting this resident to his senior fellow.

[debthern]

guess I am a little confused about the no verbal/telephone orders...is the doctor supposed to get up in the middle of the night and drive to the hospital to write an order? You would have alot of people needed meds cause I can tell you the docs I work with would say see you in the morning.

[ChristineN, BSN, RN]

guess I am a little confused about the no verbal/telephone orders...is the doctor supposed to get up in the middle of the night and drive to the hospital to write an order? You would have alot of people needed meds cause I can tell you the docs I work with would say see you in the morning.

I work in a teaching hospital. We have residents in house 24/7. It is really nice with the medical doctors, they are on the floor regularly, can put orders in at anytime, etc. With the surgery team, though, I'm not sure how well this works.

BTW: I am allowed to take verbal/telephone orders, but only under certain conditions. That team has to be completely out of the building, and it can't be for narcs or chemo or other high alert meds.