I made an "Oopsie", need some pointers

[RNcDreams]

Hi!

I am a new graduate in a small community ED. I'm 3 months in to orientation and hanging in there. I feel like all I do is make mistakes, but my preceptor and NM think I am super duper... which is all well and good, but I still need some advice.

I realized last night after I was already in my bed half asleep that I sent a patient up to the floor (medical bed) without orders.

I'm just curious, in the grand scheme of things, how horrible is this mistake, and what are some pointers you have to help me remember it?

I know it's a logical thing that you need instructions on how to care for your patient, but in my (currently) one track mind, I have orders from the Emergency Doc and I (without guidance) occasionally forget that I need a set for the floor to follow.

Yesterday was also extremely busy, with all 30 something beds full with wall beds, and they were DYING to get people out and into beds or home.

Would the floor treat him like a boarder waiting for a bed?

--Also, I was actually in a meeting with my preceptor and NM evaluating my progress, and one very ... I'll say "enthusiastic" (code for kinda pushy) tech wanted to know why he wasn't on his way yet, and my preceptor wanted to know if the chart was copied and I said yes... and by the time I was out of the meeting, he was gone.

Eeeeek!

[NurseCard, ADN]

So let me get this straight... you HAD the order from the doctor to send the patient to the floor, right? You also had a page of other orders from the ER doctor for the floor nurses to follow, as well as other paperwork... all of that stuff simply didn't make it to the floor with the patient?

What probably happened was, the floor nurse and unit secretary probably said "Where is this patient's orders?", the tech said "Gee, they aren't here are they?", and probably went down to the ER, said "I didn't have this patient's paperwork when I went to the floor", and then someone went and made copies of the paperwork, and the tech or someone ran it all back up to the floor.

The tech MIGHT have fussed n' cussed a little bit about it, but I wouldn't worry about it. Sounds like you made a perfectly forgiveable mistake. As a nurse you are GOING to make mistakes; that's just a fact. In this case you could have said, maybe, "Make sure the chart was copied and you have all the paperwork before you go to the floor", to the tech.

But this was a little mistake that you can admit that you made, apologize, and then kinda let it go.

[RNcDreams]

No, that's not what happened. I had ER orderes, but no orders for the floor.

I haven't the faintest idea if they were written and placed in the chart while I was in the meeting, but either way I'm pretty sure the patient went up to the floor without orders for the floor nurses to follow.

[everthesame, LPN, LVN]

The floor nurses may not have had very kind thoughts at the time because they would need to 1. call ER and see if the orders were still down there and 2. call the doc to obtain verbal orders. As long as it isn't repeatedly happening, it really isn't a biggie, just more of an annoyance and usually easier to remedy than the direct admit who comes from a doctor's office directly to the floor and doesn't have orders.

I say this as a med surg nurse. I may grumble a little, but I would get over it pretty quickly. We all make mistakes and the one you describe really is pretty minor and pretty easily remedied. BTW, where I work, the ED faxes the orders up to the floor so we can get a jump on preparing for the patient's needs. The original orders then come up with the patient.

[JoshuaAdamsRN]

Who writes the admission orders in your facility? Is it residents, the ER doctor, a moonlighter, or the patient's attending? Are they always written before the patient goes to bed upstairs? Did you give report to the inpatient unit? If an ER nurse did that in my hospital, it would most likely be the start of World War III - the floor vs. the ER.

[jennyfyre]

I am a unit coordinator on a peds/gyn floor.. and believe me.. this is NOT the end of the world. You'd be surprised at how many times orders, for whatever reason... need to be tracked down or get new ones. As a previous poster said.. it's more of an annoyance than anything else.

[CarVsTree]

I agree with most other posters. Very annoying to have a pt. come up to floor without orders, but generally easily remedied.

Our hospital uses CAPOE so we can just call doc and if doc has half a brain (some do not qualify) he can just give a telephone order and we can put it in system.

This happened just the other day, pt. arrived with no pain/actiity orders. Day RN called (she's MUCH nicer than me) doc said, shouted actually; "I need VS before I can give pain meds (confused pt. can be heard screaming in pain and fighting staff in background) Nice RN explains, can't get vitals while she's fighting us.... Then call me back when you have vitals. (Pt. had L1 compression fx & advanced dementia). Nice RN got vitals (best she could) and called idiot doc back and he ordered 4mg morphine for 90# 90 year old woman. She asked to make it 2-4 he acted like she was crazy. She put it in for 2-4.

BTW, I later had to call for activity orders. He shouted into the phone BEDREST. I'm like, 'yeah, I get that. HOB 30? He got reported what an a$$. Two nights prior he wouldn't give me haldol or anything else for that matter... for pt. that was attempting to get oob, pulling at tubes, etc. Pt. could be heard in background. All at the same time we had another pt. in room in resp distress... Once I mentioned the attending's name and my intent to cal him, the Haldol was magically ordered.

So... that is what makes no orders annoying. The docs!

[bigsyis]

I am amazed whoever took report didn't want the orders...

[MAISY, RN-ER, BSN, RN]

Is it a facility requirement that physician's orders accompany patient to the floor? If not, I am not sure what the problem is.

In my facility we are only required to get orders for our observation patients prior to moving a patient to the floor. Obviously, if a patient is in the ER for awhile we attempt to get admission orders, but that is not my priority as an ER nurse. I am sure the floor nurses would heartily disagree, however, before I get flamed -I really do initiate my patient admit orders if I have a hold and they have to be sent to the floor. Many nurses do not, and many ERs don't require it.

So I guess it depends on where you work. If your NM thinks you are doing great that's all that matters.

Maisy;)

[oneLoneNurse]

I am a unit coordinator on a peds/gyn floor.. and believe me.. this is NOT the end of the world. You'd be surprised at how many times orders, for whatever reason... need to be tracked down or get new ones. As a previous poster said.. it's more of an annoyance than anything else.

Could not agree more. Your OK. Take a deep breath and move forward.

Sounds like people think alot of you, this is not going to change their opinion. In the scheme of things you could do alot worse.

Keep smiling.

[nuangel1, BSN, RN]

its not a big deal .the nurse would call md for orders thats all.in my ed we are not required to get floor orders before pt goes to floor.exception is if pt is staying in ed overnoc then we do get and start orders .but otherwise no.also if pt does have floor orders unless there is a stat we don't do them .we don't have to .we are not a teaching hospital so our attendings have to come in and see pt and write orders .we try not to take tel orders.

[CarVsTree]

I am amazed whoever took report didn't want the orders...

We don't always have lead time to check on orders. If ED calls and you can't take report (that would be if they call) patient comes up anyway. We are no delay hospital. The sad thing is that patients suffer when this happens. Fortunately, it doesn't happen that often. Lately though something's going on down there. I know they just got a new director in ED and I'm wondering if something's up with that.