I am new to the hospital I am working at and they seem to run IV fluids for 24 hrs regardless how the pt is tolerating fluids. When I get a fresh C/S, the pt is on slow pit and IV fluids. If the pt is tolerating fluids well, not nauseated or throwing up, great bowel sounds, doing exceptionally well, I cut off the fluids about mid-day and continue with liquids to full liquids...etc. When I give report to the night nurse, they seem absolutely appalled. I explain to them that they are taking fluids PO and tolerating very well ...give them the whole above scenario but I can tell they are not happy or don't agree with what I did.
Finally I asked one day shift nurse and she said that it is anasthesia's order to continue IV fluids for 24 hours. We look at the orders and I point out the part that says "discontinue IV if tolerating PO". She then points to another section that says, "keep IV access for 24 hrs" and says, "see that means keep fluids for 24 hrs." I do not agree with her translation of that order.
What is the rational for keeping fluids going for 24 hrs if they are drinking fluids fine and output if fine...perfect scenerio basically.
The entire unit practices like this so it makes me second guess what I am doing. 20 nurses vs 1.
I completely agree. I've worked in OB for many years and this is how "it's always been done". It's definitely a culture thing. We do have sections that have just adequate output so I'm always leary to discontinue the fluids (usually low due to Duramorph etc). I work in a unit where the culture is exactly this way and it's hard (very very hard) to change. And I understand how frustrating that is.
The order is written to d/c fluid when PO is tolerated- the unit nurses are just interpreting the order to maintain access for 24 hours as an order to keep fluid running the whole time.
This whole thread is about interpretation of orders. It's stupid not to ask the person who wrote them what they meant. I would also have the provider communicate it to the unit so this disconnect stops happening.
I personally think the orders are very clear and agree with the OP.
Sometimes, it's best to go with the flow (as long as the care is not comprised) rather than be a "non team player"
Not always, not if the new data and best practice guidelines for evidence based practice show otherwise. As an older nurse, I run into new practices all the time that make me internally squirm because they go against everything I was taught in the early days. However, I constantly remind myself that there is solid medical data and research to back up the new practices, and that doing things the "old way" simply because I'm uncomfortable with change is not being a good nurse and not providing the best care I can. The old adage, "I did then what I knew how to do. Now that I know better, I do better," is excellent advice.
Thanks everyone for the reply! I actually went to my managers with research because the best way to practice is through evidence base. They actually told me there were several other nurses who brought it to their attention. They put a reminder in our staff huddle to turn off IV infusions if patients are taking it PO. :)
A few people have mentioned about asking the doctor who put in the order to clarify. I did talk to one of our Anasthesiologist and he agreed with me about stopping fluids when tolerating PO. The order is actually part of an order set. So after a patient delivers, they check boxes with whatever orders they want, so this order is standard for all patients after delivery.
PinkNBlue, BSN, RN
419 Posts
I completely agree. I've worked in OB for many years and this is how "it's always been done". It's definitely a culture thing. We do have sections that have just adequate output so I'm always leary to discontinue the fluids (usually low due to Duramorph etc). I work in a unit where the culture is exactly this way and it's hard (very very hard) to change. And I understand how frustrating that is.