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did the md's pen go into v-fib??

Posted

Specializes in Critical Care. Has 8 years experience.

ARRRRGGGHHHH!!

oh Geez, hands down the worst part of my day is my hourly chart checks for new orders and having to speak to foreign drs on the phone.

background: we have physical paper charts the docs/pa/np write orders in and it is up to the unit secretary to enter the orders (for approx 55 pts) but if she is swamped/nurse gets there first, the rn enters the order in the computer. the rn is also responsible for confirming the correct written order was put into the computer by the secretary.

problem 1: i cannot read these Godforesaken scribbles. at times, only 1 letter of a word is decipherable, the number 6 looks like the letter H, etc. it looks like their pen went into v-fibb and expired somewhere around the signature where all i see is a couple random zig zags and a loopdeeloo. if i didn't physically witness the md write in the chart, i have little clue which md ordered what. don't they have stamps or something??

problem 2: the vast majority of our drs are talented foreigners mostly indian/iranian, chinese/phillipino etc. calling for a critical value/change in condition and request for a new order is just painful. perhaps it is the phone that is warbling and distorting their english because in person i hardly have this issue. i end up asking for clarification and a repeat like 2x and when i repeat the order back i still mess up the frequency or something unless they say "NOW/ STAT".

i feel embarrassed dumb and annoyed. i have been at this facility for approx 3mos and evidently my coworkers have learned to converse and read the language of MD Vfibb.

some say that if you read the same order phrase/word, from the same dr 10,000 times you start to be able to figure out what they mean. some fill in the blanks and hope for the best. others shrug and say "ummm no clue. if they still really want that order tomorrow they'll probably rewrite it and maybe i can read it that time..."

do your hospitals have the md type their orders into the computer themselves? maybe there is a dr smart phone- nurse computer order entry capability?

this seems archaic and convoluted to me.

thoughts/suggestions??

Edited by SNB1014
added

I know several hospitals around here who issue rubber inkless stampers to all staff -- nurses, physicians, therapists, everyone-- with name, credentials, and pager number. They're very inexpensive and at least they cut down on the "Who the heck is (squiggle)?"

There is no reason at all why physicians cannot type their plans of care and prescriptions into a system. I have known physicians who carry portable typewriters for this purpose, or if your place won't do computers then perhaps they'd put a few inexpensive typewriters in the charting area. Really.

Tell your risk manager all you posted here. S/he will recognize a problem and possible adverse consequences and move to do something about it too.

Meanwhile, keep calling them up and making them repeat themselves. If they get tired of it enough, perhaps they'll work on their handwriting. If not, then you're at least fulfilling your duty to know what they want for the patients.

SNB1014, RN

Specializes in Critical Care. Has 8 years experience.

I know several hospitals around here who issue rubber inkless stampers to all staff -- nurses, physicians, therapists, everyone-- with name, credentials, and pager number. They're very inexpensive and at least they cut down on the "Who the heck is (squiggle)?"

hmmmm, not a bad idea.

I have known physicians who carry portable typewriters for this purpose, or if your place won't do computers then perhaps they'd put a few inexpensive typewriters in the charting area. Really.

bahahah i cant help but giggle at the image of a typewriter in 2013. i hope it never comes to that. but yeah, the physicians have their own "portal" on the computers to see xray/ultrasound images, i can't imagine there not being a program where they can enter the orders they want into a section under their patient.

i think a lot of this comes from the old school mentality where MDs just kinda "screw and leave". as a patient once told me "dr so and so barges in my room with his head so full of knowledge he can hardly fit through the door...then he mumbles half sentences and leaves, leaving me to replay a 2min conversation for hours trying to figure it all out"

hahaa

eatmysoxRN, ASN, RN

Specializes in Med/Surg,Cardiac. Has 1 years experience.

Call every single time. Eventually they'll get tired of you calling and having to repeat themselves over and over to the point where they write more legibly.

I can't believe that in 2013 we are still reading handwritten orders.

I don't really enter orders at my work but sometimes I will read them as the docs have written, and oh man how people actually decipher them I don't know.

Same goes for paper nursing notes. I was reading some in an old chart the other day and I could only read a select few. Some of these people write in indecipherable cursive. Do people not realize you can't read that at all?

I see why they aren't teaching cursive anymore.

Sun0408, ASN, RN

Specializes in Trauma Surgical ICU. Has 4 years experience.

My favorite is asking the MD to spell what they just said over the phone because even after repeating several times, I could not make it out. Yes, this is with the foreign MD's. Thankfully we have went to MD's put their own orders in :)

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

We've sent several MDs to handwriting remediation. Works for a few months, and then it's back to the indecipherable squiggle. We know have computerized order entry, and it has been quite a blessing.

boggle, ASN, RN

Specializes in Med-Surg.

I do not want my well being (life?) put at risk because the nurse is left to guess what that squiggle on the order sheet says. Really now, if the doc was the pt and I said this is the med/dose I "think"your doc wrote.....? Sometimes I think they are covering up for not knowing how to spell......

So PRINT already

Ha! We have had other floors tube us the order sheet before because no one on the floor wasable to decipher and we were more familiar with that particular doctor. We have also given the Dr his order sheet a few days later and he couldn't read HIS OWN writing to tell us what it said.

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

We have some docs that we have to have a committee figure out what they wrote. I usually will call and ask if it is that bad. We are finally going to Epic next year. I am so glad. No more deciphering their writing. At least when I worked at the large hospital ICU we could at least walk up to them and ask them what they wanted. Some docs were so bad during rounds I would write orders for them and they would sign then. Usually M-F the NP wrote all the orders and she had great writing. Our docs had rubber stamps too for them to use so we always knew who wrote the order. They also had to put their pager number on the order.

proud nurse, BSN, RN

Specializes in Medical Oncology, Alzheimer/dementia. Has 15 years experience.

Years ago, I worked with a doctor from Egypt. His accent was so thick and he talked so fast, I could literally be standing in front of him looking him dead in his mouth, and didn't have a clue what he was saying. He used to get so frustrated at me, asking him to repeat himself or slow down. Then when he'd get mad, he'd start spitting when he talked, which of course made it even harder to concentrate on what he was saying, lol. After about a year working with him, I could understand every word he said. Apparently it was my fault for not being able to understand him.

Ironically, his handwriting was beautiful...

nrsang97, BSN, RN

Specializes in Neuro ICU and Med Surg. Has 20 years experience.

Years ago, I worked with a doctor from Egypt. His accent was so thick and he talked so fast, I could literally be standing in front of him looking him dead in his mouth, and didn't have a clue what he was saying. He used to get so frustrated at me, asking him to repeat himself or slow down. Then when he'd get mad, he'd start spitting when he talked, which of course made it even harder to concentrate on what he was saying, lol. After about a year working with him, I could understand every word he said. Apparently it was my fault for not being able to understand him.

Ironically, his handwriting was beautiful...

We had a intensivest from Greece, who was a phenomenal doctor. I always had a hard time understanding him due to his thick accent. I constantly made him repeat himself. I know he was annoyed with me all the time.

I worked with him for 6 years and still had a hard time. His writing was terrible too. Our Egyptian intensivest was much easier to talk with. Spoke wonderful English with barely an accent, but his writing could look like hieroglyphics LOL.

As time goes on you'll learn the frequent doctor's hand writing. We have a doc who's signature looks exactly like a vfib, but it is very distinct.

I love the ones that use an entire 8 1/2 x11 sheet of paper to write 3 orders lol.

But my Hosptial has give all the docs a pen with a stamp of their name. Only about 2-3 of the docs I see use it.

PacoUSA, BSN, RN

Specializes in PCU / Telemetry. Has 9 years experience.

some fill in the blanks and hope for the best.

That is clearly a dangerous thing to do! I'd be scared to work with nurses like this!

Thank God my hospital is mostly EPR and new orders popup on the screen and we very rarely have to read a doctors scribble anymore (in fact, I don't even know what my attending's handwriting looks like unless the are completing a death certificate).

This looks like an opportunity for you to devise something that enables MDs to enter orders on computer. Perhaps you could work with your hospital's informatics team to make this happen (electronic order entering)?

NicuGal, MSN, RN

Specializes in NICU, PICU, PACU. Has 30 years experience.

All I can say is thank God for EPIC and electronic order sets!

HCA has gone to electronically-entered physicians' orders, but not all providers comply, it depends on the facility's zeal to enforce it. When taking ER admission orders by providers who cannot-or care not- to articulate their words, I simply ask them to repeat/spell out. Often, I just get the same unintelligible sounds, but louder. My response is: "It is YOUR license I am looking after, Sir/Ma'm, not mine." This usually gets their attention. As a foreigner myself, there is NO EXCUSE for not speaking proper English when accurate communication is vital to your profession and when patients' safety depends on it!

Years ago, I worked with a doctor from Egypt. His accent was so thick and he talked so fast, I could literally be standing in front of him looking him dead in his mouth, and didn't have a clue what he was saying. He used to get so frustrated at me, asking him to repeat himself or slow down. Then when he'd get mad, he'd start spitting when he talked, which of course made it even harder to concentrate on what he was saying, lol. After about a year working with him, I could understand every word he said. Apparently it was my fault for not being able to understand him.

Ironically, his handwriting was beautiful...

Thank you for my first "chuckle of the day"!

at times, only 1 letter of a word is decipherable, the number 6 looks like the letter H, etc. it looks like their pen went into v-fibb and expired somewhere around the signature where all i see is a couple random zig zags and a loopdeeloo.

Awesome. Paging the coffee clean up crew to my office now...