Missed orders

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Specializes in Med/Surg.

I feel missing something in the field of nursing is just a matter of time sometimes. It feels like all it takes to miss an order is a nurse from the previous shift forgetting to pass something on during giving report. I am a new nurse. Well here it goes: I was giving report to one of the rudest night nurses and as usual I was bombarded with questions. It was my first time having this patient so I answered as much as I could and passed on whatever I knew about the patient. I basically missed a H&H lab draw during my shift. But here is what shocked me. This order was an H&H q8hrs lab draw order and the only indication I had was on the back of the Kardex along with tens of writings, orders, special instructions with bunch of markings and lines. This was on order written by an MD four days ago and it was not passed on to me from the previous nurse. It was not an order written during my shift and I do go back and look at previous orders to get more familiar with patient's process but I didn't go 4 days back. I feel my only indication to draw this lab was on the back of the Kardex along with many other writings and I admit it I missed it. Is it me or is there something very risky going on with the system? I would like to hear suggestions and your experiences in this matter.. Thank you..

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Specializes in Cardiac Telemetry, ED.

We all miss things sometimes. It does sound like your systems has some weak areas that could use some improvement.

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Specializes in Med-Surg, Psych.

We all forget things! This is a great example of why 24-hour chart checks are so important.

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Specializes in Peds Hem, Onc, Med/Surg.

When you take report from now on you know to check the back of the Kardex and make sure everything is being done. I also found out that going back through the orders at the start of the shift makes a big difference. Twice I have found an order that hasn't been done. It happens to everyone for sure!

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No one should have to go back more than 24 hours to check orders on pt charts. Kardexes become cluttered with old, useless info because noone has time to up date them, erase what is no longer applicable. Recurring orders such as the op cited should be written in red or starred to make them stand out more. Don't beat yourself up over this, mistakes happen and I am sure you will be more cautious when you read your kardexes now.

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i know how u must feel..

ive seen some horrible kardexes... ones that are illegible with additional papers attached on to it since there was not enough space...

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Specializes in tele, oncology.

I hate reading/hearing about system errors like this. Our kardexes get updated daily...there's a front page with general info like history, contact info, admit dx, etc. and then inside there's rows for things like monitoring status (VS, One touches, etc.), labs, diet, diagnostics, activity level, etc. Then each day gets it's own column, and nights updates or carries over the information to the new day. (It comes up to eight pages long all together, with enough columns for six days.) That way we can see what has been done and what is still current...if you have a patient that was on q8h H&H's, for example, and isn't anymore, it would hopefully prompt you to ask why in report if it wasn't covered. Although it's far from perfect, it's way better than those one page kardexes where you have to erase and update.

I also have made it a habit to check on the computer for any upcoming labs within the first few hours of my shift...I like to do it right away, but don't always have the chance to do so.

Scenarios like this are one of the biggest reasons why I'm glad we're going to computer charting; there's prompts to indicate if a med or lab was missed when you pull up your patient list in the system we're going to.

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First, there is definitely a system problem. I think it's unreasonable to have to go back more than 24 hours when checking orders. That said, if you know there's a problem, I guess you should review orders further back. As to how far back, who can say?

Secondly, you have to get that night nurse under control. Just tell her, "Susie, hold your questions until I'm done, as I will likely cover what you are asking. Also, it really throws me off to have to stop and answer questions. I need to try to make sure you get all the information and that is much more likely to happen if you let me say what I have to say before you ask questions."

If you are feeling especially bold, you could ask her if she is angry at you. If she asks why you're asking, just say that you get that feeling. Or that it seems inappropriate or, gasp, rude that she won't hold her questions until you are done. I don't really advise this approach.

What is your definition of "rude"?

You could cover yourself in a situation like this, where you've missed an order, by telling the doctor it was missed and get a new order to say "Draw H&H now" or something along these lines.

Best of luck to you.

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Specializes in Med/Surg.

Thank you everyone for your suggestions and for sharing your thoughts. Not all, but 50% of the night nurses are negative, unfriendly, and rude. Hearing "thank you" for the things I try so hard to get done for them is almost NEVER. I am still amazed how an order can be still present from 4 days ago. I just think Doctors should write daily (not per shift) orders for such labs to be drawn. I mean is it only me to think that an order from a few days ago could easily be missed if not passed on during shift exchange? I usually do look at the back o fthe Kardex to see what has been done to the patient although when there are 15 to 20 things I will admit I usually look at the more recent procedures because there is very limited time to get everything done on our floor. This lab draw was towards the top. I missed it. I just hate giving the night nurses a reason to beat me down even more. I have to be on my toes. I hate to sound paranoid but I get a feeling they are out to get me, haha. I have been on this Med/Surg floor for 8 months now and they still have not been able to make me quit or get fired. The funny thing is I took report from one of these night nurses who pulled a double couple of months ago and she gave me one of the worst reports. I asked reasonable questions and she couldn't answer. I didn't even try to get back at her or antyhing. I was asking questions like "Was the MRI done?" or "Any output after a foley cath came out?". I also fix so many things including orders from the previous shift almost always that I think if these night nurses took report from these nurses they would think twice about what they're trying to do to me. Anyways, enough venting I think. Thanks again everyone... I just wish people were little more fair-minded these days..

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