Most Ridiculous Med Order

Ruby Vee, BSN · Jul 1, 2015

What is the most ridiculous med order you've seen written by a doc in the ER (either an ER doc or an attending planning to admit his pt)? I had a a doc order 2 MG of Dilaudid IVPwith a 2nd dose in 30 min for a broken (mildly) arm. I thought that was a lot...pt was going home, not admitted for surgery or anything.

Fun thread, but this order doesn't strike me as particularly ridiculous, not knowing anything about the patient's history or possible drug tolerance. That would be about what it have taken to keep me comfortable a few years ago in the middle of my cancer ordeal, during my joint replacement saga or when I had the CSF leak.

Ruby Vee, BSN · Jul 1, 2015

A former coworker of mine went to battle with a resident who ordered, and demanded the nurse to administer a rectal Tylenol suppository ORALLY! I don't know if it became a pride issue for him after being called out on the order, or what, but he refused to change it to PO, despite the pt being A&O. Needless to say, he didn't complete his residency (not his first error), and he was in his final year.

I wish it was "needless to say," but unfortunately all too many of them complete their residency and go on to plague nurses for years afterward.

Mandychelle79, ASN, RN · Jul 1, 2015

I work on a dual dx unit so we detox patients all the time. I have had a doctor order 0.5 mg of Ativan q 6 h for patients who are drinking a 30 pack per day for past 5 yrs, or nothing for the opiate withdrawal.... Thankfully we now have protocol orders or both and just ask for those when he is on call ( 2 mg ativan q2h based on score).

1deirdre1 · Jul 1, 2015

50 ml gravol IM for a 96 year old 75lb patient. He refused to change the order so I brought him a 60cc syringe, all the gravol in stock and told him he would have to do it himself.

NurseSpeedy, ADN, LPN, RN · Jul 2, 2015

This wasn't in the ER but I worked for a teaching hospital that almost all the patients were assigned to teaching staff so an intern would be writing orders on most of the patients prior to being seen by the attending. Every year I would get at least one order for "40 mEq KCl IVP". This would be followed by a clarification call asking for a new order to give piggyback and administer in a few doses (...you all know the drill)...the ones that I had to explain the rationale to always scared me.

fitzfan82 · Jul 2, 2015

Fun. That's when I suck up to my techs.

fitzfan82 · Jul 2, 2015

I really don't understand why people love Dilaudid so much. I've had it twice postoperatively and it made me so nauseous and dizzy I would have almost rather have the pain. That's why I'm the nurse everyone hates who pushes it as slow as possible (and flushes slow too)... I don't need vomit everywhere!

fitzfan82 · Jul 2, 2015

Way to stick up for your pt's safety. I admire that.

Ruby Vee, BSN · Jul 2, 2015

Fun. That's when I suck up to my techs.

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Ruby Vee, BSN · Jul 2, 2015

I really don't understand why people love Dilaudid so much. I've had it twice postoperatively and it made me so nauseous and dizzy I would have almost rather have the pain. That's why I'm the nurse everyone hates who pushes it as slow as possible (and flushes slow too)... I don't need vomit everywhere!

I didn't understand it, either. I even refused the Tylenol #2 (yes, they made them back in the day) they gave me when I had my wisdom teeth pulled, because it made me loopy. I took plain Tylenol. But the day came when I had a serious back injury, surgery, and a post-op CSF leak. Dilaudid and Phenergen were my friends. After my third bout of cancer and two knee replacements, I probably developed a bit of a tolerance. Hopefully my tolerance has returned to "normal by now." Do any of you Pain nurses know if I'm stuck with a high narcotic tolerance forever?

Oswin · Jul 3, 2015

I didn't understand it, either. I even refused the Tylenol #2 (yes, they made them back in the day) they gave me when I had my wisdom teeth pulled, because it made me loopy. I took plain Tylenol. But the day came when I had a serious back injury, surgery, and a post-op CSF leak. Dilaudid and Phenergen were my friends. After my third bout of cancer and two knee replacements, I probably developed a bit of a tolerance. Hopefully my tolerance has returned to "normal by now." Do any of you Pain nurses know if I'm stuck with a high narcotic tolerance forever?

In my experience, the tolerance does go away with time. But it re-develops more quickly in people who've built it up before. Not sure I fully understand that one, but I've seen it in multiple people, including myself.

Bobjohnny · Jul 3, 2015

My personal favorite although not in ER, or my patient, was written by a first year was "Notify provider of all abnormal lab results." We went back and counted, he got something like 20 pages that night. Glucose 121, NA 134, etc... He made the mistake of thinking he was the best thing since sliced bread three weeks out of med school.

another nice one was the Dilaudid 20mg IVP. I of course didn't give it, but I did tell the resident that the patient was really sleepy and not breathing right.

Adenosine 12mg po q6. Again not in the ED, we figured out that they meant to write for Amio. But, that still doesn't explain the dose.

Thats all I can think of right now.