Most Ridiculous Med Order

Jensmom7, BSN, RN · Jul 4, 2015

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.

That's just mean. But funny as heck lol.

Ruby Vee, BSN · Jul 4, 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.

That's wicked funny. Wicked and funny.

I once got an order for morphine 2 mg. SC q 1 hour 'round the clock. Patient was actively dying of cancer. He refused the morphine, saying "I'm only gonna die once; I want to feel what it's like." I understood that; the intern didn't. He threw a fit because I wasn't following his order. He wanted me to "Go in, hold him down and give it to him." Then he yelled at me that "No one should die alone." I think he had issues with death and dying. The patient died peacefully about 4 AM, having successfully refused 8 doses of morphine. He died immediately after I left his bedside (where I spent all my free time that night) to go do rounds on my other patients. I figure he CHOSE to die alone.

The intern caught on . . . eventually.

OutptRN · Jul 9, 2015

My favorite (so far) has been: Zonefur 100 mg IV to be given over 4 hours x 1. Physician meant VENOFER, first of all, which we only give as 250 or 300 mg and it infuses over 30 mins - 1 hour. But he was ticked at our clinic for calling to clarify. :facepalm:

Ruby Vee, BSN · Jul 10, 2015

"Potassium 40 mEq IV push" for a K+ of 3.9. They were going to push it through a 22 g. on the hand of a sweet little octagenerian. I had to have the Pharmacist put a stop to that one because neither the brand new intern (out of Med School two weeks) or the brand new GN (hadn't even taken her boards yet) believed me when I tried to explain what a bad idea it was -- and why.

kkbb, BSN, RN · Jul 15, 2015

This wasn't in the ER, but at Internal Med clinic. Doc told me to call pt and tell him about his new script for his low testosterone. The script said 2 testicles po bid.â€ Man did he blush when I had to ask him to change the order to Testim as a topical application. We still laugh about that order years later.

Christy1019, ASN, RN · Jul 16, 2015

This wasn't really ridiculous per se, but very unusual, and I've never seen it in 8yrs as a nurse. A 17yo with anorectal fissures prescribed nitroglycerin ointment to apply to the outside of the rectum. I confirmed with another physician that this was a legit use for this medication but he said noone ever does it.

Have any of you ever seen nitro paste ordered for this? And if so, wouldn't it put them at risk for hypotension and syncope? I remember an old episode of untold stories of the ER, and a woman kept mixing up her husband's nitro paste and hemorrhoid cream and the poor husband kept passing out, lol.

hajordan · Jul 17, 2015

Vodka T PRN nocte. He was a geriatrician. On reviewing the second patient that day, he tried to prescribe it for her too! Apparently to stimulate the appetite. I suppose I get a bit hungry after drinking a bit of booze!

hajordan · Jul 17, 2015

Hi Christy1019,

Yes, I've seen it a few times myself, and the idea is to use it sparingly, because quite rightly, syncope and hypotension is a risk!

And lol at the women mixing up the creams. A bit of an ewww too at that!

NurseKatie08, MSN · Jul 17, 2015

This wasn't really ridiculous per se, but very unusual, and I've never seen it in 8yrs as a nurse. A 17yo with anorectal fissures prescribed nitroglycerin ointment to apply to the outside of the rectum. I confirmed with another physician that this was a legit use for this medication but he said noone ever does it.
Have any of you ever seen nitro paste ordered for this? And if so, wouldn't it put them at risk for hypotension and syncope? I remember an old episode of untold stories of the ER, and a woman kept mixing up her husband's nitro paste and hemorrhoid cream and the poor husband kept passing out, lol.

Not nitro, but I have seen a diltiazem gel for similar reasons.

Christy1019, ASN, RN · Jul 17, 2015

Hi Christy1019,
Yes, I've seen it a few times myself, and the idea is to use it sparingly, because quite rightly, syncope and hypotension is a risk!
And lol at the women mixing up the creams. A bit of an ewww too at that!

Okay, so what kind of dose would qualify as sparingly for that use, because she had prescribed 1 inch which I felt was a lot, considering it's a standard dose for topical use in cardiovascular situations lol.

hajordan · Jul 17, 2015

1 inch?!? Unless he has a very LARGE fissure, that sounds ridiculous.

Christy1019, ASN, RN · Jul 17, 2015

That was what I was thinking. Thankfully the pharmacy called us because the insurance wouldn't cover it, so when I talked to the attending on that day, they said to just not get it filled period. Otherwise I probably would've had a irate mother with her syncopated child back in the ED lol.