Published Sep 6, 2001
Here's my issue:
Last night I got report, 2 readmissions, my other 28 people ok....one admision complete, the other med sheets need finishing, 3-7 float lpn, no prob sheets will be done I'm on my merry med pass way. But wait on the completed admission is in LARGE letters SENSITIVITY TO COUMADIN right above this is and order to admin 0.5 mg of COUMADIN low dose, but my butt, soooo....I find my RN Sup. She's unaware, find 7-3 Sup. who has to do OT and is pissed off. Attempt to discuss this with him and he says I'm going home read your nurse's notes. Why have you not read your nurse's notes? Cuz I'm doing my med pass etc. Screaming at me in the hallway incopetent lazy etc...go read nurse'snotes....NOTHING CHARTED!!!! But hey I'm not supposed to be angry? The good/bad news is 7-3 never faxed med orders to Pharmacy meds never came in (witheld,U/A) What would you've done?
are you an rn?
why did you need to find a supervisor?
i would have looked thru the chart. i would look for something in the chart that says what the reaction to coumadin is and that they are aware of it and ordered it anyway. then i would have called the doc who wrote the order. if i couldnt reach the doc i would just hold the med and chart why i held it.
i dont think i would have even sought out the supervisor. 0.5 coumadin is such a low dose that i doubt her not recieving it would have been life threatening. i certainly would also put a note on the chart telling the doc an order was written and there was a question.
id much prefer to get yelled at for holding an ordered med than to give a patient a reaction. id also write down everything that was said as well as the time.
the super will prob try to find a way to turn it around and make it look like you are lame. (thats how they cover their asses when they act like that)
where are these hospitals getting supervisors anyway?
do they have degrees in staff abuse? they must.
had a doc that handled that sensitivity issue beautifully i thought...lol
pt was "sensitive" to asa...in the md to nurse notes it says....
PT IS TO RECIEVE ASA...CALL MD IF YOU HAVE GOT A PROBLEM...
well i have lots of problems and i was soooo tempted...lol
try to find out what the sensitivity is, gather current lab and if your hospital has an issue with calling docs with questions - let the super know that you have an issue with the order in this scenario, call the doc - explain that you have just recieved this information and KNOW that he would want to know that his patient has this sensitivity. You can involve the pharmacist for information relating the current labs and the patient's previous response. If you are still uncomfortable - then go further up the chain of command.
From experience in my current work - if you DO NOT question the doctor and if you don't go to the chief of staff when you know there is a problem, then you are considered culpable. [i've had the argument with attorneys for years - "they" say - he/she should have gone over the doctor's head and called in another doctor - right - how many times would that go over????] The key will be document - I called Dr. X and told him blah blah blah - he said yada yada yada; I called super......, pharmacist.......talked to patient who said....., family who said......
"Sensativity" usually means that the patient can't tolerate the usual dose of the drug-hence the very low dose of Coumadin. My guess is that the "Sensitivity" word was there to alert you to give 0.5 and not 5mg of Coumadin-in other words that 0.5mg was not an error but a response to "sensitivity".
However, if you were concerned, you should have first read the chart, and if it wasn't documented as such, you should have called the doc. If you couldn't reach the doc-as i know you often can't in ltc-then you could have held it, let the super know you held it, and documented that it was held, doc called, no response, super notified, will hold med until able to get clarification, pt stable.
It is unfortunate that so many docs expect us to be mind readers. It should have been well documented that the pt was getting 1/10 the usual dose due to a "sensitivity" and would be monitored. But since most docs do as they please with no thought as to what the rest of us think, sometimes we have to be detectives. I had one doc reorder a med that couldn't be found in any PDR, no pharmacist had ever heard of it, and even his partner had no idea what it was. Turns out the first guy just copied what he THOUGHT he had previously written-but his handwriting was so poor even HE couldn't read it. Took a lot of detective work-and wasted a lot of time-to solve that one!
P_RN, ADN, RN
I would have HELD it in a skinny minute......
The doctor who wrote it should have been called and a clarifying order should have been written.
Does anyone remember the 3 nurses in Colorado back in '97 or so?
Through a SERIOUS SERIES of errors starting with poor handwriting by the doctor, poor syntax in writing the order, omission of a key word IN the med order, a pharmacist who misread, but didn't understand the order parameters anyway......to the nurse who thought 5 injections were too much for a 7lb baby........the other nurse who decided to get the med ordered IV........to the BABY WHO DIED! Now THAT came down to the NURSES who followed that crappy chain of errors.......
If the doc wanted the Coumadin given....he should have written give this LOW DOSE coumadin BECAUSE the patient is sensitive.
If you have time to stop your med pass and go back to read the notes on one of your 28 patients do so. BUT don't give the med.
PS Coumadin usually doesn't have peak effect for 3 days or so.......and in 3 days will the doc remember? "Hey wonder why the Protime/INR is so High?"
Oh and PS. That supervisor needs his/her mouth washed out! NO one should be shouted at in the hallway, within earshot of the patients........I'm afraid my back would have been turned and he'd be shouting at my butt, on my way to writing a complaint on him.
who was the rn who cant read....lol
THIS IS WHAT I SAID:
0.5 coumadin is such a low dose that i doubt her not recieving it would have been life threatening.
thank you very much
Too bad you couldn't have ultilized that float LPN to help you out.
Thanks for the input! Turns out that it's all my fault anyway. (surprise!) Held the med, got no answer from Super. etc. next day called on carpet bad, bad girl you didn't go over your super's head and call the doc yourself, pharm. etc....as an LPN I haven't been in a position to need to call a doc. Super's always had...don't step on toes...learned my lesson..oh and found out I had no legitimate reason to hold the med either! but hey if it happened again you're dam right I'm holding it, calling Pharm, and the doc...as for RN documentation it had better for dam sure be there or there will definatley be probs...nothing is being done the super with poor documentation!
:mad:and I was informed that I didn't document enough either!(my bad admittedly)
Learned a big lesson...
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