Need a little perspective on this med situation

[Student2Registered]

So I was working a night shift last night and my post-op arrived at around 2100. When I accepted the new orders, the order for the nerve block and PCA were DC'd but that doesn't make any sense because those things are in place for post op pain. I paged the "service pager" which is a generic # that gets you in touch with the on call MD for that service. Didn't hear back right away. Then I found another patient on the verge of a Rapid Response and got the primary RN in to manage the situation and I began helping in that situation like any team player would :)

So a couple hours have gone by and I page the service pager again, no response. I talk to the Charge Nurse about it and she mentions calling the next in line for that service but then says something about them not being in house in the middle of the night and maybe its not worth calling a chief resident at 3AM. So at 5AM when the primary MDs come in, I page the service pager and get a response. MD states it was clearly a mistake for those orders to be DC'd and she'd be reinstating those orders. Okay, job done (I thought), I see new orders pop up on the screen but I'm busy passing 0600 meds, blood draws etc...

So as I'm giving report to the Day Shift RN she points out that there is no active order for the PCA. The MD had only reinstated the nerve block order but she clearly told me on the phone both would be reinstated. When I explained this to the Day Shift RN she seemed pretty upset that the PCA order wasn't active and went into the "In the future you should really call the Chief Resident for that order."

Now I know that its important to have the orders correct. I just feel that night shift differs from Day Shift in the availability of MDs and prioritizing calls. I feel I used judgement in knowing those orders being DC'd were a mistake.

On a scale of 1-10, how bad is this mistake? Thanks :)

[BettyBoop01]

First off, it was the Dr mistake and you did what you could to rectify it. I think you did fine, if the Dr hadnt made a second mistake in the am, it would have been fine. Right? You did what you could, day nurse can get it corrected again.

[Reno1978, BSN, RN]

Cleaning up orders is something that can wait if it doesn't impact patient care.

Reading this, however, I'd be concerned that your patient had no adequate pain management from 2100 until after 0600. Did the patient arrive with a PCA that you just had no orders for?

[Student2Registered]

the pain meds were in place and infusing as "originally" ordered. I never DC'd them b/c it didn't make any sense to DC pain meds literally "immediately" post op. I just left them as is and kept paging the doc for clarification. Literally in a 12 hour shift I charted at least 5 communication attempts.

[Orange Tree]

I doesn't sound bad to me, at all. I would have paged the MD on the way out when I realized the order had still not been corrected, though.

[bosnanurse]

I wonder if you paged doc so many times why you did not page your supervisor and follow chain of commands? If nothing else that's how it works in my place.. call no response ..wait call again no response wait ... call supervisor and ask what to do .. ( they are paid little bit more to think through :)))

[coolpeach]

After you spoke to the Dr, could you do a Telephone Order Read Back. At my hospital if a Dr tells us he wants something over the phone I chart it in the orders, write down TORB/his name/my name, and fax it to the pharmacy and it becomes so. Since he verbally gave the order to continue the PCA order couldn't you just write it as a verbal order.

[nurse2033, MSN, RN]

Sounds like a 8/10 mistake for your system for this issue, but not for you. You did the right things especially by page the doc. If they dont' respond, there is nothing you can do about that except try again, and notify your charge nurse.

[brownbook]

I just love your perspective that night shift does have different priorities. Seems that day shift nurses have the attitude that nursing and patient care are exactly the same 24/7. Of course many issues and needs are the same and must be taken care of. However there are realistic differences in prioritizing MD calls at 0200.

As a former 17 year night shift worker, I think you handled the situation fine.