Night Shift Error...Maybe

Unless the MD wanted both of them running I don't think you made an error. What did the order say when the cardizem gtt was ordered?

Honestly, I did not go back during my chart check to the original cardizem order. I did not think twice about the saline lock, but I guess I should have gone back to the original cardizem order to see if the cardiologist d/c'd the IVF.

Honestly, I did not go back during my chart check to the original cardizem order. I did not think twice about the saline lock, but I guess I should have gone back to the original cardizem order to see if the cardiologist d/c'd the IVF.

Well, I honestly don't think it's an error. If the new orders didn't specify that IVF be started after the Cardizem drip be d/c'd then I don't see where you went wrong. Unless, yes, the previous order specified to keep IVF running even after the Cardizem drip was d/c'd. Even then, unless this pt really needed the fluids, I don't see how being hep-locked for a short time could harm him/her. :S

is it true that nurse's eat their young

I am worrying about something one of the day nurses asked me before I left this morning.

One of my patients last night was on a Cardizem gtt which was d/c'd yesterday on day shift. The day nurse converted the patient to a saline lock.

While I was in report, reviewing the Kardex, I noted that prior to the initiation of the Cardizem gtt there were IVF ordered.

During my chart check that night, the order for discontinuing the Cardizem gtt did NOT include orders to resume the IVF. I continued to the leave patient saline locked.

Then today's day nurse asked me increduously why the patient was saline locked since IVF were listed on the Kardex. I said the IVF were order prior to the start of the Cardizem gtt. No resume or new IVF fluids were ordered yesterday and calling a MD in the middle of the night to simply resume IVF is frowned down upon. The day nurse said she would talk to cardiologist about.

Maybe I am too tired now, but did I make an error?

Help!

Since D5 and NS are the typical IVF's and both are compatible with Cardizem, I might've thought that the doc wanted to run the IVF's with the Cardizem. We often will run either of those or a combination downstream on a passive drip with the Cardizem on the pump.

The best way to find out would be to call the ordering doc. Usually, the PCP will order IVF's and then the cardiologist will come in behind and order other stuff. In that case, I would've called the PCP to ask.

IMO, the nurse who actually started the Cardizem might best have clarified the IVF question as soon as the Cardizem was ordered. Since she did not do so, whoever discovered the order might have followed up on that. (But I agree, I would not have called the doc in the middle of the night.)

If I get an incompatible IVF with a Cardizem order, I would most likely start a new IV site and assume that the doc wants to keep the IVF running in addition to it.

But best to clarify.

I don;t think you made an error. Don't beat your self up about this. The day shift nurse that took the order for the cardizem to be d/c's should have asked the MD if they wanted to continue IVF. But I TOTALLY understand where u are comming from. I know cardiologists hate to be woken up in the middle of the night just to ask about IVF. We have a house MD and a tele resident at my hosp.at night and if they don't cover the MD I call the cardiac fellow and if they don't cover the MD I call the tele resident again, give the most recent labs and vitals and would sy that previos IVF were running but no order to resume. If nothing is accomplished with 1000 phone calls I usually call at 6AM to the cardiologist and see if they wanted the IVF reordered. If I get no call back I document everything, and endorse to the day shift all the calls I made and they need to call thr cardiologist and get the order.

Hi Everyone

Just an update.

I forgot to mention that this patient was a dialysis patient as well. So my thinking with not restarting maintanence IVF was "OK makes sense since she is just going to be dialyzed tomm.(Friday) anyways." This patient makes no urine, etc etc.

So I came back in last Saturday, same patient there. She was still SL, actually no IV access, since she was such a difficult stick. I had no idea why she STILL had be in the hospital, since we where managing the patient the same exact way as prior to admission, but it was an easy patient.

Anyways thanks for all the replies!

And then we wonder why we have longer than necessary lengths of stay. Where is the case manager if the patient no longer needs to be hospitalized?