Tolerating PO, maintenence rates of ns are just silly in the ER. Anything under 500 ml/hr is silly. If you really think they need 125 ml an hour, I'll be happy to bring them an 8 ounce glass of water every couple of hours.
I am not refering to the dehydrated LOL with CHF. I am talking about the garden varity pt who is going to get a bunch of pointless tests and then get sent home with an ambiguous dx.
Specializes in Emergency, Case Management, Informatics.
If the worst thing I have to complain about is an MD ordering NS at 150, I'm having a pretty good day.
I'd much rather complain about that MD that's ordering 0.5mg of Dilaudid on a 300 pound man, since I have to actually take the time to find a nurse to witness a waste of 0.5mg of Dilaudid (sorry, but I'm not going through the liability of carrying the other 0.5mg around with me in case I can use it later... nope), gotta document the waste, and in about an hour I'm gonna have to go back through the whole cycle all over again because that 0.5mg of Dilaudid didn't do jack, but the physician refuses to order more than 0.5 at a time because he's worried about O2 sats dropping and doesn't trust me enough to monitor my patient or hear the monitor alarm going off at the nurses' station.
We charge $110 per IV bag. Our IV catheters are $50, tubing is another $30. What insurance will pay is alot smaller, most supplies are not directly billable. The people who do get billed directly, because they have no insurance, are not very likely to pay. Then you have to add in the time it takes an RN to insert/maintain. I have worked with ER physicians who order painful procedures to discourage patients coming in for minor (in their opinion) issues that should have gone to their family physician.
I have worked with ER physicians who order painful procedures to discourage patients coming in for minor (in their opinion) issues that should have gone to their family physician.
Completely unethical and a huge waste of resources right there.
But back to the original post - I'm not an ER nurse, but I completely understand and agree with the op's point. Even if that supposedly stable pt crashes suddenly, there are ways that iv meds can be given. Maybe your dude hasn't been checked off on them yet?
Who cares what was written? You're not the doctor...
Want a change? Go be a provider and write your own orders.
Exactly...who cares who writes the orders..if you want you own orders then be a provider. There is always a reason for maintenance fluids....why would a sane person maintain a 500 ml/hr infusion rate on maintenance fluids? Dosage is based on age, weight and clinical condition. They don't need to have CHF to get a slow infusion rate...they might have hyponatremia e.t.c
Then we have what we call neurotic...they need some IV fluids because they feel dehydrated and IV fluids makes them heal and "feel better". Just start then damn fluids at 125ml/hr and in 2 hrs the workup is complete and they are ready to go home... Phew
And yet the patient may weigh 300 lbs and receive 0.5mg of Dilaudid...there is a reason for that.
An a nurse you have the right to question orders that may compromise patient safety but don't complain just because the orders don't fit your convenience...Jeez!!!
An a nurse you have the right to question orders that may compromise patient safety but don't complain just because the orders don't fit your convenience...Jeez!!!
Why not? I have a multitude of DOCTORS who complain that their patients going bad in the middle of the night doesn't fit THEIR convenience. Jeez.
An a nurse you have the right to question orders that may compromise patient safety but don't complain just because the orders don't fit your convenience...Jeez!!!
I don't think the OP was concerned just about his or her own convenience. I think OP sounds like a nurse who is considering the patient's inconvenience, pain, potential for unnecessary infection, possible med error, and any other problems that may occur when conducting an unnecessary medical procedure/medical administration. That is our job - patient advocate. We have to question cost as well as necessity, otherwise we might as well just staff the ER with med techs and EMT's (no disrespect to either).
who cares what was written? you're not the doctor...
want a change? go be a provider and write your own orders.
1- me.
2- you. that is, if you happen to be a pt who might genuinely benefit from my time, but your care is delayed because i am ensuring that somebody gets 250 ml of fluid during their stay.
i like starting iv's. i find it interesting and satisfying. i consider unnecessary iv's good practice, and hone my skills for when it matters.
my concern is that is is not the best use of some limited resources:
Who cares what was written? You're not the doctor...
I do because I'm pretty sure that I am paying for the unnecessary workups being done in my community and my state with higher taxes and higher insurance rates.
You have to remember that many old people/kids etc are pretty much dehydrated, especially when waiting for a surgical consult - or any consult for that matter - they don't eat & drink much, or don't drink water - they think tea/coffee at home is all they need, hence diuretic effect, hence they need fluids.
People love getting IVs - no really. One experienced physician told me he always got IV NS started on his patients cos 'it looks like we're actually doing something to help them'. The public then think we're being proactive & doing something re their complaint.
I concur with the theory that it makes the patients feel like we are doing something, especially the hypochondriacs. They come in to feel "pampered" and "taken care of." They are already completely neurotic and have some ridiculous vague complaint that isn't worthy of anyone's time so maintenance fluids sounds like a good start.
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Murse901, MSN, RN
731 Posts
If the worst thing I have to complain about is an MD ordering NS at 150, I'm having a pretty good day.
I'd much rather complain about that MD that's ordering 0.5mg of Dilaudid on a 300 pound man, since I have to actually take the time to find a nurse to witness a waste of 0.5mg of Dilaudid (sorry, but I'm not going through the liability of carrying the other 0.5mg around with me in case I can use it later... nope), gotta document the waste, and in about an hour I'm gonna have to go back through the whole cycle all over again because that 0.5mg of Dilaudid didn't do jack, but the physician refuses to order more than 0.5 at a time because he's worried about O2 sats dropping and doesn't trust me enough to monitor my patient or hear the monitor alarm going off at the nurses' station.