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Ordering antibiotics!?!

Medications   (4,729 Views 16 Comments)
by Bec7074 Bec7074 (New Member) New Member

Bec7074 has 3 years experience and works as a Registered Nurse.

5,196 Visitors; 117 Posts

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So today I cared for a gentleman who became febrile at 38.7. I called the doc and pan cultured him as ordered, including a UA. The patient was not on antibiotics and was admitted for a lung AVM. The UA came back positive for Many bacteria, WBC, nitrates, etc. Since I work nights, I knew the doc wouldn't be looking for it. I called him (he's awake and in house) to let him know it was positive. However he never started the patient on antibiotics and acted like he didn't know why I was calling. I don't understand why the patient doesn't receive broad spectrum antibiotics. Any thoughts? I was just wanting to do what's best for the patient and get this UTI under control and reduce his length of stay. The only thing I can think of was it was a busy night on our ICU and they were admitting a gunshot wound down the hall. Any insight?!

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BrandonLPN has 5 years experience and works as a LPN.

26 Likes; 34,876 Visitors; 3,358 Posts

Could he have been waiting for the culture?

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RNperdiem has 14 years experience.

193 Likes; 1 Follower; 28,985 Visitors; 4,111 Posts

My random thought...

Was this doctor a cross-covering doctor?

I find cross covering docs tend to "band-aid" patients until the morning when the regular doctors go on rounds and discuss the patients and problems in depth and formulate a plan.

That is one more reason to like working days.

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iluvivt has 32 years experience and works as a Infusion specialtist.

51 Likes; 24,038 Visitors; 2,704 Posts

The patient needs to be on antibiotics so the infection does not advance into urosepsis if he is not at that point already. The only thing I can think f is that maybe he wanted to wait until he saw the patient on rounds so he could assess the patient and also check on sensitivities if they were done..but in the meantime I agree he needed some antibiotics! Did you have a WBC ct and di you tell him about the pt's symptoms?

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classicdame works as a Hospital Education Coordinator and adjunct nursing.

2 Likes; 2 Articles; 25,940 Visitors; 7,255 Posts

This is the reason people are in the hospital - to get 24 hour care. I believe the doc dropped the ball and should have ordered meds. How hard is that? The final report on the culture could be 3 days away. Could always change meds if another is deemed more appropriate later.

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psu_213 has 6 years experience.

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Yes, I would agree that ABX are appropriate given the positive UA; however, there are may reasons why the doctor may not have ordered them right then over the phone--which others here have already mentioned. Were ABX started in morning?

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Bec7074 has 3 years experience and works as a Registered Nurse.

5,196 Visitors; 117 Posts

Just an update. Went back to work tonight and the patient is on vanc and meropenem. And still febrile with nasty urine....but it made me feel better.

Working nights can be frustrating. I often feel the "keep Em alive till 7:05" which is unfair to patients.

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Anna Flaxis works as a Registered Nurse.

1 Like; 30,091 Visitors; 2,815 Posts

Ugh, how frustrating.

Have you heard of the SBAR format for communicating with others about the condition of the patient?

S=Situation

B=Background

A=Assessment

R=Recommendation

Following this format, you would have told the doctor something like "Mr. Smith is a ____yo admitted for lung AVM. He developed a temperature of 38.7 and cultures were sent. The UA is positive for many bacteria, WBCs, nitrates, etc. My assessment is that Mr. Smith has a UTI, and I'd recommend starting him on antibiotics. Would you like to order antibiotics?"

Then the doctor can say yes or no, and hopefully if he/she says no, they'll include a rationale.

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BrandonLPN has 5 years experience and works as a LPN.

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I was told by the nurse who precepted me that it's overstepping our bounds to "recommend" anything to a doctor. (she meant both LPNs and RNs)

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Anna Flaxis works as a Registered Nurse.

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It's not overstepping our bounds at all. We ask doctors for orders that we think are appropriate all the time. If you had a patient with a fever who had no Tylenol ordered, would you feel it's overstepping your bounds to call the doctor for an order for Tylenol?

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BrandonLPN has 5 years experience and works as a LPN.

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I think she meant you would call the doctor, tell him about the fever, but suggesting a medication or diagnostic test ot treatment or whatever was being presumptuous.

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Anna Flaxis works as a Registered Nurse.

1 Like; 30,091 Visitors; 2,815 Posts

Really? Wow. Why is it being presumptuous to know that a patient with a UTI needs antibiotics?

Suggesting a specific antibiotic might be sort of presumptuous, but....

Edited by Anna Flaxis

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