Orders entered into a computer not completed within 24 hours

[nelly1630]

I would like some feedback regarding how other facilities are handling the issue of orders that are entered into a computer and are not being completed within 24 hours, and then are missed for follow up. Our facility just had an issue with orders being written by physicians that may not be directly related to nursing, but end up falling on the "nurse not following a physician's order".

IV Lasix was ordered on a pt, but the pt did not have an IV (infiltrated). Several attempts at the IV were made, and then another physician came in and ordered the Lasix to be given PO until the IV was inserted. Pt then refused the IV. 2 days later, the original physician was called because the urine output was low for the past 24 hours and saw that the IV lasix was never given. Physician asked for an incident report to be written.

Radiology test was ordered but the machine was down and the test not done. Then when the machine was back up, the creatine level was too high for the test to be done. Radiology cancelled the test. Wasn't passed on to the nurse so no one knew to follow up. Again, the physician came in and saw the test wasn't done. Nursing explained that the test was ordered and radiology dc'd the test in the computer because the creatinine was high. Physician asked for an incident report to be written. Nurse did not follow the order.

Are other facilities having this problem and what do they do to help fix this issue.

Thanks,

[P_RN, ADN, RN]

This doesn.t sound so much a nursing failure as it does a failure to communicate. The IV lasix order was over ridden by the po order. The xray was over ridden by policy where the creatinine was too high. Why weren't the doctors communicating with each other I wonder.

Fill out an occurrence report: IV Lasix not given. IV access not obtainable by nurse, or director, Dr. +++++++ notified and changed order to oral Lasix.

XR unable to be completerd as machine not in working order And pt's creatinine was _______mg/ml. Dr. YYYYYY notified.

Doctor ++++ and Doctor _______made aware of circumstances.

BINGO.

[oramar]

It sounds like this hospital has system problems and that several people and proceedures and policies are falling down here. If the doc thinks he can deal with that by writing up ONE person he is shouldn't be suprised when nothing changes.