Orders from hell...

[Leonardo Del Toro]

From time to time I run into real gems of medical writing.

Levaquin 750 gm P.O. q. 48 hours for 2 more days

the trick is to find how many pills this will be

Can you?

[NurseCard, ADN]

Had a GI doc once that, when he would get mad about something the

nursing staff supposedly missed.. would WRITE an order that said

"Write an incident report about ___"

[blondy2061h, MSN, RN]

Oh, I just remembered a great one. We had a patient on an uncommon specialty drug for an off label indication that had to come from a far away pharmacy and was exorbitantly expensive. The patient was dying and made a miraculous turn around on said med. We'll call this guy Patient A. At the same time Patient A was admitted, Patient B came in with the same condition under the same service. The physician immediately began trying to get approval to get Miracluzamab for Patient B but it was looking like it would take awhile.

So he wrote an order "Please give one of Patient A's Miracluzamab pills to Patient B daily. We'll replace them when Patient B's supply comes in." Yep. So Patient A's name was actually in Patient B's chart.

Incidentally, this was the same physician as the aforementioned highly inclusive Ativan order.

[djh123]

I get one-time-only orders from one doctor for 6u Novolog for someone who's 600+ blood glucose. (Our stupid glucometers, even though they have 3 digits, don't go to '999' - if it's above 599, it just says "HI" - yes, some engineer should be drawn & quartered. Because if it says "HI", you have no idea if they're 601 or 851. Regardless, 6 units ain't gonna do much.)

[OlivetheRN, ADN, BSN, RN]

"Please check rectal temperature" sounds benign enough except the patient had no orifice. The MD then forgot this half an hour later and ordered a Tylenol suppository 🤦🏻*♀️ I ended up writing him a helpful sticky note that simply said "no orifice" and left it stuck to his computer.

[LibraSunCNM, BSN, MSN, CNM]

Back in the not-so-good-old-days of OB nursing, we used to get orders that read: "pit to distress" which meant keep cranking up the IV drip pitocin to induce and maintain labor until the baby could not tolerate it any longer and showed signs of fetal distress. THEN we could stop.

HORRIBLE. Glad they don't do that any more.

I think there are definitely OBs out there still doing that, I'm sad to say.

[blondy2061h, MSN, RN]

I get one-time-only orders from one doctor for 6u Novolog for someone who's 600+ blood glucose. (Our stupid glucometers, even though they have 3 digits, don't go to '999' - if it's above 599, it just says "HI" - yes, some engineer should be drawn & quartered. Because if it says "HI", you have no idea if they're 601 or 851. Regardless, 6 units ain't gonna do much.)

The assay's ability to accurately determine a glucose in capillary blood is the limitation, not the display. At levels this high most institutes have policies that stat plasma glucose levels should be sent to the lab. Even in lab to get ab accurate reading they need to dilute the sample at levels this high.

[tch1920, BSN, RN]

Sounds like the MD doesn't want to be called later. lol

[Amethya]

Even as a CMA I can see that order is weird... like what?

[Boomer MS, RN]

Oh, I just remembered a great one. We had a patient on an uncommon specialty drug for an off label indication that had to come from a far away pharmacy and was exorbitantly expensive. The patient was dying and made a miraculous turn around on said med. We'll call this guy Patient A. At the same time Patient A was admitted, Patient B came in with the same condition under the same service. The physician immediately began trying to get approval to get Miracluzamab for Patient B but it was looking like it would take awhile.

So he wrote an order "Please give one of Patient A's Miracluzamab pills to Patient B daily. We'll replace them when Patient B's supply comes in." Yep. So Patient A's name was actually in Patient B's chart.

Incidentally, this was the same physician as the aforementioned highly inclusive Ativan order.

[fawnmarie, ASN]

Written by a psychiatrist on a long-term geri-psych unit, "Can she get a haircut? It's a mess!" The patient's conservator wouldn't agree to it.

[klone, MSN, RN]

Back in the not-so-good-old-days of OB nursing, we used to get orders that read: "pit to distress" which meant keep cranking up the IV drip pitocin to induce and maintain labor until the baby could not tolerate it any longer and showed signs of fetal distress. THEN we could stop.

HORRIBLE. Glad they don't do that any more.

Oh, some still do. They just can't blatantly call it that in black-and-white anymore for litigation reasons.

Some physicians would call during the shift and ask what the pit was at, and get pissed off when you'd tell them it's at 6, and by their mental calculations of 2q20, it should be at AT LEAST 18 by now!!

[djh123]

The assay's ability to accurately determine a glucose in capillary blood is the limitation, not the display. At levels this high most institutes have policies that stat plasma glucose levels should be sent to the lab. Even in lab to get ab accurate reading they need to dilute the sample at levels this high.

OK, thanks for the explanation. I didn't know that, nor does anyone where I work. And no, we don't ever do a stat lab on it, but I'll keep that in mind for sure.