Orders from hell...

I'm sorry, but what is a "tappered" dose?

I believe its supposed to be "tapered" dose, which is when the dose gradually decreases until they are no longer taking the medication (ie. Prednisone 50mg PO Daily x3 days, then 40mg x3 days, then 30mg x2 days, etc.).

I had a doctor order smoke breaks for a COPD client. I had to have long conversation with him about what can be prescribed.

An ECG to diagnose death, eh. And he didn't make you prove that the leads hadn't fallen off?

No, thank god....but we also made sure to print the tele strip for the same timeframe...lol. By the way, he never did that again....

Wow! From where do they get their nurses and CNA's ?

Not sure...but it's endemic in some of the nursing homes. I would hazard a guess and say "none of the schools I attended" because all my instructors would have killed anyone who didn't get vitals and record them....

I had a doctor order smoke breaks for a COPD client. I had to have long conversation with him about what can be prescribed.

Actually, it is a legitimate order in some of the LTCs I work in where smoking is still allowed for some of the residents. Do I agree? Nope, but I also feel like if you're talking about someone in his or her 80s or 90s and this is one of their few pleasures in life, I provide the education and then write safety orders. Family or friends have to provide the cigarettes and the facility has designated smoking monitors and times. I know of at least a few folks in each of those buildings who like being the smoke monitor because they go out and smoke, too.

Most of the buildings, though, are smoke-free now which I like much better.

I also write orders for alcohol for the intermittent resident as long as the family or friends provide it.

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 machines are only calibrated to be accurate up to a certain number so a 599 could be 601 or 899.

Even the low numbers are only accurate down to a certain number and so anything under or above the parameters set by the manufacturer needs to be confirmed by a lab draw.

6u won't help any blood sugar that high. 😃

You'd be amazed how even surgeons don't use sterile technique on their postop dressing changes. Took my loved one to surgeon for first postop visit. First, the assistant took off the dressing with scissors that were likely used on 50million other patients,without so much as being wiped down by alcohol between patients.

She then was going to take out stitches, until we reminded her that it had only been a week since they were placed and asked her to check with doctor first. It was bad enough she insisted on removing the steri strips without checking.

Then he comes in, checks wound using clean (not sterile) gloves, doesn't wipe it with anything, and proceeds to dress it with clean gauze. He had used his gloved hand to adjust the location of his stool before putting the gauze on the wound. If loved one doesn't get infection, it will only be because of my prayers.

So orders to chart VS, I&O, etc., orders to bathe, are not far-fetched at all. The orders you got were likely written by a doctor who has seen it all and wants to ward off wrong behaviors, not personally directed at you.

I worked with a CT surgeon who always whipped out his own nasty looking scissors to remove chest tubes. I'd always pad down the bed and the floor with chucks, and lay a sterile suture removal kit next to it. When he was ready I'd peel back the top and leave it near him … he'd always ignore it, pull out his funk covered scissors from his lab coat pocket, snip, snip - yank out the chest tube (insert patient screaming here) blood flying, and fling it to a section of floor without any chucks. Zip - he'd pull the sutures closed like purse strings (the patient still yelling in agony, trying desperately to find themselves through the haze of pain) spin on his heel and walk out - leaving me to comfort a writhing patient, and a nasty mess to clean up while cursing under my breath.

One day he left his fancy surgery telescope glasses sitting on the counter and left … I tried them on, played with them a bit, then ran a saliva covered finger down each lenses before putting them snuggly back into the padded case. Let him chew on that for a while as he obsessively polished them while wondering what happened to them.

Many moons ago I worked in a large teaching hospital. We all dreaded July 1 when the new crop of very green interns made their appearance. Second week of July, new intern writes orders for his new admission and remembers hearing his resident tell him to write prn orders for anything that could possibly come up so the night nurses won't call and wake him up. He was totally shocked and annoyed when I called him cause his patient wanted a sleeping pill. "Check my orders..... I already wrote for something to help him sleep" he says in his most annoyed voice." Yes, you did" I tell him "but are you sure you really meant to order MOM 300 cc po QHS prn sleep, cause if I gave that, sleeping would be the last thing the patient would be doing!!" Not to mention this is not the correct dose for this med! Of course he didn't believe me, the lowly nurse, and had to check with his resident before changing the order! Lol

Ah yes … the dreaded July 1st of any year. Signifying that all the training you put into the interns over the past 365 days was just flushed down the toilet, and you had to start from scratch all over again reinventing the wheel.

It was amazing how those nice, sweet medical students now interns could turn so quickly into nasty, know-it-all gits.