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?

[3ringnursing, BSN]

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.

[Ruby Vee, BSN]

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.).

Yeah, sorry. Someone already pointed that out. I blame sleep deprivation for thinking that a "tapper dose" is actually a thing. DUH!

[Ruby Vee, BSN]

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

Decades ago, one of our pulmonologists had to have heart surgery. He was a bigtime smoker with no intention of quitting. The cardiologist wouldn't order smoke breaks, so he bullied one of the residents on the pulmonary team into writing the order. But he was in the ICU, so none of the nursing staff had the time to take him out to smoke. That was OK -- he knew how to turn off the monitor before he disconnected himself and he knew to escape while a fresh CABG was coming back from surgery so everyone would temporarily be helping out with their patients on alarm watch in the new patient's room. (It alarms in the other patient's room, so you can run and check your patient.) Only if you turn off the monitor correctly, it doesn't alarm "asystole" or "disconnect." His room was right next to the back stairwell, and he used the back stairwell all the time to run down the one floor to his office. So off he went. What he didn't remember was that he needed his ID card to swipe back in to the hospital from the stairwell. He didn't have his ID card on him -- or pants, or slippers -- just the ICU gown. He was locked into all-glass enclosed stairwell on a rare sunny day with the sun heating up the place like a greenhouse. Wasn't able to get out, and banging on the door didn't attract attention since the staff didn't use that stairwell, not needing to get to a private office on the next floor down. When his nurse missed him, we checked all of the smoking areas outside the hospital, then we checked his office . . . no one thought to check the stairwell because no one ever USED the stairwell.

[Ruby Vee, BSN]

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....

I would think not -- and I'll bet he's reminded of that night from time to time.

[3ringnursing, BSN]

Decades ago, one of our pulmonologists had to have heart surgery. He was a bigtime smoker with no intention of quitting. The cardiologist wouldn't order smoke breaks, so he bullied one of the residents on the pulmonary team into writing the order. But he was in the ICU, so none of the nursing staff had the time to take him out to smoke. That was OK -- he knew how to turn off the monitor before he disconnected himself and he knew to escape while a fresh CABG was coming back from surgery so everyone would temporarily be helping out with their patients on alarm watch in the new patient's room. (It alarms in the other patient's room, so you can run and check your patient.) Only if you turn off the monitor correctly, it doesn't alarm "asystole" or "disconnect." His room was right next to the back stairwell, and he used the back stairwell all the time to run down the one floor to his office. So off he went. What he didn't remember was that he needed his ID card to swipe back in to the hospital from the stairwell. He didn't have his ID card on him -- or pants, or slippers -- just the ICU gown. He was locked into all-glass enclosed stairwell on a rare sunny day with the sun heating up the place like a greenhouse. Wasn't able to get out, and banging on the door didn't attract attention since the staff didn't use that stairwell, not needing to get to a private office on the next floor down. When his nurse missed him, we checked all of the smoking areas outside the hospital, then we checked his office . . . no one thought to check the stairwell because no one ever USED the stairwell.

So … how was he found? Tell the rest of the story!

[Nurse_]

" Ok to use ET tube"

[DRYnurse]

Many years ago, we had a sweet little 90+ year old lady who was unfortunately badly constipated. Her doc made rounds and wrote the following order:

1. One quart cooking oil retention enema - get from dietary

2. If that doesn't work, try dynamite

We soon got a call from the pharmacy asking if we could get the order changed. Reason: dynamite was not on the formulary.

[margaret11]

This looks fun. Isn't levaquin MG? Not GM? And typical dose is 250 or 500 ...no? And every 48 hours for 2 more days would be one more dose I think...depending on last dose. Don't give 750 GRAMS. Ha!

[simplyjenny]

Re the pulmonologist in the stairwell: I NEED the rest of this story!

[choughlesRN]

Physician consult for inpatient rehab. Reason for consult read, "Please get this guy into rehab. He keeps falling and going boom".

[perfectbluebuildings, BSN, RN]

"Do not call me again tonight unless the patient is actively coding!!" (pediatric patient no reason to believe they would code but had many changing medical needs throughout the shift that needed doctor's orders/intervention, and doctor just didn't want to deal with them anymore.) Yikes.

[EKUGRAD, BSN, MSN, RN, CNS]

Former night nurse here. I can dig that order.

Night Psych nurse here. There have been nights I would have killed for that order !!