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Discussion

Physicians order

I had a heated debate amongst nurses today, including the unit manager. I received in report that a dialysis patient get a UA/C&S. Usually, when I see this order I know right away it is a clean catch specimen, but considering this patient has dialysis t/o the week, barely voids. I asked the unit manager if I needed to get an order stating UA/C&S by straight cath. She was hesitant in saying yes, but I have learned through working in other facilities, the order needed to state how it is to be obtained. The UM I could tell wasn't sure and just agreed with me and said yes, to go ahead and fax the dr. When night shift came in she was furious that I had not performed the procedure even though I told her I had not received the clarification from the dr yet. She, and another ease dropping nurse stated I didn't have to do that and that I should've just done it. Am I right in doing so?

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    If they want to perform an invasive procedure without an order, let them. I would not. Period.

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    At my place of employment, when an order is received to obtain a UA specimen, our policy allows nurses to obtain it any way we can reasonably get it, whether through clean-catch midstream, straight cath, or otherwise.

    If the patient had an indwelling Foley, would you clarify the order to state that it must be drawn from the catheter's port? I wouldn't!

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    Unless you are familiar with the policy and/or look up the policy, I also would get a clarification from the MD.

    Not to mention the fact that if your patient doesn't produce much urine, it may take more than once to straight cath for a sample. Which would then take perhaps bladder scanning for urine first. Never the less, there should be some policy in place to address this issue.

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    • Experts

    I would get an order to do the cath. They end up with a UTI or already ahve one and have one and payment is refused because of a nosocomial infection and you didn't get the order...you would be the one in trouble...unless of course of your facility has the written policy as Commuters facility does.

    The other nurse wants it done...let her get it.

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    Get an order.

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    in the day of needing a Dr. order to put lotion on someone's skin,

    you bet I'd get an order to cath

    if the u/a was ordered, because the pt. was symptomatic

    i'd have sent more than one fax, but not cath without order

    besides, it wasn't a stat order either

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