Prioritizing infusions

[sistrmoon]

Let's say you have a patient with a wound MRSA infection who also has low platelets(7). You have one hour left in your shift. Platelets are ready but if you hang them, antibiotic will be late. Pt only has one peripheral and is a difficult stick refusing further access attempts. Which do you hang? Two of my experienced coworkers disagree.

[sistrmoon, BSN, RN]

Do I understand this right- you are giving platelets to a patient who has no signs of bleeding or invasive proceedures planned? Platelets do not "build up" in the patients system the way you can see with PRBCs transfusions. Any increase in platelet count will be very transitory. It is a waste of blood products and a risk to the patient-(the more foreign blood products given to a patient the greater chance of developing sensitivities that can result in very dramatic reactions with subsequent transfusions) to give platelets just based on a number. Not that it is your choice to give or not to give the platelets- that is the doctors call, but given the fact that the platelets are likely to do no good and may cause harm, and the antibiotic is likely to do some good and do little harm, I'd give the antibiotic and let day shift waste thier time.

I agree with you, but not my call. They always transfuse under 10.

[MunoRN, RN]

I agree with you, but not my call. They always transfuse under 10.

Writing the order isn't your call, but evaluating the appropriateness of the order certainly is, as well as helping to educate Physicians about the principles of blood product transfusion therapy.

[suanna]

Writing the order isn't your call, but evaluating the appropriateness of the order certainly is, as well as helping to educate Physicians about the principles of blood product transfusion therapy.

Yep- Nurses do do that. And the doctors are always so polite and grateful when they are "educated" by the night shift nurse calling first thing in the morning about the treatment they ordered for correcting a patients "critical" lab value. I must say on the few occasions I felt the need to talk an attending into changing an order I myself have gained some education- mostly in colorful turns of phrases I haven't thought of or interesting anatomical maneuvers I could try. Now-a-Days I try to pick my battles and avoid wasting my breath on things I know they are not going to change. All it is going to do is convince a doctor I'm a troublemaker and a Know-it-All.

[MunoRN, RN]

Yep- Nurses do do that. And the doctors are always so polite and grateful when they are "educated" by the night shift nurse calling first thing in the morning about the treatment they ordered for correcting a patients "critical" lab value. I must say on the few occasions I felt the need to talk an attending into changing an order I myself have gained some education- mostly in colorful turns of phrases I haven't thought of or interesting anatomical maneuvers I could try. Now-a-Days I try to pick my battles and avoid wasting my breath on things I know they are not going to change. All it is going to do is convince a doctor I'm a troublemaker and a Know-it-All.

If a doctor wants to view a nurse doing their job and advocating for their patients as a troublemaker that's their problem, it only interferes with you doing your job if you let it.

In my experience it's only when the majority of the nursing staff fails to advocate for good patient care that the Physicians respond this way on a regular basis. When their questionable decisions are almost always questioned they tend to know better than to disregard the nurse doing their job because those events are the norm, not the outlier.