Pronunciation

You will find repetition in the disease names and medications that you use. Keep a notebook and write them down so you can review the condition and practice saying the names out loud.

FYI, it's "generic", not "genetic"- that one letter can make a difference!

re: deciding which doctor's orders "to do or not do", you may want to explain what you mean. Depending on the situation, that can get you (and your patient) into a very bad situation.

1 hour ago, TriciaJ said:

What Dr's orders NOT to implement? That doesn't make sense.

 

Thank you for your advice. for example, I had two doctor orders 1) chart vital signs q8h and 2) order said chart vital signs q1h. I was little confused doo I chart q 8hr or q1h.

Thank you.

2 hours ago, Jedrnurse said:

You will find repetition in the disease names and medications that you use. Keep a notebook and write them down so you can review the condition and practice saying the names out loud.

 

Thank you for your advice.

Always err on the side of caution when you're not sure.

You're not going to harm a patient by checking their vitals hourly. However, if you wait 8 hours to check vitals for a patient who should have been checked hourly, the patient could decline without anyone noticing and have a poor outcome. 

At the same time, you don't have time to check everyone's vitals on an hourly basis just for fun.  If there's not a clinical indication, call the doctor and get an order to discontinue hourly VS. If they're annoyed that you called, who cares? That's on them, and next time they should only order what actually needs to be done.  

Just remember, if anyone tells you something like "Oh, hourly vitals are ordered for all of the patients around here, but we really just check q8 on most," that's crap. You can't willy nilly ignore active orders just because that's how things are done in your unit. Don't knowingly follow bad practices just because others might.

Ask yourself the following for every order:

-Does this order make sense for my patient? Is there a clinical indication for why my patient needs this?

-Is this order safe for my patient right now? Consider the safety of order parameters, and consider how your patient's vitals, labs, allergies, and assessment findings might make the order unsafe.

If you see that an order is unsafe, don't carry it out. Document why you've held the order and that you've notified the physician. (You don't need to notify the MD for holding orders that already have given parameters for holding.)  If the order itself is dangerous, like a medication from the patient's allergy list or an unsafe dose, have the provider discontinue the order completely so that no one else accidentally gives it later.

-If you are unsure why an order is written for your patient, run it by your peers. Your patient might also know why from discussions with the provider. If no one can figure out why your patient needs a questionable med, test, procedure, etc. based on the clinical picture, seek order clarification.  There's nothing wrong with asking the provider their thought process. That's how errors are prevented. Maybe the provider entered an order in the wrong chart, for example.

Maybe ask a peer how to pronounce the most common meds or conditions in your unit, but otherwise, even experienced nurses often mispronounce things. You can always look up pronunciations online and practice at home.  You'll learn with time! 

Some computer programs are very prone to errors. We are using Cerner where I work and it is particularly difficult on the ordering end of things. I've been working the ER and acute care, the acute-care side of things is a real cluster and I finally told them I cannot work with this system, for many reasons, and will only work ER from now on. Half the doctors seem to be clueless in how to put in orders accurately.