I'm a new grad, I've been in a step-down/tele unit for about two months now. At my hospital, almost all of the patients are prescribed Lovenox for DVT prophylaxis, even if the patient is mobile and gets out of bed occasionally. People get TED hose and SCDs sometimes, too, but they don't comply because they're so uncomfortable.
Most patients don't say anything about it, they just let me give them their shot. But a lot of times they whine about it, and make it clear they hate those shots. I've also had a couple patients refuse it, saying that the doctor told them they don't really have to have it because they get up and move.
My question is this. For the patients that are mobile, and complain about getting the shot, would it be out of line for me to tell them they have a right to refuse it, and since they get up and move around they aren't at a high risk for getting a DVT? Or should I just keep my mouth shut about it? So far I haven't been holding it unless my patient refuses it without any additional information or prompting from me, but some of them hate it so much I'd hate to keep doing it to them if it wasn't necessary.
We anticoagulate everyone. Ortho pts get Lovenox. Generally others get heparin or lovenox is ordered and they autosub heparin anyways. The pt has the right to refuse but education is essential.
I wasn't standing in the room when the doctors said that, so I don't know for a fact that's what they said verbatim. The reason it struck me as odd was because I have had several patients telling me that over the past couple of weeks.
At my hospital, nurses do round with the doctors, but I work nights and that doesn't happen at night. I guess maybe if it keeps happening I should bring it up in report so they can bring it up during rounds.
It would be infuriating for a patient to have a PE, then find out that a doctor has been telling them they don't need Lovenox, OR to find out a nurse hasn't been giving it because the patient doesn't like getting shots.
1) educate them about the pros/cons of refusing the meds
2) position the needle very near the site and when you push it, push it fast so it doesnt hurt (based on my experience, also i also ask them if it hurts). it helps me build rapport with them and also get feedback if it stings so i can improve on it
3) if the doctors say "its not needed". then document it. even if its just stated by the patient. then document it like it is (patient refuses lovenox saying "doctor told me its not really important so i dont want it"). this way YOU COVER YOURSELF
4) also, if the doctors say "its not needed". maybe its not anymore. like if a patient is really ambulating most of the time.
but confirm to the doctor if its ok, or if they want to add an aspirin order. usually they do order aspirin or coumadin. just make sure for your patients safety. THATS OUR JOB :)
-spent most of my time on short term rehab, and then ortho floor
was recently in to get my gallbladder out, I have a multitude of health problems. Ended up staying 2 nights.
second night the nurse said she was going to give me this drug via orders from on duty head surgeon (not my doctor)
looked it up on my phone and refused it.
i know it's a good precaution.... Unless you are a patient with mastocytosis or any type of mast cell disease.
we carry an usually high natural Endogenous Heparin level.... Mine is at the same level as someone who receives heparin regularly.
this could have been disasterous.
of course my hospital also requires me to beg to have my cortisol checked halfway to an adrenal crisis, been down as low as 0.4 when they finally check.
so I've learned to just not trust any facility or docs in charge, they don't read my chart.
Shanua
20 Posts
We anticoagulate everyone. Ortho pts get Lovenox. Generally others get heparin or lovenox is ordered and they autosub heparin anyways. The pt has the right to refuse but education is essential.