Questioning Doctor's Order

pagandeva2000, LPN · Nov 1, 2008

Can you tell I've been down this road before?
Glad to be of help!

Well, because you survived it with your integrity and license intact, I'd ask you for advice and suggestions anytime! Thanks again for sharing your thoughts and insights!

hottiemom04, BSN, RN · Nov 1, 2008

The whole point of this thread is to DOCUMENT...DOCUMENT...DOCUMENT...no matter how minute of detail it may seem at the time, it may be crucial when a question arises:spbox:

Scrubby · Nov 1, 2008

It's not easy questioning doctors orders especially when your new to nursing.

I almost overloaded a patient with digoxin. The doctor had crossed out the morning dose from the chart which the patient had received that day and I was given an order to give more in the afternoon. I can't remember the exact dosages but he would have received a pretty high dose in one day. I didn't notice the crossed out order until I was about to give it and I asked a more experienced nurse about it. She was horrified said it could be harmful so I rang the doctor about it.

You'd think the MD would have appreciated someone catching this. But no, of course I was the idiot even though she had written down give this afternoon.She yelled at me in the nurses station in front of everyone and said well of course you wouldn't give it and tried to make herself look good and me bad. I told her that she'd written the order for that afternoon, here it is in black and white, she should be more careful instead of blaming the nursing staff for her carelessness.

I'm glad I don't have to give drugs any more. Too risky, especially when you have idiot doctors like this who just blame the nursing staff when they don't do the right thing.

Batman24 · Nov 2, 2008

I do it this way:
MD notified of holding scheduled lopressor administration d/t HR of 50, BP 88/38 & no parameters given for holding med, no new orders rec'd, charge nurse notified.

Well done.

In regards to pharmacists I document who I spoke to, time, why, etc. I do it as loicatus does above...simply and without any personal input.

pagandeva2000, LPN · Nov 2, 2008

What I was trying to gain (and received fantastic insights from you all) is how to document without it seeming to be negative, or judgemental charting. That can be difficult sometimes, especially for those who are not experienced in doing so. Learning this will save any of us. For me, I ain't doing it if it doesn't seem to be safe. However, if I decide not to, I want to be able to document it correctly; you know how it is, tainting but not tainting it...the same games that the doctors play.

Editorial Team / Admin · Nov 2, 2008

What I was trying to gain (and received fantastic insights from you all) is how to document without it seeming to be negative, or judgemental charting. That can be difficult sometimes, especially for those who are not experienced in doing so. Learning this will save any of us. For me, I ain't doing it if it doesn't seem to be safe. However, if I decide not to, I want to be able to document it correctly; you know how it is, tainting but not tainting it...the same games that the doctors play.

It's good you are thinking in this manner, Deva.

...without it seeming to be negative, or judgemental charting

Document the facts, not supposition, opinion, trivial interjections, bias, etc. You are not judging; you are stating facts.

pagandeva2000, LPN · Nov 2, 2008

It's good you are thinking in this manner.
Document the facts, not supposition, opinion, trivial interjections, bias, etc. You are not judging; you are stating facts.

You are correct. What could have happened to me is out of being so frustrated with the entire ordeal, I would be tempted to write ":banghead:Idiot physician who got his license from a matchbox told me to give such and such...I then said to myself 'he must be off of his rocker' and told him to kiss where I twist"... (exaggerating, but you get my drift... :lol2: )

Editorial Team / Admin · Nov 2, 2008

You are correct. What could have happened to me is out of being so frustrated with the entire ordeal, I would be tempted to write ":banghead:Idiot physician who got his license from a matchbox told me to give such and such...I then said to myself 'he must be off of his rocker' and told him to kiss where I twist"... (exaggerating, but you get my drift...)

hahahhaa - uh, no. LOL!!

loricatus · Nov 2, 2008

You are correct. What could have happened to me is out of being so frustrated with the entire ordeal, I would be tempted to write ":banghead:Idiot physician who got his license from a matchbox told me to give such and such...I then said to myself 'he must be off of his rocker' and told him to kiss where I twist"... (exaggerating, but you get my drift...)

I think we have the makings of a new thread here:lol2:

CHARTING WE WISH WE COULD GET AWAY WITH

MiaLyse, APRN · Nov 2, 2008

I've had this happen. My patient was NPO after her swallow study showed that any consistency resulted in aspiration. Dr. comes in and gives her jello and orders that she can have that and something else I don't remember now. I brought the swallow study results to him and he said to me, "how would you like it if you were told you couldn't eat anything?" I was thinking, "what?" I did not follow the order, I followed NPO, notified the supervisor who notified the DON. DON over rode the MD and ordered the patient to stay NPO. I don't know what happened after that.

I still don't understand what he was thinking...

BinkieRN, BSN, RN · Nov 2, 2008

i've had patients with known allergies to penicillin, and they've ordered them, however the md writes "known allergy " as part of the order.
as far as administering, i was of course very cautious and questioned everything from the need for it to specifically what the patient has felt previously.
when i documented, i noted that it was a known allergy, approved by the md, s/e explained to patient and so forth . then after it was given i documented what the response was (then breathed a sigh of relief :uhoh21:)

i would not give any med with a "known allergy"! no way, no how! if the doctor wants the patient to have it he/she can give it themselves. if a patient is not truly allergic, i.e. codiene makes them nauseated, then i would give it. since it's not a true allergy, there would be no reason to order it with "known allergy" but rather, causes nausea give with zofran.

pagandeva2000, LPN · Nov 2, 2008

I would not give any med with a "known allergy"! No way, no how! If the doctor wants the patient to have it he/she can give it themselves. If a patient is not truly allergic, i.e. codiene makes them nauseated, then I would give it. Since it's not a true allergy, there would be no reason to order it with "known allergy" but rather, causes nausea give with Zofran.

Sometimes, resources have conflicting information. For example, the Azactam situation; the drug information guide provided in our electronic charting system says that it should not be given if patients have allergies to penicillins (which, then, I would have questioned the same about cephalosporins). Two different nursing drug guides-2006 one says that allergies to penicillins/cephalosporins may not be a reason to hld the drug, but observe closely for immediate hypersensitivity symptoms, 2008 one says to be alert if allergies to any antibiotics, and wikipedia says this: http://en.wikipedia.org/wiki/Azactam. This is why, to me, documenting the resources, including the pharmacist makes sense, because I did see that the patient had been on it a few days with no reaction noted. I think I would have been more comfortable, however, if the doctor also recommended within the order to have something on standby in case there was a hypersensitive reaction. I tell you, the headaches of nursing... :banghead: