Questions about Drs orders HELP!! Please!

[kwagner_51]

This happen on my 11-7am shift last night. I work in LTC. Here is what happened. A pt. [not mine] was agitated and wet. I helped the CNA walk him to the BR. he told me he was going to die!! Scared the bejeebies out of me!! I tried to divert his thinking by asking what he did for a living. He couldn't remember.

Got him back in bed and we left the room. About a half hr later I could hear him moaning and yelling. I told the other nurse that I was going to get a quick set of vitals on him : 165/92 98.6 24 110 85% c/o chest pain and couldn't lay still on the bed. I got the other nurse and she also assessed him. She sent him to the hospital with elevated BP and chest pain.

Shift continued until the ph call from the hospital. DX UTI!! When asked what the telemetry said they acted like the had NO CLUE what she was talking about! WTH!! When she said EKG they were like yeah its normal!!

Anyway, here is the question for all you older much more experienced nurses.

The order was for levaquin Q48hr x 7 pills = 2 weeks.

We didn't understand the order so she called the hospital back. Talked to a Dr with a thick accent. he said it was 500 mg Levaquin every other day x seven pill and that = 2 weeks!

Has anyone heard of this? I didn't know that ATB could be given every other day!! I know if that was my prescription I would forget to take the dang pills.

Any insights would be greatly appreciated as I try to learn more about my profession!!

[purple_rose_3]

I worked in LTC for a year. Never seen this type order.

[txspadequeenRN, BSN, RN]

I have never heard of a ABT order like that in LTC unless it is a IV med. I would be calling the medical director of your facility to see if he wants to continue that order or change it.

[Inquisitive one]

May be d/t decreased renal function.

[Inquisitive one]

Dosing based on creatinine clearance.

[lauralassie]

Seen orders like this due to renal function as well as chronic infections that have been treated with many atbcs in the past. The order is just as it states. Don't know why they didn't do an ekg. Perhaps when they talked to the pt he adimentley denies chest pain. Although in our ER anyone who is debilitated or older gets and EKG (sometimes it seem they get one even if they're there for an STD). I would be sure to reasses the pt frequentley for further sx. Also , is the pt hospice or DNRCC or the likes ?IN that case an antbc would be appropriate, EKG may not be. If the ER sent copies back with him look at what his "cheif complaint" was ,. Many Dr's go stricktley by this. sorry about bad spelling.. to sleepy to look stuff up, just trying to stay awake while my cake bakes after night shift.

[Daytonite, BSN, RN]

Karen. . .in all the LTCs that I worked, we were not allowed to accept orders from any other doctor except the patient's doctor. So, when we had a patient who came back from doctor's appointments or the ER with prescriptions we called their attending physicians (doctor of record) at the nursing home and got a verbal order from them that it was OK to give those medications. At that time, the patient's doctor can then modify the order if he desires since he knows the patient. He also has the option of calling and speaking with the ER physician if he desires. We still saved all the documentation that came back from the ER with the patient, including the prescription. However, it was the patient's physician of record at the nursing home who's order was the only one we could accept.

You might want to check your policy manual on this, but I'm betting that your facility probably does something similar. In any case, this patient's doctor should be called and notified of what has occurred as a matter of notification anyway or the facility and you nurses might get into trouble for not keeping him informed of a change in the patient's condition.

[Altra, BSN, RN]

I have seen Levaquin & other abx prescribed every other day. Think about decreased renal function in the elderly.

[jetscreamer101]

I've seen it QOD also. I even had one that was ordered 3 x/week x 3 weeks.

[NurseguyFL]

What others have posted is correct. MDs will sometimes order semingly weird dosings of certain types of medications specific to the patient's condition. Renal alternation is usually the reason. Some doctors may write that each dose of certain meds should be adjusted by the pharmacist specific to the patient daily lab results. Its called renal dosing. Even if the MD writes for a specified dose, pharmacy will automatically check the patient's labs before they mix and send out certain drugs anyway, and if they see that the ordered dosing is unsafe for the patient they usually hold the med until they verify with the MD.

[arizonanurse]

Levaquin is often given q48 hrs for renal patients. Same with Vanco...sometimes that is given every 4 or 5 days, even, depending on how bad the creatinine clearance is.

[CoffeeRTC, BSN, RN]

You still have to call their doc to verify orders when they return.