The worst or strangest orders you have seen...

Daytonite, BSN, RN · Jul 20, 2007

Just out of curiosity, what was the rationale behind this?

I'm sure you can imagine what most of us thought! I never personally asked the doc. Too intimidated. I was a much younger nurse at the time and docs were still kings then. Most of us just complained about this to the head nurse. She told us to just ignore the order. He never had a hissy fit about it.

At another facility, we had a really handsome younger doc, full of beans and attitude, who would re-write an order that hadn't been carried out in landscape and huge letters across an entire order sheet just so it would get noticed. I clearly recall one smart alec nurse telling him "this is no way to get nurses to sleep you, doc," and him turning beet red. :lol2:

Roy Fokker, BSN, RN · Jul 20, 2007

Post surgical patient.

Morphine 1-2 mg IV Q30 mins PRN

On a post ortho surgical patient - 45 years old, alert and oriented.

Why the heck do they not order a PCA????!!!!

AAAAAAAAAAAAAAAAAAAARGHG! Burns me up no end when I end up having to push 1 mg out of a 2 mg syrette Q hour and having to WASTE all of the "excess" and the "end of the shift".

As if I don't have enough to worry about!!! :mad:

If that wasn't bad enough, we have some of the surgeons ordering IPPB Q4hrs.

Sounds innocuous, right? Well, what about when patient is asleep with pulse ox 98% and lung sounds clear?

at 2300?

at 0300?

at 0700?!!!!

See what I mean? We've repeatedly requested them to make the IPPB either PRN or at least Q4 'while awake'. These are routine post op surgical patients.

Some of these STUPID orders really tick me off - because they are redundant and time consuming!

cheers,

Ambien 5-10mg po q4-6h prn.
sweet. 10mg of ambien every 4 hours. They'd really be asleep then.
This was a verbal order over the phone from an a-hole doc who was bothered that i called him, at 5pm, to get an order for Tylenol for a HA. I said my spiel, and then "and she has no PRN orders". (this was an antepartum patient). he said "and why would she?" then, after the order for tylenol said "let me give you some other things, too, so i dont keep getting called"

I once had an anesthesiologist order me to:

"Give Dilaudid 6 mg IVP now. Repeat in 10 mins".

I repeated the order thrice asking him to confirm what he was saying - each time stating patient's vitals (post of patient. Systolic barely touched 100. Resps 14). The third time, he snapped and said "Just do what I say! You called me for help! It's not your place to question my orders!!!"

I says "Yes Sir! Whatever you say Sir!" and hung up the phone.

Never did carry out that order.

cheers,

JennaRN1006 · Jul 20, 2007

hehehehe on the stat banana!! thats great. Also, the caffeine, how can us nurses get some! :lol2:

Stat banana... for patient with low K... LOL new resident. Oh, and 500 mg caffeine IV... that was an interesting one...
Float heels... always good to be reminded of that one... LOL

JennaRN1006 · Jul 20, 2007

I saw the caffeine used in premies when I did my OB/peds rotation. I was lucky to spend sometime in the NICU. They used caffeine as a stimulant so the babies would breathe.( thats what the nurse told me...Im not in the NICU, so I maybe wrong)

Well you learn new things all the time. I haven't came across a patient that desired one... but it makes sense (I guess) that a patient is really sore or knows they will be up a lot (due to diuresis) and would like a foley to assist. :)... with major diuresis that would probably be a good thing.
Like I said before, I really did not know about caffeine medically but it totally makes sense. Just curious, why do you give it to premature infants? I have never worked with babies before.

JennaRN1006 · Jul 20, 2007

maybe we should make the new interns supply the nurses with coffee every morning. LOL a girl can wish

at 5:00am 500mg of IV caffeine sounds really good to night shift. Maybe we could get the DR. to order for the nurses

arpeggiated · Jul 21, 2007

PLEASE

PLEASE elevate legs on three pillows each

PLEASE

Are you gonna come buy the pillows? Because sometimes it's an act of God to get one pillow per pt, let alone 7! Especially on a A/O pt c BRP.

Same doc:

PLEASE

PLEASE d/c pt. Same orders as yesterday

PLEASE

I would love to d/c the pt. Trust me, we don't keep incontinent quadriplegics here for fun. Would you like us to d/c pt home? or to a SNF? And by the way, can we clear up that little problem where the pt's family has been reported to APS?

*rolls eyes* If I ever have to be admitted and he's on call, I will go AMA and come back in the morning when one of the other docs is on call. His orders are just ri-donk-ulous.

MAISY, RN-ER, BSN, RN · Jul 21, 2007

The worst orders I receive is when one of our ER docs(assistant director) writes orders from my nursing notes/triage notes. Full works ups, meds, and tests without seeing the patient.(also the obvious, previously charted commonsense ones, pulse ox, cardiac monitor, oxygen etc...) I WILL NOT FILL ORDERS(unless standing orders like aspirin, oxygen or nitro) UNTIL PHYSICIAN SEES PATIENT! So my charting goes something like this....patient to room ambulating with steady gait accompanied by family member-alert and oriented, c/o pain.....awaiting physician evaluation. 10 minutes later-narrative with vitals-lined and labs at bedside-awaiting physician evaluation. 30 minutes later, called physician to report patient wants to see physician-physician says orders up-report-cannot follow throught without your exam. physician pissed off-but sees patient-often changes orders or adds based on exam. Always bitches me out, ask me if I care? NOPE!!! This has gone on since I was a brand new nurse being precepted-as I spend more time working with him, I am amazed that anyone encourages this behavior. Obviously, since I havent been written up, I am doing the right thing!

allnurses Guide · Jul 21, 2007

At another facility, we had a really handsome younger doc, full of beans and attitude, who would re-write an order that hadn't been carried out in landscape and huge letters across an entire order sheet just so it would get noticed. I clearly recall one smart alec nurse telling him "this is no way to get nurses to sleep you, doc," and him turning beet red.

THAT is priceless . . . . . :D

steph

Chunky612 · Jul 21, 2007

I had a resident write this order...

Please make patient better BID and PRN

BluntForceTrauma · Jul 21, 2007

We had a patient who had a history of ETOH and was in withdrawal. He kept screaming "Bugs are crawling on me!" The nurse paged the doctor @ 3 in the morning to tell him this, needless to say he hung up in her face.

The next morning during his rounds, he wrote "Bug checks q2h".

leslie :-D · Jul 21, 2007

md wrote following order for g-tube pt.

"may have food po, as tolerated."

i questioned md about order since pt had swallowing eval prior and was strict asp precautions.

md stated he could be cited for denying pt "a pleasure of life".

pt's brother brought her choc chip cookies.

she had 1, aspirated and died next day.

md never wrote order again, for any g-tube pts.

leslie

MadisonsMomRN, BSN, RN · Jul 21, 2007

md wrote following order for g-tube pt.
"may have food po, as tolerated."
i questioned md about order since pt had swallowing eval prior and was strict asp precautions.
md stated he could be cited for denying pt "a pleasure of life".
pt's brother brought her choc chip cookies.
she had 1, aspirated and died next day.
md never wrote order again, for any g-tube pts.
leslie

thats awful! :down: