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UGH what do you think?!>?

Posted

Specializes in med/surg, ortho/neuro, ambulatory surg.

I had a pt last night that had a total knee replacement done on the 21st, well this pt last night was tachycardic, irregular HR and running a temp of 102.4. Previous shift medicated him with tylenol and got the temp down to normal. At 0400 lab comes to draw blood and I just happen to see her in the hallway and she states that the pt told her he had ran a fever and she was going to do blood cultures (as she was filling the bottles with blood to do the blood culture.) I thought oh ok couldn't hurt whatever and didn't think anything of it other than I didnt know lab could just decide what labs they thought were neccessary but whatever. At 0730 the nurse relieving me got a phone call from lab saying they had blood culture samples but no orders and that they needed orders to run them. I stated what had happenned and that they were no orders, the nurse getting report said well just write the order. I wrote the order and thought nothing more of it and came home. I was just called at 1400 by the charge nurse and informed that the Dr for this pt was upset and wanted to know why we ordered Blood cultures I told her what happenned and she was very understanding but said not to ever do it again and that she would let it go and not write anyone up. My question is ok I know I should have questioned this more but I was tired and ready to go and thougt it couldn't hurt to figure out why this guy was running a temp after surgery what would you have done?

That is an easy mistake to make. But you definitely can't write orders without getting a doctor. The lab girl should've known better, she was probably trying to save herself a trip. Because it sounds like the cultures did need to be ordered and she would've had to come back and draw them.

You should've had the day shift nurse call the doctor for a phone order and to update the patient's condition. I would think the day nurse would have known to do that.

Well, at least you know now and will probably never make that mistake again. I wouldn't stress it, especially if the charge nurse isn't.;)

NotReady4PrimeTime, RN

Specializes in NICU, PICU, PCVICU and peds oncology. Has 25 years experience.

I guess I'm really lucky to work where I do. If I think a kid needs blood cultures, they get blood cultures. If I think they need a CBC drawn, they get a CBC. The lab doesn't question it, and the doctor is always happy that I've gone ahead and used my nursing judgment. Oh, and if I think I need another IV then the patient gets another IV.

babynurselsa, RN

Specializes in ER, NICU, NSY and some other stuff. Has 12 years experience.

Most docs I have ever worked with have standing orders for blood cultures for temp greater than 101.

Check your unit policies.

If this doc was upset I guess next time I would just make sure and call him first.

Most blood cultures are collected in 2 different arms, and at times 15 min apart. I feel the phlebotomist probably just pulled two off as she was collecting labs. To me, she was wrong. What if the dr said yes, and how he wanted them. Would they just have used these tubes?

wonderbee, BSN, RN

Specializes in critical care; community health; psych.

I probably would have handled it as the OP did and gotten in trouble for it. However, when I worked in a hospital, it was a teaching institution and the new docs were grateful for good nursing judgment. They would just sign off pretty much on whatever we asked for. It's the trust factor.

tx2007, RN

Specializes in med/surg, ortho/neuro, ambulatory surg.

See like someone else said I didnt question it cause I thought we had a policy for a temp greater than 101 they get blood cultures, I will look for that tonight this particular doc is just an a$$. Anyother doc would have signed it and been like oh thanks for doing that. At least I'm not the only one who would have done it, but I was awake today from 1400-1700 due to this call, just couldn't fall back asleep. Well I am soon to be off to another night of work. Hopefully I wont get any calls tommorrow am. BTW I did have my phone off I just decided to check my messages since I have 2 little kiddos in daycare and thought I should call back before day shift got off at 1500.

CarVsTree

Specializes in Trauma ICU, MICU/SICU. Has 4 years experience.

Why didn't you call the doc if she was febrile and tachy? What were her respirs, what was her sat? Why not dip urine which you don't need an order for? Was the doc aware of the pt's temp from the previous shift?

I don't understand why you don't understand why the doc was upset. It is out of our scope to order cultures (unless driven by protocol which is actually a doctor's order). You also failed to consider other possibilities such as, PE, UTI, pneumonia, atelectasis, etc.

tx2007, RN

Specializes in med/surg, ortho/neuro, ambulatory surg.

I did not call the Dr because this particular doctor will ALWAYS yell if you call him at night. Respirations were fine normal 18-20, O2@2L O2 sats 98%. Never thought about urine dip what does that check for?? Yes dr was aware of temp frmo previous shift his response "give tylenol and I will see the pt in the morning." I did speak with my charge nurse and talked about the possiblity of something being wrong such as PE, UTI whatever. This is amoung one of the MANY reasons I will be leaving this hospital Dr.s are catered to and we are told not to disturb them unless your pt is going down hill. BS that's why they became Dr's and if they don't want to be woken up then they got in the field. I hate that the Dr's here can treat us like crap and we are expected to take it. This particular Dr I called last night for a similair situation and his respons to me was "why are you calling me at 0100 you better make sure no one else needs me for the rest of the night I Do NOT want another call tonight." I HATE this Dr I swear he thinks he is GOD and we should bow down and kiss his feet (um no not me!) Sorry this turned into a rant!:angryfire

Why didn't you call the doc if she was febrile and tachy? What were her respirs, what was her sat? Why not dip urine which you don't need an order for? Was the doc aware of the pt's temp from the previous shift?

I don't understand why you don't understand why the doc was upset. It is out of our scope to order cultures (unless driven by protocol which is actually a doctor's order). You also failed to consider other possibilities such as, PE, UTI, pneumonia, atelectasis, etc.

RN and Mommy

Specializes in Ortho/Neuro.

i had a pt last night that had a total knee replacement done on the 21st, well this pt last night was tachycardic, irregular hr and running a temp of 102.4. previous shift medicated him with tylenol and got the temp down to normal. at 0400 lab comes to draw blood and i just happen to see her in the hallway and she states that the pt told her he had ran a fever and she was going to do blood cultures (as she was filling the bottles with blood to do the blood culture.) i thought oh ok couldn't hurt whatever and didn't think anything of it other than i didnt know lab could just decide what labs they thought were neccessary but whatever. at 0730 the nurse relieving me got a phone call from lab saying they had blood culture samples but no orders and that they needed orders to run them. i stated what had happenned and that they were no orders, the nurse getting report said well just write the order. i wrote the order and thought nothing more of it and came home. i was just called at 1400 by the charge nurse and informed that the dr for this pt was upset and wanted to know why we ordered blood cultures i told her what happenned and she was very understanding but said not to ever do it again and that she would let it go and not write anyone up. my question is ok i know i should have questioned this more but i was tired and ready to go and thougt it couldn't hurt to figure out why this guy was running a temp after surgery what would you have done?

[color=deepskyblue]i would not have let the lab draw the blood cultures. it sounds to me like they were just being lazy and didn't want to come back up. for a temp of 102.4 i would have notified the md and asked if they wanted blood cultures. lesson learned. never ever write an order unless you actually got the order! cya!

RN and Mommy

Specializes in Ortho/Neuro.

why didn't you call the doc if she was febrile and tachy? what were her respirs, what was her sat? why not dip urine which you don't need an order for? was the doc aware of the pt's temp from the previous shift?

i don't understand why you don't understand why the doc was upset. it is out of our scope to order cultures (unless driven by protocol which is actually a doctor's order). you also failed to consider other possibilities such as, pe, uti, pneumonia, atelectasis, etc.

[color=deepskyblue]well said! there could be many causes for her change in status!

CarVsTree

Specializes in Trauma ICU, MICU/SICU. Has 4 years experience.

I did not call the Dr because this particular doctor will ALWAYS yell if you call him at night. Respirations were fine normal 18-20, O2@2L O2 sats 98%. Never thought about urine dip what does that check for?? Yes dr was aware of temp frmo previous shift his response "give tylenol and I will see the pt in the morning." I did speak with my charge nurse and talked about the possiblity of something being wrong such as PE, UTI whatever. This is amoung one of the MANY reasons I will be leaving this hospital Dr.s are catered to and we are told not to disturb them unless your pt is going down hill. BS that's why they became Dr's and if they don't want to be woken up then they got in the field. I hate that the Dr's here can treat us like crap and we are expected to take it. This particular Dr I called last night for a similair situation and his respons to me was "why are you calling me at 0100 you better make sure no one else needs me for the rest of the night I Do NOT want another call tonight." I HATE this Dr I swear he thinks he is GOD and we should bow down and kiss his feet (um no not me!) Sorry this turned into a rant!:angryfire

Sorry it took me so long to reply, haven't been on in a few days. Sounds like all you had was a temp to work with. Since doc was aware and didn't order anything on days, I wouldn't have gotten anything on nights unless a big change. but, its all a learning experience.

Urine dip looks for protein, blood, ebc's etc. Can be done at the bedside with results in under 2 minutes.

Good like finding a better place. Any chance of getting a job in a teaching hospital.

crb613, BSN, RN

Specializes in Med Surg/Tele/ER. Has 7 years experience.

I did not call the Dr because this particular doctor will ALWAYS yell if you call him at night. Respirations were fine normal 18-20, O2@2L O2 sats 98%. Never thought about urine dip what does that check for?? Yes dr was aware of temp frmo previous shift his response "give tylenol and I will see the pt in the morning." I did speak with my charge nurse and talked about the possiblity of something being wrong such as PE, UTI whatever. This is amoung one of the MANY reasons I will be leaving this hospital Dr.s are catered to and we are told not to disturb them unless your pt is going down hill. BS that's why they became Dr's and if they don't want to be woken up then they got in the field. I hate that the Dr's here can treat us like crap and we are expected to take it. This particular Dr I called last night for a similair situation and his respons to me was "why are you calling me at 0100 you better make sure no one else needs me for the rest of the night I Do NOT want another call tonight." I HATE this Dr I swear he thinks he is GOD and we should bow down and kiss his feet (um no not me!) Sorry this turned into a rant!:angryfire

Good for you on leaving! This kind of stuff just makes my blood boil! What person in their right mind would call if it were not necessary? I do not care if a doctor likes it or not.....if my pt is in need, & the doc did not write orders to cover needs...guess what? :idea: Ring, Ring, Ring!

crb613, BSN, RN

Specializes in Med Surg/Tele/ER. Has 7 years experience.

double post....

deeDawntee, RN

Specializes in Travel Nursing, ICU, tele, etc. Has 12 years experience.

I would never have let a lab person go ahead and draw labs without my approval. Sometimes phlebotomy will draw an extra tube or two, but blood cultures are a lot of extra blood to draw "just in case". And I would never have had written an order a Doctor never gave me. (Unless there are some kind of standing orders.) That is practicing medicine without a license. You knew that the Doc was aware of the pt's condition, so I guess I don't blame him for being upset.

On the other hand, to feel that you cannot call is absurd. A post surgical ortho patient can need so much that first night, that I think you are so right in getting out of there. I worked ortho for 2 1/2 years and calling Docs that first night was commonplace. Pain control issues were the biggest issue, along with low urine output and fever. Good luck to you with your next position, hopefully there will be nicer Docs to work with.

I would have called the MD for the temp & tachycardia. I would not care who the doc is! This is your patient and your license. You worked hard for your license! That doc needs to be reported to administration. You should never be afraid to call a MD, thats what they get paid the big $ for.

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