What did the Doctor mean! Someone help

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Here is the problem. Ok i went in to check one of my resients blood sugar level and it was 425. So on the sliding scale it says to notify the doctor for anything more than 400 of course! So i called the on call dr about the blood sugar results and he said to give 50 units of regular insulin and recheck again in four hours. So I reread what he said, give 50 units of regular insulin and recheck again in four hours and he said yes and after taking the order i wrote RBVO per (doctor's name). So I gave her the 50 units and rechecked her within the four hours that was told and it went up to 435. I called him back and told him the results and he said give her 15 units of regukar insulin and recheck in 2 hours so read it back to him give her 15 units of regular insulin and recheck in two hours he said yeah one five just like the last time! And I was thinkin justlike the last time. What do you mean the last time you told me 50 units and I read back the verbal order. Does this mean trouble. I mean the first order I did read back and he agreed. The second order I read back and he agreed. What got me is when he said 15 units just like the last time! Im like what the hell is he talkin bout! Im scared! Any opinions or advice of what can happen would be greatly appreciated!

Specializes in PN NURSING SCHOOL.
I've seen 180 units also. LTC people are totally out of control, and there is little motivation to attempt tight control, due to costs and he time involved, so they keep getting insulin thrown at them. Besides, the food in those places doesn't help.

So I shouldn't bring it up to the DON being that it's too days later? Cuz I'm thinkin what if I say something and I'n return she says what made u wait two days later to question the order! So do u think I should just leave it at that. He was the on call dr! Any advice would help thank u so much! What would u do I'n this situation that happened two days ago. Would u just let it be.

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Specializes in LTC, MDS, plasmapheresis.

The DON has nothing to do with what was or was nor ordered. What she has to do with is crafting safe policy for the building, and making sure the nurse practice act, and state and federal regs are followed. If he denies the order and refuses to sign it, it is between you and him. It's happened to me many times. Since insulin can kill, an easy fix is for each physician to have in file a clear, signed and dated statement (sliding scale) of his insulin doses based on sugar reading. Also, if he refuses that, or the reading is beyond the scale, have a witness to any order that you are leary of, and have that other nurse cosign the order. That's a generally acceptable form of protection, but it might cause the physician to be angry.

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Specializes in LTC, MDS, plasmapheresis.

Nursing homes are not for the faint of heart, see?

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Specializes in geriatrics, dementia and like, insurance.

Del07, if you choose to tell your DON or not really depends on how you feel about the situation. If you reported it to the oncoming nurse and it's been a few days, then you could wait until you return to work to check the chart yourself. My best advice, and I cannot stress this enough, is to cover yourself. You stated you read back the order to the doctor and he verbally authorized it as correct. When you are documenting for your own records, you need to be sure you write this down. Will it protect you if it comes down to your word versus the doctors? Maybe, maybe not. But your version is stronger if you have it written down and dated for your personal records.

You could wait until you return to work to check on the chart, on your patient, and on your patient's dosage history. Then make your decision on how to proceed. You're a new nurse. Follow your instinct but proceed cautiously and always document for your own records what's happened.

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Specializes in LTC, MDS, plasmapheresis.

Check your state BON and your employer's policy for receiving telephone orders, and follow them explicitly. In fact, the DON is much like a BON- not your friend, but there to hold the staff accountable.

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Specializes in PN NURSING SCHOOL.
Del07, if you choose to tell your DON or not really depends on how you feel about the situation. If you reported it to the oncoming nurse and it's been a few days, then you could wait until you return to work to check the chart yourself. My best advice, and I cannot stress this enough, is to cover yourself. You stated you read back the order to the doctor and he verbally authorized it as correct. When you are documenting for your own records, you need to be sure you write this down. Will it protect you if it comes down to your word versus the doctors? Maybe, maybe not. But your version is stronger if you have it written down and dated for your personal records.

You could wait until you return to work to check on the chart, on your patient, and on your patient's dosage history. Then make your decision on how to proceed. You're a new nurse. Follow your instinct but proceed cautiously and always document for your own records what's happened.

Yea I charted I'n the nurses notes I'n her chart and we document it I'n a notebook that all the nurses write I'n on what happened on the shift so we could know what happen on the previous shift! It's like a cover urself notebook so there for subverted being said what u told me is absolutely true!i will check te chart when I go back to work I'n a few days because I work a weekend special which we automatically get our 40 hrs! I only work sat and sun and I love my job! I hope everything works out for me! Thank you so much!

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Del07, I can see you are really struggling with this and putting aside all talk of what is appropriate dosing for what patient -- which we really can't know, looking at this from the outside -- I am going to say that I'm sure that by now they would have called you if there had been a problem.

It is not as if you made an attempt to hide this information, you've charted it, passed it on, discussed it, everyone knows about it, and no one has said anything. Also, your patient is fine. If you made a med error, you may now consider yourself one of the club, we've all done it, and you will learn and move on, and it won't happen again.

This shows how important it is to make sure that you clearly understand a doc's orders, that you read it back clearly, even if they get snippy and gripe at you, you are covering yourself. Doing that will save you a lot of anguish in the future...what you are going through now is a learning experience that all new nurses go through.

You don't learn to make good judgement calls without making a lot of bad judgement calls to begin with.

So. Do yourself a favor. Stop spinning. Wait this out. Do something kind for yourself. Remember, you wouldn't be this upset if you didn't care deeply about doing a good job. And that is what is important here, you are a nurse who cares.

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Specializes in PN NURSING SCHOOL.
Del07, I can see you are really struggling with this and putting aside all talk of what is appropriate dosing for what patient -- which we really can't know, looking at this from the outside -- I am going to say that I'm sure that by now they would have called you if there had been a problem.

It is not as if you made an attempt to hide this information, you've charted it, passed it on, discussed it, everyone knows about it, and no one has said anything. Also, your patient is fine. If you made a med error, you may now consider yourself one of the club, we've all done it, and you will learn and move on, and it won't happen again.

This shows how important it is to make sure that you clearly understand a doc's orders, that you read it back clearly, even if they get snippy and gripe at you, you are covering yourself. Doing that will save you a lot of anguish in the future...what you are going through now is a learning experience that all new nurses go through.

You don't learn to make good judgement calls without making a lot of bad judgement calls to begin with.

So. Do yourself a favor. Stop spinning. Wait this out. Do something kind for yourself. Remember, you wouldn't be this upset if you didn't care deeply about doing a good job. And that is what is important here, you are a nurse who cares.

Thank u so much for ur advice! U made me feel alot better! Thank u! Thank u! Thank u!!

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Specializes in Wound Care, LTC, Sub-Acute, Vents.

i would not say anything now especially the patient is doing fine. you got a t.o. from the doctor, read it back and he said yes. so you followed the proper procedure.

what i would do differently is tell/call the supervisor after you got the t.o. and ask him/her if he thinks 50 units of regular insulin is okay to give because you are a new nurse so you just wanted a second opinion. the supervisor should be able to help you. that is his job!

i have never given 50 units of regular insulin in my 3+ years in ltc. so i would definitely ask/tell the doctor if he was sure 50 units and say "five zero units of regular insulin because i have never given that much". if he says okay then i write the t.o. and i would call the supervisor and ask for his advice.

when i was a new lpn, i got a t.o. for levaquin 500 mg po bid x 7 days dx:uti . i read it back to the doctor and she said "yes". i always look up an unfamiliar med so i saw in my drug guide that it is usually levaquin 500 mg daily x 7 days for uti so i reported my findings to the supervisor because i was a new nurse and needed an advice. supervisor said call back the on call md which i did and got the order changed to daily x 7 days.

even though i have 3 years nursing experience now, i still ask my rn supervisor or other floor nurse for advice when i need a second opinion or i call the pharmacist and ask questions. it's funny though because my coworkers now go to me to ask me for advice or opinions, which i don't mind. :D

i know you are a new nurse so please don't be afraid to ask questions. better safe than sorry.

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