What should I do? I think I goofed!!

SuesquatchRN, BSN, RN · Dec 15, 2008

I don't need to nag you that you shouldn't be entering verbal orders you didn't actually get.

I don't know what the policy is there on chart review and reconciling orders, but I'd rather catch myself than be caught, if you know what I mean.

Ruby Vee, BSN · Dec 15, 2008

hi,
i'm a new rn with only 2 months of working solo under my belt. i think i goofed big time.
i had a pt last week who had a prn order for tylenol in suppository form. it had been order rectally when he had previously had an ng tube and was npo. so he developed a bit of a temp and he refused the rectal form and asked for po. heres my goof....i entered the order using the same md who had ordered the rectal form without calling said doc.
how bad did i goof??
why did i not call? because the docs yell at me everytime i call them unless its for something urgent. i was having a bad night and coulldnt take another ticked off doc.
help? did i really screw up?

so what you're saying is you entered a verbal order without notifying the physician that you said gave you the order? ouch!

i might have done the same thing if i knew for sure the patient could handle the po med, and if i knew the doctor well. but then i've had 30 years (plus) of exprience, and you've had a couple of months. you've probably seen the experienced nurses around you do the same thing, but you're not in a position to do that. so you goofed. not big time, but you shouldn't have done that, and it could come back and bite you in the butt.

here's the other thing:

the physicians shouldn't be yelling at you. next time one does, tell him you're not going to tolerate that kind of treatment. then don't. hang up and call him back (it's usually a "him", isn't it?) when he's had time to get control over his behavior. document every inappropriate order he gives you (so he says "don't call me again unless my *(^%$# patient is dead," write that in the order book. it only takes once or twice before they catch on and stop yelling at you.

i don't like getting yelled at, either, but i got yelled at a lot when i was a new grad. probably because i did a lot of dumb things, called for dumb reasons, and didn't have all my ducks in a row when i did call. so if you start a thread about calling doctors, i promise i'll give you some good advice. i just don't want to hijack this thread! (pm me when you start your thread because i don't always check in when i'm working.)

allnurses Guide · Dec 15, 2008

Fess up to the doc. Some will be understanding and sign the order. Others will not.

steph

Rabid Response · Dec 15, 2008

You goofed big time. If you were caught doing that at my hospital you wouldn't have a job anymore. I work nights and also hate bothering MDs for what seem to be minor issues, but there is no other way to get a new order. What you did was falsify documentation, practice medicine without a licence, and possibly forgery. Yikes.

WinterGirlyRN · Dec 15, 2008

Ruby, should I call the doc and let him know what I did? I feel the need to be truthful about this. Should I tell me nurse manager too?

BEDPAN76 · Dec 15, 2008

I would have told the patient that his doctor did not order it by mouth. Having it rectally one time wouldn't kill him. Tell the pt. you will leave a message/call in the am for the doctor to change the order. :smokin: I would rather wake the doctor for something way more important. JMHO

allnurses Guide · Dec 15, 2008

Ruby, should I call the doc and let him know what I did? I feel the need to be truthful about this. Should I tell me nurse manager too?

I'm not Ruby . . .but I say yes because he will see it sooner or later.

Always be honest with your colleagues. They will trust you to tell the truth.

steph

allnurses Guide · Dec 15, 2008

Just mostly have to agree with what's already been said. Tell the doc what you did.. maybe you can just say "You know, the patient is tolerating PO now, and for that reason I really didn't feel it necessary to bother you at 2 am for this particular order". Hopefully he'll just go ahead and sign it.

BUT, DON'T BE AFRAID to call the doctor if your patient needs something! If the doctor yells at you, do what Ruby Vee said, tell them that you don't appreciate being yelled at. If they keep yelling, hang up and then call back in a few minutes. In my opinion, doctors need to unite and take calls for each other. We have one doctor who functions pretty much as our "hospitalist", though he also has an office practice. He takes on most of our patients that either don't have PCP's, or their PCP's don't see patients at the hospital. He's overworked, and I know that, but to me it really doesn't give him an excuse to scream at us when we call him for something.

allnurses Guide · Dec 15, 2008

I would have told the patient that his doctor did not order it by mouth. Having it rectally one time wouldn't kill him. Tell the pt. you will leave a message/call in the am for the doctor to change the order. I would rather wake the doctor for something way more important. JMHO

:yeahthat: Didn't think of that approach. Also, HOW bad was the patient's temp? Generally if it is less than 101.5, the patient can survive until in the morning. :) Either that or if he's that uncomfortable with it, he can go ahead and take it in the available form.

Keepstanding, ASN, RN · Dec 15, 2008

unfortunatley, the doc will probably scream at you more because of this, than he would have if you had initially called him in the first place.

sorry, hope this get's cleared up for your sake.

praiser :heartbeat

Flare, ASN, BSN · Dec 15, 2008

:yeahthat: Didn't think of that approach. Also, HOW bad was the patient's temp? Generally if it is less than 101.5, the patient can survive until in the morning. :) Either that or if he's that uncomfortable with it, he can go ahead and take it in the available form.

For me it would have depended on the temp too... hand him an incentive spirometer and tell him he better start coughing and deep breathing and assuming he could have fluids make sure he is drinknig enough to get that temp down. If the temp continued to climb then you have just cause to call the doc and say that the patient has an elevated temp and is refusing the tylenol supp.