Worst doctors orders ever received

[jenfromjersey]

I have a two nursing degrees, going for a third and have a whole lotta common sense. When I see stupid or hear stupid orders I may or may not carry them out..here are my all time favorites:

1) Male patient with active lower GI bleed...HGB of 5...Hypotensive and tachycardic..has 2 large bore IVs running with NS wide open as fast as it will go...blood bank working as fast as possible to get me my units of PRBCs ASAP...BP barely 90 systolic.

Order from resident: "We need orthostatic vitals on this patient"

[Quickbeam, BSN, RN]

"Start IV for mother's comfort".....

Kid was late getting home from school, lied about getting hit in the head with a crow (!), mother brought him in to the ER. Kid was fine. Mother demanded child be admitted. Then she demanded he get an IV. MD caved to get her off his back.

[Lorie P.]

ua c&s on a hd pt that does not urinate, has been on hd for 8+ years and tells you" i don't pee"!

[jenfromjersey]

some more:

2) 600lb + female patient on bariatric stretcher already but can't get the side rails up anyway. Being admitted to hospital for med/surg complaint.

Doctor's order: Insert foley cath for accurate I & O

I actually followed this out and got it first shot..with a few leg holders in the room for help. I figured wasn't a bad idea since I couldn't imagine how I would roll her onto a bedpan anyway. The doctor herself appeared surprised when I came proudly out of the room with the urine specimen in hand.

3) Frequent flyer drug seeker here for the 53rd time in last 6 months with chronic pain complaint. Arms are swollen and ecchymotic from hers and our attempts at finding a vein.

Doctor's order: Dilaudid 2MG IVP

Umm...you have two options doc..change that route to IM or I'll tilt the table so you can get a better look at her IJ. Cuz the last 3 charts show that my co-workers have attempted unsuccessfully to find a vein and although I'm good I'm not a miracle worker

4) Drug dosages that are so small as to be rendered useless.

Insulin sliding scale dose of 2 units SQ (for a blood sugar of greater than 150. Is 150 that bad that we need to inject air and a miniscule amt of insulin into someone?)

Ativan 0.25MG IVP (on woman who weighs twice as much as me and is crawling off the ceiling..."I don't want to snow her"..what?)

Motrin 400mg po (for patient who flipped over handlebars on her bike and has more road rash than intact skin....yet we will easily give Dilaudid 2mg to people with NOTHING wrong...here is where I get to put on my patient advocate hat..."Since she's not driving..do you think maybe something stronger might be in order?..she does have a clavicle fracture you know?)

Please add on as I'm sure that I have seen the same in my practice and will be equally amused or P#@@ed off at "what were they thinking?"

[jenfromjersey]

YES! The urines ordered on long term dialysis patients...love that! The patients actually laugh with you though at the stupidity of it.

[Quickbeam, BSN, RN]

when I came proudly out of the room with the urine specimen in hand.

Hee! I'm laughing so hard. Only a nurse could understand that sense of "mission accomplished!".

[rjflyn, ASN, RN]

YES! The urines ordered on long term dialysis patients...love that! The patients actually laugh with you though at the stupidity of it.

Actually this is a common order and makes sense as some pts do make scant amts of urine. The small amounts they void don't flush the urinary track and we frequently see them with UTI's, generally they are septic as well. So one must ask the pt if the ever void and how much. Typically we straight catheterize them.

Rj

[jenfromjersey]

RE: dialysis patients and urines...I laugh at the orders when they are simply "click boxed" by the ER doc as part of their "routine" set. You need to evaluate each patient and order what is appropriate for them..not be a robot and order the same thing on every tom, dick and harry.

When the docs order urine on my obvious kidney stone patient who has a hx of kidney stones dating back to the year 1 and states that he can't void...I ask them do they really want the sample? Because if they do we have 2 options...fluid bolus or straight cath. Yes..the urine is important but it won't change the fact that he has an 8mm stone lodged in his ureter. Let's get the CT stone protocol first and worry about the urine later on when the Toradol kicks in and may actually be able to void.

If I have a chronically ill patient, dialysis or not, who presents with any indication of infection I obtain a straight cath...unless I believe that the patient is capable of walking to the bathroom and clearly understands the meaning of clean collection technique.

[kellyc034]

I'm only a PCT, but this order was interesting:

"Ambulate pt on unit as tolerated."

Pt was a double amputee at the knee with no prosthetics.

Hmmmm.......someone really dropped the ball on that one.

[nerdtonurse?, BSN, RN]

Well, I'm in the "urinalysis on an anuric" bandwagon, too....

But my real favorite was 1.0 GRAM lopressor PO --I called the doc, and asked, very politely, "what the sam hill are you trying to do to my 90 pound pt?!?" I mean, not even going into the very, very visible "dot" that is a big no-no, but there was no M anywhere on that order -- every nurse in the station was looking at it going, WTH!?

Doc got all PO'd, made some smart remark about "nurses that can't read," so I faxed him the order and asked for "clarification." He called back a few minutes later, never acknowledged that if I'd given the lady the drug as prescribed she would have died, and he "changed" it to 10 mg lopressor.

And you bet your bippy a copy of that order went to my NM.

[nursej22, MSN, RN]

80 something yo pt c/o chest pain. MD says its arthritis, give her tylenol and don't call me again unless she codes.

Oh, yeah, you know what happens next.....:uhoh21:

[LoveMyBugs, BSN, CNA, RN]

rectal temp on a pt with an ostomy.