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"

[back2bRN]

mwboswell,

Thanks, your posts are generally right on, so I wondered....

You are absolutely correct, a balancing act it was.

Apology accepted, enough said.

[MrsWampthang, BSN, RN]

These are not ER orders, but here are some of the orders I read before:

"Cut patients fingernails and toenails today"

"Elevate patient's scrotum while lying in bed"

Actually I've seen orders like that in the long term care where I worked before. The scrotum was elevated because it was swollen. As for cutting the nails, I think the attending doc wanted to make sure it got done. Course, he was anal retentive and didn't think things wouldn't get done unless he wrote and order for it. The orders that always made me mad were the ones to DC foleys on patients that were unable physically or mentally to hit the call lite and ask for a bedpan. The ADON put sticky notes in the docs charts asking for foleys to be DCd and the doc would write the order. (I know, that's a whole other thread!)

Pam

[MrsWampthang, BSN, RN]

you're kidding, right? you have to be kidding!

ok, i'll show my stupidity. i also think, why are these bad orders? they may be silly orders, but not bad orders. as i said in my previous post, i have seen them. elevating scrotum because it was extremely swollen. cut finger and toe nails because the attending doc was a jerk and wanted to make sure it got done,:icon_roll but staff at some facilities may need that kind of order so that basic hygiene will get done. i've seen staff do a tremendous job caring for patient's feet, hands, nails etc, and i've seen staff that won't do anything for the patient unless someone is practically standing over them and the order is written in blood. just a thought. and i don't think there is anything wrong with wondering why these orders would be considered a "bad order". just my two cents.

pam

[NessEDRN]

Psych patient going wild in the ER, multiple attempts of calming the patient failed secondary to his schizophrenia and paranoid delusions. Security was already in the room physically restraining him.

Expecting some Halodol and Ativan orders, got:

"attempt to verbally de escalate the patient"

Someone would need to verbally de escalate me bordering on physical restraint.

[lpnstudentin2010, LPN]

ok this one is a little off the subject because it was an issue i recently had with pharmacy, not a doctor, and it was about my script.. I have been dx'ed ADHD for five years and have been on regular adderall, not the XR, for five years... as you know its a controlled substance therefore i have to get a new script every month and turn it in, no rapid refills for me lol. well i've always taken it to the CVS down the street, every month for FIVE years.. i don't know if this was a new pharmacist or what but i turned my script in and its a computer generated script ordered for the Adderall rx 314.9 etc etc, well the pharmacist gives it back to me and says "i can't fill this, this is a new brand of adderall that i don't have in stock yet, if i call to order it its going to take a couple weeks to get it in, you need to check a different pharmacy" and i say.. umm what new brand of adderall would that be that ur talking about?? and she says Adderall DX, we don't carry it. so i roll my eyes at her and say " you ARE kidding i hope.. there is no such thing as adderall dx, thats the DIAGNOSTIC CODE for the prescription! check my file here i've gotten the same exact script every month for five years filled here! and she refused to check it and said i was wrong and that i needed to go to another pharmacy... :angryfireso i'm livid at this point because i just got off a 16hr shift on midnights, stayed awake till the pharmacy opened, and had to work again that afternoon so i was hoping to get this done quickly so i could go to bed...

so i drive down to walgreens four miles away, when the pharmacist asks if she can help me i say "i hope so, the other place refused to fill this script for me because she doesn't have 'adderall RX' in stock" and the lady starts laughing and saying, please tell me ur not serious... a PHARMACIST said that to u? thats the diagnostic code! THANK YOU THATS WHAT I SAID! so she then proceeded to call that pharmacy and give the pharmacist a refresher course on medication abbreviations lol she asked her "what did u think DX stood for? Doesnt eXist?? i thought that was funny... so in the end the pharmacist that actually graduated college instead of buying her degree on line filled my script for me, who knows if any of u will find this as dumb as i did but i think its kinda scary when our pharmacists are dosing out meds when they don't even know whats real and whats not... especially to elderly people who don't understand half the meds anyways!

I have had issues in recent weeks with CVS too.

Adair HFA inhaler --- "that doesnt exist", didnt look it up-just told me it was non existent, it is new but is existent doc calls all of a sudden they can fill it, need to order it but I will get it the next day.

ventolin HFA inhaler --- "that is no longer being manufactured" I went to the school nurse at my college who called "oh, we can fill that"

[Christy1019, ASN, RN]

I have had issues in recent weeks with CVS too.

Adair HFA inhaler --- "that doesnt exist", didnt look it up-just told me it was non existent, it is new but is existent doc calls all of a sudden they can fill it, need to order it but I will get it the next day.

ventolin HFA inhaler --- "that is no longer being manufactured" I went to the school nurse at my college who called "oh, we can fill that"

lol i'm starting to question CVS's education requirements for their pharmacists..

[DDRN4me]

some of our docs like to write orders like they are writing a grocery list.

start tapering this med down x3 days then down to x for 3 days then d/c; concurrently taper med

B x5 days then dc WHILE starting Med C qdx3 days then BID x3 days then increase to xmg x 3days.

by the time you figure out what in blazes they really want they come and d/c the order!!:stone

[lpnstudentin2010, LPN]

lol i'm starting to question CVS's education requirements for their pharmacists..

I have stopped using them...I travel the 30 minutes home from college to fill scripts at my local pharmacy. That pharmacist keep saying "Didnt she look it up? Why didnt she look it up" to do with the advair inhaler

[mcknis]

Yesterday on a drug OD'er, had a d/o "drug overdose-pt crushed oxycontin and shot it up" Actually was how dx displayed on kardex. He had abx ordered for no reason, and really shouldn't have been in hospital. ????????????

[ThrowEdNurse, BSN, RN]

I had 91 yoa NH train wreck (of course she was a full code.) She was trying to go see Jesus due to her aspiration "every time she ate for the past 3 mos" according to the NH. She now has gurgling respirations at 45/min and BP in 60's. I am trying to set up to tube her and it occurs to me the resident and attending who are on at the time aren't seeing the same pt I am apparently. They're all like "well start a line and get some cultures. We'll need urine, too." WHAT??? WHAT??? WHAT????

"Uh, yeah, the ambulance started a line as the pt is actively DYING!!!" Are you kidding me? So I say, "What are we going to do about this pressure?" I am trying to be nice and give the resident a chance because she is brand new and am trying to just not boss her. The ATTENDING says,"Oh, let's bolus a liter." I repeat WHAT???? Yeah, I've only started 3 of those on her before you got in the room. Can I get a real order? Well, now is the time when you realize that you are in bizarro world all alone and you are going to have to care for the pt alone. So, in comes the tech with a cath to in and out her for urine. I say, "No, let's get a real foley on this woman." Again the ATTENDING says, "No, I only do foleys on people who really need them. She can wear a brief." WHAT????? Now I begin speaking slowly to the physician thinking she is confused. "Well, I kind of thought she does need it?'' She asks me why! "Um, well her pressure is 60!" And I swear to god she asks me how a foley is going to help increase the pt's blood pressure. And this is how I found myself explaining to the only attending physician in our ED this day how we can use urinary output to monitor cardiac output. Please keep in mind that I work in a very busy, high acuity ED. There was no excuse for this.

So 2 hours later when the poor woman finally quits breathing, I walk in the room to find the resident standing there with her mouth open. She looks at me and says, "I think we need to intubate." I agree and begin to prepare for intubation. She's still not moving. So I same, "Um, here is the crash cart (which I wheeled in the room 1.5 hours ago in anticipation of the inevitable) why don't you open that red box on top and take out the ambu bag and breath for her while we set up?" OMG!!!

30 mins later here comes the ICU resident. I am actually glad to see him although he is no rocket scientist either. So now I ask for an order for levophed or something so we can keep her alive another day and hopefully even sedate her properly! He says, "well, let me get a central in her first." Now I officially lose it and start yelling, "NO! This is ********!! I have 2 perfectly fine peripherals. I am not going to stand her and watch you attempt a subclavian for 30 min until you inevitably drop a lung! I have an ICU bed upstairs for her! Give me a pressor order so I can safely move her up and you can finish killing her up there!" He refuses. He wants to do the line in the ED. Again OMG! 30 min later when he can't get the line in because the pt isn't sufficiently sedated which I can't do with a pressure of 2 he says. "Well let's some levophed going, get her upstairs, and I'll do the central in ICU."

I wish the common public would know and understand of these types if situations. I mean, I have never had the stars align so perfectly against a pt with such incompetent physicians before, but it does happen. Usually it's just one dumb Dr. or something. But I know in cases like these it's always a good nurse that has managed to keep the pt alive. I wish the people who think that nurses are "order doers" and waitresses would understand this too! And a special shot out to my fellow RNs who were by my side that day and kept my other pts alive and stopped me from killing a MD and quitting my job.

[northshore08]

ThrowEdNurse, I..I..I don't know what to say. Actually, I am wiping the tears of sympathy and laughter out of my eyes. Your description of that neverending un-code is priceless! Sounds like your docs were missing a few Legos that day, and the patient has you to thank (?) for helping her live.

Did that poor lady ever get her celestial discharge? May God have mercy on her; I hope so! (She's done her share of teaching!)

[ThrowEdNurse, BSN, RN]

You're so right. I have never considered that term before but it was definitely an "uncode." The uncodes from hell are often far worse than when the pt actually just gets it over with and codes. I don't know if she is still alive, I never checked, but she did make it safely upstairs to ICU. I felt bad for the ICU nurse in report though because even when I am calm I have a huge potty mouth. All I can remember about the report I gave on this pt was the unusual high number of expletives I was tossing around like a drunken sailor..