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"
Abbreviations are becoming the bane of our existence....as we all can see....what the heck does that mean?? Can mean different things in different instances.
Also - as to the dialysis pt: even if they pee a few drops here and there, you must get a C&S before treating as all UA dips and micro exams will yield protein, most likely blood and WBCs.
Oh I have a good one... surgical floor...Surgical Chief Resident writes "Turn patient's bed towards window" our rooms are not set up for that " Turn patient's lights off at 8pm and do not disturb until 8 am" is this the freakin Marriot or a hospital so don't do pm meds or vitals because we don't want to disturb the patient...lol mind you we have that one hour rounding stuff admin thought of
"Please bathe patient. If nursing staff is too incompetent to do this, please inform me."
This order was written on a 26 year old young man, who walked all around the hospital at least 8 hours a day, and was perfectly capable of taking a shower. He just didn't want to. Were we supposed to restrain him? Haha.
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
My worst ever order was on a CHF patient who was supposed to be discharged that day. He had been edematous and hypotensive throughout his hospitalization but we were encouraged that he was down to 1-2+ edema to his BLE and his systolic was in the 90s. He still had fairly significant scrotal edema but was going to be discharged with some home health. The resident put in his discharge order and then ordered....Lasix 20 mg IVP STAT, metoprolol 25 mg STAT and another BP med STAT (I don't remember what--I think it was lisinopril).
Oh I have a good one... surgical floor...Surgical Chief Resident writes "Turn patient's bed towards window" our rooms are not set up for that " Turn patient's lights off at 8pm and do not disturb until 8 am" is this the freakin Marriot or a hospital so don't do pm meds or vitals because we don't want to disturb the patient...lol mind you we have that one hour rounding stuff admin thought of
Oh, Man! We used to get orders like that, to turn the bed to the window, even if the rooms weren't set up for that, and one that when I saw it and said, "What the ---" It was "Do not awaken patient for anything from 6pm until 6am. If you need vitals, then guesstimate." GUESSTIMATE??!?
Okay - the one who talked about 2 units of insulin for a blood sugar of 150 - I can top that - our hospital's standard protocol is for 1 Unit for a blood sugar of 120 or above!
Us too. SSI of 1 unit for BS 100-150. Oy vey. Does that much even get past the needle?
Okay - the one who talked about 2 units of insulin for a blood sugar of 150 - I can top that - our hospital's standard protocol is for 1 Unit for a blood sugar of 120 or above!
Ours is 1 unit for BS greater than 150....I think it's a waste of a stick, it's only a dot.
Oh and the other day, I had a 250-300 lb vascular patient POD 1 with his entire left arm and half of his left leg with stitches and staples....for pain he had 0.1mg dilaudid q4h....that's it. And the guy next door with abd pn, but no surgery had 2mg q4h.
An actively vomiting young male pt. Due to his long stay of 2 years we were very aware of this cycle of illness. He had wound care and every couple of months he would get sick and get vanc/fluconazole iv.
Well he ordered him to be NPO (pt non compliant though) and IV fluids DC'd all on the same order. It was NS.
I waited till that hospitalist left for the day and got a new order
from a different doc.
I am glad he was not on when the pt coded and passed.
THe same day of the order I got a new admit that had an order to be OOB. This is the same doc as the previous one.
AHA diet with all PO meds. Well found out the pt has a peg tube and has not had anything in over a month PO. Plus only responsive to pain.
Luckily the new doc was on and was able to change orders without getting ripped a new one by the original doc.
SSI of 1 unit for BS 100-150. Oy vey. Does that much even get past the needle? 
traumaRUs, MSN, APRN
87 Articles; 21,287 Posts
Abbreviations are becoming the bane of our existence....as we all can see....what the heck does that mean?? Can mean different things in different instances.
Also - as to the dialysis pt: even if they pee a few drops here and there, you must get a C&S before treating as all UA dips and micro exams will yield protein, most likely blood and WBCs.