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"
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?)
You think 2 units is bad.... the last hospital I worked at, their sliding scale protocol seriously had doses of ONE unit for certain blood sugars (like 115 or something)
and THEN it gets better....the HS dose was automatically half of the daytime AC dose so it would call for 0.5 units of insulin!!!!!!!!!!!!!!!!
As my coworker put it, "I've got more insulin in my spit!"
Yeah thats not worth my time....or a stick to the patient
Blood glucoses of 150 should be covered with insulin. I don't know how it is at other hospitals but for every patient that is admitted they are automatically put on the SQ insulin protocol whether or not they are diabetic. Patient heal better and have less infection with tight glycemic control. I wish I could post how long the insulin protocol is on my unit. It's almost ten pages. If our patient is NPO we cover glucose levels 110-150 with two units of regular insulin and if they are greater than 150 they go on an insulin drip.
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.
Had the same thing happen with a heperin gtt. Order was to maintain PTT at 60. We have a protocol and he wouldn't budge on giving me a range, so you can bet I called when the first PTT came in a 61.
You think 2 units is bad.... the last hospital I worked at, their sliding scale protocol seriously had doses of ONE unit for certain blood sugars (like 115 or something)
and THEN it gets better....the HS dose was automatically half of the daytime AC dose so it would call for 0.5 units of insulin!!!!!!!!!!!!!!!!
As my coworker put it, "I've got more insulin in my spit!"
Yeah thats not worth my time....or a stick to the patient
I would have an awful lot of hs sugars around 114 in that case.
I had one from the same doc for metoprolol 25 mg IVP and Lovenox 40 mg IVP. I said "Let's not try to finish the patient off all at once, shall we?" Try po and sc. The only time we did IV Lovenox was during a clinical trial (that mustn't have been too successful because I don't see them doing it anymore). This doc's last name started with "Kell". We used to call the doc "Kill" because of her stupid orders.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
"flower care q 24 h." (he actually wanted us to water the patient's flowers. umm -- this is a transplant icu. no flowers allowed!)
"patient to lift 1 liter iv bags x10 tid." the md is an exercise junkie, but that patient was a quadriplegic.
"yes i do want abgs q 1 hour, exactly like i ordered them. i don't care that the patient is dnar and does not have an art line." (actually wrote that in the chart in bigggg letters! with a sharpie. was shocked when told he couldn't remove that page from the chart and discard it when his attending pointed out to him what a moronic order that was.)
"do not call me with abnormal lab values, abnormal vital signs or arrhythmias. call my partner instead." (partner was in hawaii on his honeymoon.)
and, for a k+ of 2.3 in a patient having runs of vt: "give him a banana and recheck k+ in a couple of hours."
and, for a k+ of 2.3 in a patient having runs of vt: "give him a banana and recheck k+ in a couple of hours."
:smackingf
omg! you're freakin kidding me! that cracks me up!!!!
"holy crap! the patient keeps going into vt! i need a banana....stat!... what do you mean the cafeteria is closed for the night! we have no choice! get me a banana!"
ACRN06
92 Posts
You think 2 units is bad.... the last hospital I worked at, their sliding scale protocol seriously had doses of ONE unit for certain blood sugars (like 115 or something)
and THEN it gets better....the HS dose was automatically half of the daytime AC dose so it would call for 0.5 units of insulin!!!!!!!!!!!!!!!!
As my coworker put it, "I've got more insulin in my spit!"
Yeah thats not worth my time....or a stick to the patient