I had a really crappy day, but I'm going to try NOT to vent and ask for feedback.
I work evening shift and did not call the doc to clarify an order. The order was regarding IV ABT vs. PO/FT ABT. Morning shift had a hard time establishing an IV in said pt, so they received orders for "if no IV give x ABT PO/FT." When I received report, I was told, said pt had IV established that day. I gave IV ABT scheduled for my shift, but additional ABTs were ordered(not to be administered on my shift), and those were ordered PO/FT "if no IV". Third shift comes on asking about clarification of said order. I had not called the doctor. Honestly, I didn't realize the need to call. Thus, night shift calls doc at 1am to clarify order regarding IV vs. FT/PO as night shift had one PO/FT ABT to give. Doc was understandably ******. Then, night shift nurse says, "oh, I'm going to talk to manager about this because this should have been clarified on your shift." Actually, the initial order was taken on morning shift. Anyway, unfortunately, I was busy. Personally, I would have given said ABT per FT and clarified in the morning. The entire shift sucked. I was so busy, and then it is rather irritating when night shift comes on and wants an extended report. Seriously? It's right there on the Kardex. I still left several hours late. Feedback?
I wouldn't have called either. The indications of the order were specific enough IMO: Patient had an IV, you gave it IV. If patient didn't have an IV then you would have given it PO/FT per order, or you would have started an IV if you felt frisky enough (within orders) and given it that way.
Me thinks she's just taking her frustration/anger out on you. Sorry you're her whipping nurse for this.
I absolutely would not have called...the order is very clear....is this night nurse a new nurse and uncomfortable with making any independant decisions???
I sympathize with the doctor...he probably went off on the night nurse and that is why she wanted to go and "tattle" on you....however, I have been the DON in a LTC facility and if she came to me, I would have firmly but politely shown her the errors in her thought processes...and explained why we do not call the MD at 1 am when we have a perfectly clear order and why we then do not try to throw another co worker under the bus....that is all...
I would interpret the phrase, "if no IV, then PO," to mean that this "if-then" test is implemented each and every time a dose is due. I would NOT interpret it to mean that the "if-then" test is only implemented at the time of the first dose with the decision reached by the "if-then" test carried on to all subsequent dosing times. The order seems quite clear to me...
It sounds to me like the order of a dr. who really really did not want to be called. Did this happen on Thanksgiving? His orders were clear and specific and covered all bases. If that nurse wanted to call, I would have loved to have heard that conversation.
There is nothing to clarify. It says it in the orders, and pt had IV. i would have given it IV and not paged doc, because if it clearly stated it then there would be no reason to call.
It's the other RN fault and she is looking for someone to blame it on. You did nothing wrong.
That nurse is just ****** b/c they got reamed by the doctor at 0100! They wanted someone to blame. I wouldn't have called if I were that nurse and I definately wouldn't I called if I were YOU! I think you are FINE in this sitch!
We get into this all the time- our pharmacy policy- once you settle on one course of the medication- IV/PO as indicated by the order you cannot go back to the other route without a new order. It dosn't make sense to me, but it is a pharmacy decision- you can however ask the pharmacy to call the doctor to clairify the order- they more often than not say no, but it would be nice to have them get snipped at by a physician that thought they had covered all the bases just to find out that isn't the case. The order can be written " ATB IVPB whenever IV access established- whenever IV not available give med PO, but return to IVPB as route of choice when IV can be re-established. Same MG dose and frequency." That is clear and covers the options needed for pharmacy. If you find yourself bouncing back and forth more than once- the problem isn't an unclear ATB order- it's a need for advanced IV access- PICC line or such.
from my perspective as a student, the crazy amount of alphabet soup floating around in healthcare seems like it would be dangerous...what do you guys think?
When I am charting, I take the few extra moments to just go ahead and type out the full words.....
Agreed. The abbreviations that have been used for umpteen decades worked fine until recently...I an see grains being phased out for milligrams, but hs, ac, pc, gt, ngt, po, iv......all pretty standard stuff. Complicating it= more errors.
Actually, yes, she did threaten to talk to the manager after she got reamed by the doctor.
I went back today and realized it was the doctor who wrote the original order that she was wanting clarified! It wasn't a TO or VO. I don't know why she didn't, but had she called pharmacy, I believe they would have sent up the med IV because of the way the order was written. The day was so busy for me; I didn't have time to even eat, and I didn't encounter any problems because the antibiotic I was to give on my shift was already sent up IV. And like many of you have agreed, I didn't see anything to clarify to begin with.
And the ironic thing is the same angry doc went in the very next day and changed everything to per FT(feeding tube), and d/c'd the med that the night nurse got re-ordered. So, she should not have changed a thing, because the doc went in and wrote everything as it was...the only change was no more IV ABT(ABX, Antibiotics, etc). Go figure.
Feedback?
I think you are FINE in this sitch!
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
I wouldn't have called either. The indications of the order were specific enough IMO: Patient had an IV, you gave it IV. If patient didn't have an IV then you would have given it PO/FT per order, or you would have started an IV if you felt frisky enough (within orders) and given it that way.
Me thinks she's just taking her frustration/anger out on you. Sorry you're her whipping nurse for this.