Written up for something beyond my control

[mombabyRN96]

We had a 50 year old that our gyn doc admitted the night prior to surgery for a TAH because "she couldnt be trusted to stay NPO after midnight." He ordered a betadine douche to be given at HS. The pharmacy sent up a bottle of some betadine solution in a liquid medicine bottle. I had no means to give that as directed since it was not an actual douche with a nozzle attached nor did i have any capability to safely make my own. I needless to say did not give it, told the day nurse the reason why. She was furious and waited till i got home that morning, then called me and ranted for 2 minutes on my voicemail about how furious the doctor was and that she was writing me up and didnt understand why i couldnt give it. I am not understanding how it was possible to give this as directed??? Btw our small "for profit" facility pharmacy closes at 9pm so my hands were tied except to go to my local grocery store and buy the right product myself!! This nurse who wrote me up made me feel like i killed this pt! Any advise i could get would be much appreciated!!

[HeartsOpenWide, RN]

Our pharmacists are on call, if they made the drug wrong I would call the house sup so they could call the pharmacist in and make it correctly. You say pharmacy leaves at 9pm (lucky, ours leaves a 5pm sharp) what time did you get the bottle?

[mombabyRN96]

Our pharmacists do not come back in after they close. I got the bottle at 8 pm and i told them it wouldnt work...they said that was all they could give me.

[babyktchr, BSN, RN]

The only other option you would've had was to call the doctor and tell him what you were given by the pharmacy and let him decide what to do. He could've given you the "recipe" for what he wanted or decide if it wasn't necessary. I would've also written up the pharmacy for not filling an order properly.

My thought though was how the doc is going to get his overnight stay paid for by insurance. That reasoning isn't going to fly. And in all my years doing OB, I have never had a doc ask for a betadine douche prior to TAH. Interesting that he felt this was worth getting all puffed up over.

Talk to your manager. Hopefully she will see this for what it is. Next time though, I would cover your bases and call the doc.

[klone, MSN, RN]

Why would you be doing a lady partsl wash for a TAH? Did you mean TVH? FWIW, I had a TVH and they never had to do a lady partsl wash on me, at least not until I was in the OR and under anesthesia and up in the candy canes.

You probably should have called the doc AT THE TIME and explained that they didn't give you the nozzle, and asked him what would he like you to do? This is something that should be turfed to your charge nurse, who would enlist the house supe. At our hospital, this probably would have resulted in a hospital-wide search for a nozzle or something else that could be used.

[mombabyRN96]

It was a TAH, and the doc that wrote the order was not on call that night so the nurse practitioner that was on delivering babies that night does not give orders on GYN pts.. I was the charge nurse that night but i was so busy! I had 2 baby's go bad and pain control issues with 2 other pts so i didnt really think this was going to be turned into the issue that it did....oh well, thanks for all the comments and i will be speaking to my manager next week! I just didnt think i had to sweat the small stuff especially since this grown woman was just admitted to be babysat anyway!

[rn4babies63]

Why would you be doing a lady partsl wash for a TAH? Did you mean TVH? FWIW, I had a TVH and they never had to do a lady partsl wash on me, at least not until I was in the OR and under anesthesia and up in the candy canes.

We now have a doc that is ordering Betadine douches for c-sections.

[klone, MSN, RN]

I have never heard of such a thing. Is this evidence based?

Do you routinely take your own patient load as charge nurse?

[klone, MSN, RN]

Interesting, I just did a journal search, and found several studies on povidone-iodine lady partsl prep used before TAH and that it may decrease the incidence of infection.

Also, a Cochran review in 2010 found that a povidone-iodine lady partsl prep done before cesarean deliveries decreases the rate of endometritis from 9.4 to 5% in women, especially when membranes have already been ruptured, and there is no adverse effects to this low-cost intervention.

Huh, learn something new every day!

[suckulator]

I work in the OR and circulate many TVH and TAH's. We always do a betadine lady partsl prep just prior to surgery after induction and intubation. I don't see the rationale of a betadine douche on the floor pre-op.

[iluvivt, BSN, RN]

Yes I have seen it ordered but I have been a nurse some 31 years now. This is what I would have done...got a regular fleets enema..dumped it out and put in the betadine solution. If you did not have that just use a tap water enema set up..but you would have to pinch off part of the tubing with a kelly clamp or other clamp as that would be a fast WHOOSH in !