When you're first starting out an intern, you literally get called on every page you write. Mostly cuz you forget obvious things, like writing that the order was PO. But when you start working in a new hospital, especially one where orders are not electronic, sometimes that constant paging on every order starts again:
Pharmacy: "Hi, Dr. Fizzy, I'm calling about an order your wrote on Mr. Smith for natural tears."
Me: "Oh...."
Pharmacy: "You wrote for Natural Tears 2-3 drops per eye nightly. But we don't do ranges. So you have to rewrite the order as either 2 drops or 3 drops per eye."
Me: "You're kidding me."
There was an episode of Scrubs where JD asks Dr. Cox about the dose of Tylenol, and he replies angrily, "It's regular strength Tylenol. You just throw it at the patient's mouth and whatever stays in, that's the dose." That line always bothered me, because of course, you can easily overdose on Tylenol and get very sick. But you can't overdose on Natural Tears! You just squeeze the bottle and whatever goes in is the dose!
The best part was how I didn't rewrite the order immediately, and they paged me about it AGAIN. Because clearly this was really urgent.
"And you didn't specify whose eye you wanted the tears to come from."
ReplyDeleteIt's not ALL our fault. Joint Commission is at least partially to blame. They say they'll cite us for allowing an Artificial Tear order of 2-3 drops, if the order doesn't specifically say when it's OK to use 2 vs 3 drops.
ReplyDeleteLame? Yes. Stupid? Yes. Unfortunately, our hands are tied.
Yeah, blame JHACO. Trust me, we don't like it any more than you do.
ReplyDeleteAlways remember JHACO's motto: If no healthcare can be delivered, no mistakes can be made.
Grumpy: The natural tears, as usual, come from the on call residents.
ReplyDeletePharmNerd: I just don't get why our pharmacy calls like 10x more than any other pharmacy I've ever worked with.
I'm so glad to not be a floor nurse- it is so embarrassing to have to page a physician about this foolishness. "Yeah, hi doctor, I know this isn't a busy hospital or anything and you don't have other patients but you didn't write the prn indication for this Vicodin. Pain? Wow, thanks, I never would have guessed, and this is a very valuable use of both or our time."
ReplyDeleteEveryone knows RNs don't have the judgement to decided whether the patient needs 2 vs. 3 drops or artificial tears. We might overdose them and they might die.
hoodnurse: We had an M&M just last week about a patient who was OD'd on natural tears, had seizure, and was intubated.
ReplyDelete@ first I thought it said "Useless people" ... maybe that still fits...
ReplyDelete+1 to hoodnurse. Trust me, nurses don't like this garbage any more than you do. It's embarrassing.
ReplyDeleteFrom an Rx point of view, we know it's a pain. But when we have a Dr. write unapproved abbreviations, no PRN indications, no routes of administration, it's a pain for us too. Lortab for pain? Well, the patient already has tylenol for mild pain, tramadol for moderate pain and Percocet for severe pain. Got to stratify it. Vitamin K: PO, IM, sub Q, or IV? Often the same Drs continue ignoring the rules and make more phone calls and pages for everyone. We are just the peons stuck enforcing the rules. We didn't write them. But we do get written up when we don't enforce them. And God forbid the wrath of the doctor when we misinterpret what they wanted..."It should have been obvious that it was IV!!". Well save EVERYONE some time and WRITE it! (sorry, it's been a LONG shift at work and the next one starts very soon!)
ReplyDeleteThis is an OTC, so in our retail pharmacy we would slap a label on with written directions to save sales taxes OR hand the script back and let them purchaseit. For our LTC patients we would let the skilled nursing staff clarify and send out with correct dosing. Writing RXs for OTCs always confuses people because they they think because it is on a script pad that their insurance will cover it. IF it only worked that way.....
ReplyDeleteWow that sounds like a pain.
ReplyDeleteif this was in a retail setting, the pt was probably screaming at the pharmacy staff that it's an EMERGENCY and that we need to call the doctor right away to clarify the directions so that they can get the drug RIGHT AWAY. most likely the prescription was written last week and the pt just brought it in 15min before pharmacy closes...
ReplyDeleteThat's a failure to appreciate what is important and what doesn't fucking matter.
ReplyDeleteI get more pages about butt paste than pressors in the ICU.
ReplyDelete