Thursday, March 8, 2012

Do it right the first time

A really good piece of advice I got from an attending during my first week of intern year is that it saves you a lot of time if you write your orders correctly the first time. That way the nurses don't have to call you on it.

I know it seems obvious, but early in intern year, you're constantly making stupid mistakes when writing orders, like leaving out the "PO" or forgetting to sign them or leaving out the date and time. Spending an extra five seconds making sure you did everything right can ultimately save a lot of time.

Unfortunately, sometimes during residency, you have no choice but to write an order you know with 100% certainty you'll get called on.

Attending: "Can you write for the patient to get 12.5mg of trazodone?"

Me: "It comes in 50mg tablets."

Attending: "Oh. Well, maybe you can cut it in quarters?"

Me: "I doubt it."

Attending: "How big are the tablets?"

Nurse: "They're really small."

Attending: "Well, write for it anyway. If the pharmacy calls you about it, you can change it."

Me: [grumbles curses under breath]

Naturally, I wrote the order and the pharmacy paged me half an hour later to tell me that the pills couldn't be divided that way, so I had to rewrite it. All in all, it was like 10 minutes of wasted time.


  1. That's a good motto to have in life, especially being in school. If you do things right the first time, you won't have to waste time and do it all over again. Thanks for this. :)

  2. Hi Fizzy,

    I have been following you for a couple of years now and so I want to say thanks for the great blog.

    I must say that giving crumbs of pills is quite frustrating and the patient never gets the exact dose ordered as nurses will, invariably, give the "biggest piece". Pill splitters are not advanced technology and if the pill is only slightly bigger than a grain of sand to beging with, the dosing can get quite erratic. Once upon a time, I had an order for 0.25 mg of ativan and the hospital only stocked the 1mg oval tablet. First off, the nurses would spend 10 minutes consulting each other on which piece was closest to the prescribed dose, and number two, what was the point of giving such a low dose anyway? The pill costs pennies, a half dose would do the trick, but the doctor orders a 1/4, and that needs 30 minutes of total nursing time, and at $40/h, that pill just cost a whole lot more. Is it really a good use of resources?

    Also, the RNs need to deal with cranky pharmacy staff before they throw up thier hands and finally call the prescribing doctor. And if you think that the pharmacy gives you a hard time, try being the nurse on the wrong end of the phone. Especially if we don't know why it was ordered the way it was. Go whole or go home!!

    Keep blogging, I love it!