Monday, July 14, 2014

Clear, Hazy, Whatever


One of the psychiatrists has never written a coherent, sufficient order.  Aside from the handwriting, which is almost indecipherable, he always omits at least one necessary part of the order:  strength, route, duration, indication.  He'll discontinue a medication that was never ordered.  He'll order an existing medication in a different strength at a different time- and he either means that this new time and strength is in addition to the existing order or he means that the prior order is (silently) discontinued and that this is the new and only current order for the particular med.

I had to sit him down and review two pages of orders for a patient that were screwed up in so many ways.  I noticed the problem last week when I floated through the ward.  I called the doctor to return to fix the problems.  By the end of my shift, he had not showed, so I copied the pages and highlighted the errors to be fixed.  One week later, when I returned to the same ward, I found that the orders had not been fixed and that the pharmacy was sending medications that were discontinued weeks ago.  Three different nurses handwrote the medications onto the Medication Administration Record "because why else would the pharmacy send them?" one explained to me.

And no, there is no 24 hour chart check to review the orders.  The night nurse opens each chart, writes "24," a little circle (hour), a check mark, her initials, and then closes the chart.

The doctor's response:  "Why is it that when the pharmacy screws up or a nurse transcribes an order wrong, I am the one blamed for someone else misinterpreting what I wrote?"

The supervisor's response:  "You don't really expect a nurse to look at all the current medications that a patient is taking, now do you?  If the doctor discontinued a medication, but it was not an active order, you just go on.  Same if the doctor wrote an order for a medication that the patient is already on.  You just transcribe the order and move on.  So what if there is a duplicate order or something is not clear?  That is what the doctor ordered, so who are you to say that we should not follow the doctor's order?"

That's not what I said at all.  This is why this place is going to hell in a handbasket.

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