The stupidest thing a nurse has ever paged you for...

Let me preface this by saying that I have worked with many able and talented nurses, but:
Three straight days the same ICU (!) nurse fed a patient and tied off the NG tube of a patient requiring complete bowel rest because "the NG tube wasn't giving off anything and the patient was hungry." I think I'd rather be paged about stupid stuff than have someone who, although well intentioned, is probably harming the patient.

@3am

Nurse: Dr, I wanted to make you aware that the pt hasn't put out any urine during my shift tonight. It's been almost 5h.
Me: Do you think the foley needs repositioning? Did you try flushing it?
Nurse: The pt doesn't have a foley in.
Me:...? Is the patient asleep?
Nurse: Yes, resting soundly.
Me: !!! That UOP is appropriate.

To this day I have no idea why she thought a sleeping pt should be urinating. She's a frequent caller during the night and I know her the second she calls due to a strong accent.

Do we REALLY have to start this topic, AGAIN, HERE?

First of all, there are tons of threads here already on the topic.

Secondly, the title is a bit insulting to our members who are nurses. After all, some of the stupidest pages I've gotten have been from other physicians. Perhaps the thread could be "the stupidest page I've ever gotten" - IF you REALLY felt it was necessary to start ANOTHER thread on the topic and watch it degenerate into people bashing nurses AGAIN.

Sorry to be such a drag about this and I do enjoy, and even participating in these discussions, but its beating a dead horse and really does run the risk of alienating other members of SDN.

Kimberli Cox said:

Sorry to be such a drag about this and I do enjoy, and even participating in these discussions, but its beating a dead horse and really does run the risk of alienating other members of SDN.

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If these "other members" of the student DOCTOR network are nurses and they get their panties in a bunch, who the hell cares?!? This is a forum for physicians to vent their frustrations at some of the inane incidents in an increasingly difficult medical environment.

actually, these are funny...

I've worked w/ *****s like those described above...

not sure why "intern year is us against the nurses" should be the case...

I've always found interns to be eager, willing, and overall, a pleasure to work with...

Remember, stupidity does not equal malice...

ATM Machine said:

This could be an entertaning way to blow off steam if everyone listed stupid things nurses paged them for. Remember, intern year is us against the nurses...

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I dont see why intern year is 'you against the nurses'. If you continue to think that way it is going to be a loooong year for you. A nurse can make your night as long, and miserable as they want or they can make sure you get some well deserved sleep. I'm sure you'll see things differently once you actually get in the hospital. I agree with Kim, but I think these threads are funny. I always get a laugh at them.

Im an RN in CVICU so I rarely work with residents/interns, but I don't get offended by these threads. Nobody should until they degenerate into sweeping generalizations about RNs. I know very well there are some stupid nurses, just as everyone knows there are some stupid interns. Keep in mind floor nurses don't typically have near the autonomy or knowledge base that unit nurses do. Floor nurses are usually reluctant to verbal the most mundane things (colace, chloroseptic, etc.) unless theres a protocol. So you will get paged for stupid things.

Nurse: Doctor, I just wanted to let you know that your patient is passing gas...

ME: So you want me to put the patient on airway precautions??
(negative pressure room, mask and gown upon entry)

I tried to reply earlier and for whatever reason the site was not allowing it. The majority of the nurses I work with are great, and I've had my butt saved by them quite a few times. There's only maybe one or two on every floor that consistently spew stupidity every time they call.

Oh, and no way it's "interns vs nurses". After having nearly completed intern year, it's more like "interns vs patients".

The_Sensei said:

If these "other members" of the student DOCTOR network are nurses and they get their panties in a bunch, who the hell cares?!?

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I do. SDN is designed for all members of the pre-med, pre-allied health, medical and allied health communities. This forum is not closed to any members.

This is a forum for physicians to vent their frustrations at some of the inane incidents in an increasingly difficult medical environment.

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It is not a forum for physicians to vent their frustrations. While that activity is tolerated, the forums are designed for educational and informational purposes. SDN has long held the policy that insulting other members is a violation of the TOS. Nurses are members of SDN. I also find the threads funny but wanted to caution users about comments like, "its us against the nurses" etc. These are not funny, not helpful nor educational and IMHO, do not belong on the open professional forums.

SouthSideSteve said:

I dont see why intern year is 'you against the nurses'. If you continue to think that way it is going to be a loooong year for you. A nurse can make your night as long, and miserable as they want or they can make sure you get some well deserved sleep. I'm sure you'll see things differently once you actually get in the hospital. I agree with Kim, but I think these threads are funny. I always get a laugh at them.

Im an RN in CVICU so I rarely work with residents/interns, but I don't get offended by these threads. Nobody should until they degenerate into sweeping generalizations about RNs. I know very well there are some stupid nurses, just as everyone knows there are some stupid interns. Keep in mind floor nurses don't typically have near the autonomy or knowledge base that unit nurses do. Floor nurses are usually reluctant to verbal the most mundane things (colace, chloroseptic, etc.) unless theres a protocol. So you will get paged for stupid things.

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Thank you for your input. I agree that these are funny...but after seeing several of these threads crop up over the years on SDN, they have almost without fail degenerated into name-calling. I just didn't see the need for another thread here when there are several other active ones on the same topic on SDN.

Dr. Cox, while you're at it, how about contributing a funny anectode? I'm sure that you've must have seen some stuff that, looking back at it, is pretty amusing.

werewethere said:

Dr. Cox, while you're at it, how about contributing a funny anectode? I'm sure that you've must have seen some stuff that, looking back at it, is pretty amusing.

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Yes, I do...but I've posted them in the various other threads about this topic. Wouldn't want to violate the TOS by posting the same thing in multiple places would I?

Kimberli Cox said:

Yes, I do...but I've posted them in the various other threads about this topic. Wouldn't want to violate the TOS by posting the same thing in multiple places would I?

Click to expand...

You mean to tell me that you have run out of new stories to post? What will we use on this particular thread as a guide to good taste without your contribution?

Remember, stupidity does not equal malice...

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However, it does often trump it in terms of the resultant damage.

werewethere said:

You mean to tell me that you have run out of new stories to post? What will we use on this particular thread as a guide to good taste without your contribution?

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Sorry - I have reached the point in my academic career where I rarely (and I mean rarely) get paged anymore. I have probably received the same number of total pages this entire year as the intern on service gets in 1 hr.

I did actually get paged today...which suprised the heck out of me and got a bit sore at the circulator who told me she was "too busy" to answer my page. I found that hard to believe since I hadn't asked more any more materials and they weren't counting instruments or sponges yet. When I finally answered the page after scrubbing out and told the nurse answering that the page was from 25 minutes ago...the circulator tried to argue with me that "it wasn't that long ago". Guess she didn't realize our pagers come with a time tag.

So not a funny story but the only pager related story I've had all year.

So here's one that hopefully doesn't offend all the unit secretaries lurking on this forum...

Background story: A patient had been getting ABGs so chronically that he had developed a pannus over his radial artery. One of my co-interns wrote him for a lidocaine jelly on the pannus prior to ABG. Of course, a unit secretary has no clue what a pannus is. But...

(one week later...)

Nurse: Can you renew Mr. B's lidocaine jelly to his penis?

Intern: Ugh... Why is Mr. B getting lidocaine jelly to his penis?

Nurse: I don't know.. it says in his medbook that he's been getting it for a week, just prior to his ABGs.

Intern: I guess it makes sense he hasn't complained...

Kimberli Cox said:

Sorry - I have reached the point in my academic career where I rarely (and I mean rarely) get paged anymore. I have probably received the same number of total pages this entire year as the intern on service gets in 1 hr.

I did actually get paged today...which suprised the heck out of me and got a bit sore at the circulator who told me she was "too busy" to answer my page. I found that hard to believe since I hadn't asked more any more materials and they weren't counting instruments or sponges yet. When I finally answered the page after scrubbing out and told the nurse answering that the page was from 25 minutes ago...the circulator tried to argue with me that "it wasn't that long ago". Guess she didn't realize our pagers come with a time tag.

So not a funny story but the only pager related story I've had all year.

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Well, I always felt that time seems to slow down, in a good way, in the OR. Guess the circulator feels the same way. Thanks for giving the hope that some day the pager will rest, because I'm sure I won't be anytime soon.

werewethere said:

Well, I always felt that time seems to slow down, in a good way, in the OR. Guess the circulator feels the same way. Thanks for giving the hope that some day the pager will rest, because I'm sure I won't be anytime soon.

Click to expand...

The pager will slow down eventually, although it can be hard to give up the control for us surgery types.

Stupid page of the day:

PACU RN: I see you've written for Mrs. X to take her home meds.

Me: Yes, there's a lot of them aren't there - ha ha! ( she has two pages of meds for her COPD, renal transplant, DM, chronic pain, etc.)

RN: Why do you want her to take her home meds?

Me: Because most of them are pretty important...I'm confused, why are you asking?

RN: No, I mean why do you want her to take her home meds instead of getting them from the hospital pharmacy?

Me: Oh, well because she's already paid for her home meds and if we provided the very same drugs from the pharmacy they would bill her insurance company 3-4 times what they cost otherwise. Besides, she asked if she could.

RN: But isn't the reason for her being in the hospital to take meds from the pharmacy?

Me: Uh, no...the reason is because I cut off her breast and replaced it with a big muscle from her back, leaving drains and she's got lots of medical problems which need to be observed.

RN: Oh, ok...thanks.

I'm still confused by the conversation.

Kimberli Cox said:

RN: But isn't the reason for her being in the hospital to take meds from the pharmacy?

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Absolutely, the job of the patient is not to get better, but to keep us in business. Hopefully the patient is doing well, she sounds like one of those unlucky people who becomes a hospital frequent flyer through no fault of their own.

Kimberli Cox said:

The pager will slow down eventually, although it can be hard to give up the control for us surgery types.

Stupid page of the day:

PACU RN: I see you've written for Mrs. X to take her home meds.

Me: Yes, there's a lot of them aren't there - ha ha! ( she has two pages of meds for her COPD, renal transplant, DM, chronic pain, etc.)

RN: Why do you want her to take her home meds?

Me: Because most of them are pretty important...I'm confused, why are you asking?

RN: No, I mean why do you want her to take her home meds instead of getting them from the hospital pharmacy?

Me: Oh, well because she's already paid for her home meds and if we provided the very same drugs from the pharmacy they would bill her insurance company 3-4 times what they cost otherwise. Besides, she asked if she could.

RN: But isn't the reason for her being in the hospital to take meds from the pharmacy?

Me: Uh, no...the reason is because I cut off her breast and replaced it with a big muscle from her back, leaving drains and she's got lots of medical problems which need to be observed.

RN: Oh, ok...thanks.

I'm still confused by the conversation.

Click to expand...

Shame on you. You deprived an innocent hospital the opportunity to mark up the medications several hundred percent over the mark up that the drugstores use. You are personally responsible for lengthening the time that Medicare declares bankruptcy by several milliseconds.

I will say that I understand the nurses confusion. With all the new rules on medication and right dose etc. It is hard to figure out how to chart home meds. The nurses really hate them.

David Carpenter, PA-C

Kimberli Cox said:

The pager will slow down eventually, although it can be hard to give up the control for us surgery types.

Stupid page of the day:

PACU RN: I see you've written for Mrs. X to take her home meds.

Me: Yes, there's a lot of them aren't there - ha ha! ( she has two pages of meds for her COPD, renal transplant, DM, chronic pain, etc.)

RN: Why do you want her to take her home meds?

Me: Because most of them are pretty important...I'm confused, why are you asking?

RN: No, I mean why do you want her to take her home meds instead of getting them from the hospital pharmacy?

Me: Oh, well because she's already paid for her home meds and if we provided the very same drugs from the pharmacy they would bill her insurance company 3-4 times what they cost otherwise. Besides, she asked if she could.

RN: But isn't the reason for her being in the hospital to take meds from the pharmacy?

Me: Uh, no...the reason is because I cut off her breast and replaced it with a big muscle from her back, leaving drains and she's got lots of medical problems which need to be observed.

RN: Oh, ok...thanks.

I'm still confused by the conversation.

Click to expand...

Maybe she was confusing "Take home meds" and taking it literally, meaning "Take them home."

I don't know. Some things, you just shrug and keep moving.

fab4fan: I didn't think about that - it could have certainly been that she was thinking I initially meant for the patient to take her meds home with her as the order was written: "patient may take home meds, at usual doses and schedules"

core0: I understand they hate those orders but since the caller was a PACU nurse, I assume she was just clarifying for the floor nurse. Besides, as interested as I am in the nurse's well-being and making their job as simple as possible, I am more interested in making the patient happy. Believe me, if it had been up to me I would have preferred only writing the patient for strictly necessary meds (ie, her immunosuppresion, SSI, and some nebs)...as it was, she wanted to take every last damn vitamin, all of which I had to enter into the EMR. But I did rather enjoy depriving the hospital of their overpriced meds.

wewerethere: this lady is unfortunate - besides the renal txp, COPD, DM, she's also had breast cancer before, on the contralateral side (with an MRM there - at least she "matches" now), a parathyroidectomy, multiple AV fistulae and grafts, etc. She had more surgical scars than I've ever seen on 1 person.

KentW said:

When I had that situation, I would write: "Patient may self-administer home medications as follows..." and then I'd actually write out the drug, dose, route, frequency for each one. That way, it was obvious that I had reviewed the meds s/he was on.

Nurses are trained to be wary of orders like "resume home meds" because of the tendency for stuff to slip in that shouldn't (e.g., like potassium supplements in a patient admitted with hyperkalemia or something). That may be why your order caught their attention.

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Oh, I would have never gotten away with that. We are also no longer allowed to write, "resume pre-op orders". I ordered every last damn medication she was on, route, dosage etc. It took me nearly 30 minutes. The EMR here is so out-dated that it takes multiple steps to order each drug and with every new one added you have to go back to the main menu, start from "Add Orders", go to "Pharmacy", check "Allergies Reviewed?", "Order Medication", "Order Scheduled Medications", go to "oral medications", find the drug in the alpha formulary, then click on dosage, number, route, and schedule. Its exhausting and not mention frustrating if you make a mistake and have to start all over.

We are also not allowed to let patients "self-administer" home meds in the hospital setting. The patient must surrender their meds to the pharmacy which dispenses them to the nursing staff, just as they would if they came from the pharmacy stash, and the nurse administers them (or at least puts them in the little paper cup). When I do this, I make sure to tell the patient to carefully look at the bill and make sure they are not billed for pharmacy services.

But I do understand why there could be confusion although I personally am still confused about specifically what the confusion was.

Kimberli Cox said:

Oh, I would have never gotten away with that. We are also no longer allowed to write, "resume pre-op orders". I ordered every last damn medication she was on, route, dosage etc. It took me nearly 30 minutes. The EMR here is so out-dated that it takes multiple steps to order each drug and with every new one added you have to go back to the main menu, start from "Add Orders", go to "Pharmacy", check "Allergies Reviewed?", "Order Medication", "Order Scheduled Medications", go to "oral medications", find the drug in the alpha formulary, then click on dosage, number, route, and schedule. Its exhausting and not mention frustrating if you make a mistake and have to start all over.

We are also not allowed to let patients "self-administer" home meds in the hospital setting. The patient must surrender their meds to the pharmacy which dispenses them to the nursing staff, just as they would if they came from the pharmacy stash, and the nurse administers them (or at least puts them in the little paper cup). When I do this, I make sure to tell the patient to carefully look at the bill and make sure they are not billed for pharmacy services.

But I do understand why there could be confusion although I personally am still confused about specifically what the confusion was.

Click to expand...

As long as your hospital is being paid based on a drg - it won't matter what the hospital bill says - the drugs, the nursing time, the food, the pumps & tubing are all included in the drg. Likewise, when drugs are sent to the pharmacy - they are stored there. The only ones used are multidose units (inhalers, ointments), contraceptives & drugs which are not carried by the pharmacy itself (some unusual "branded" drugs). We don't dole out the pts own medication - we store it & return it with all the other valuables they bring in upon discharge.

We haven't billed out drugs individually (to the third party payor) in decades. The bill will get itemized, but the bean counters use this to renegotiate the drg reimbursement every year.

Remember - there is no way to reimburse for things like meal trays, the porter who cleans the bathrooms, the maintenance people, gardners, etc...that is part of the room charge.

Nursing time is normally incorporated into drug charges. Thats why you'll see a Hydrocodone/APAP tablet costing $5.00. Altho OR/PACU nursing SOMETIMES gets wrapped up in disposable charges in those units.

The pt doesn't pay that, nor does the insurance company (or Medicare/Medicaid). Those numbers are used to calculate the drg reimbursement for each procedure done. Thats why you have all those folks in medical records coding like crazy - to add to the drgs you might have missed (drug interactions, transient rf secondary to dye, etc....) If a pt is cash (& is actually going to pay - not a transient which gets written off), the bill is negotiated down to the drg price for a cash payment.

Understanding hospital charging & reimbursement is not an easy thing to get, particularly in a state which has a significant number of insurance plans.

1. Nursing student call @ 7pm:
"Serum troponins are low (<0.08), do you want to replete them?"

2. From the PHARMACIST today:
"You wrote an order for unfractionated heparin 5000 q12, but the patient has renal failure. You have to use heparin."

Kimberli Cox said:

fab4fan: I didn't think about that - it could have certainly been that she was thinking I initially meant for the patient to take her meds home with her as the order was written: "patient may take home meds, at usual doses and schedules"

Click to expand...

I wouldn't have read it that way had you not posted what transpired. But there are some people out there who are very concrete, and maybe she was one of those people.

I was burned one too many times by the "may take home meds" order so I made docs either write them out or listen to me read them off as a telephone order (less ideal). It was a pain for everyone, but then there was no chance of the "I never ordered that" card being thrown.

Anyway, that's all moot since we now have the cumbersome med reconciliation sheets courtesy of JC.

Kimberli Cox wrote:

But I do understand why there could be confusion although I personally am still confused about specifically what the confusion was.

Click to expand...

I need to save that for a future signature line.

carrigallen said:

1. Nursing student call @ 7pm:
"Serum troponins are low (<0.08), do you want to replete them?"

Click to expand...

So, did you bolus or slowly dripped them in?

As a previous nurse, previous CRNA and now an anesthesiologist I just don't know what to think about this thread.
Nurses are yelled at if they do call for trivial stuff and yelled at if they don't. If you talk to them, it is amazing what doctors will berate them for. Believe me, after 35yrs in the business, I advise every new physician to bite your tongue, keep your mouth shut and thank every nurse you work with. Treat them with respect, even if you might not think their actions deserve it, and they will save your ass more times than you even will know about. Not to mention making your days and nights more enjoyable. I have yelled at exactly two nurses in the 15yrs I have been a physician and I regretted it right away and apologized for being unprofessional immediately. There is never a time that berating someone can be considered professional behaviour. You will have a much better and enjoyable career if you just relax and work with nurses and not have an "us vs them" attitude.
Just my two cents, and change, after a few years observing doctors' relationships with nursing staff.

fab4fan said:

I was burned one too many times by the "may take home meds" order so I made docs either write them out or listen to me read them off as a telephone order (less ideal). It was a pain for everyone, but then there was no chance of the "I never ordered that" card being thrown.

Click to expand...

I've never worked in a hospital that DIDN'T make me write them all out (or enter them into the EMR). Its certainly not a way for the physician to get out of extra work.

Most of our hospitals will not take verbals for admit, post-operative or transfer orders. They tried banishing verbal orders completely until they realized that some services take home call and it would be a tad inconvenient to come in from home every time someone wanted a Tylenol order.

fab4fan said:

But I do understand why there could be confusion although I personally am still confused about specifically what the confusion was.


I need to save that for a future signature line.

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Well, if that isn't a convoluted statement, I don't know what is. Confuses me just to read it! You have my permission to use it as your sig line!

werewethere said:

So, did you bolus or slowly dripped them in?

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Really, we have to go sign them out in triplicate at the blood bank, after they have found a suitable massive MI candidate that hasn't started TPA therapy.

(I'm in Florida on assignment...so there is never that big a wait....all the golf courses around Orlando help with supply, especially in the heat).

We give them slow push through tubing with a special filter....kind of like cryo......

Kimberli Cox said:

I've never worked in a hospital that DIDN'T make me write them all out (or enter them into the EMR). Its certainly not a way for the physician to get out of extra work.

Most of our hospitals will not take verbals for admit, post-operative or transfer orders.

Click to expand...

I was recently in the West Palm area and they STILL write the "resume home meds"....along with never checking the med rec, or writing DC orders. I have to phone/fax chase all over the county.

With this in the background:

(Imagine a grating Loooong Island accent)

Nurse, Harvey was discharged by his doctor at 0800, what do you mean he can't leave yet....I'm PERSONAL friends with Jim the CFO of this hospital, surely he write the orders. We're BENEFACTORS I tell you!!!!!My Harvey has to be home in time for his TV game shows. Order!!!Schmorders!!! I tell you

caroladybelle said:

I was recently in the West Palm area and they STILL write the "resume home meds"....along with never checking the med rec, or writing DC orders. I have to phone/fax chase all over the county.

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Doesn't help the patient either. They don't understand "resume home meds" - you have to write them all out as well as anything you've added or changed while in the hospital. I've had patients still be taking their old meds, which were stopped in the hospital, along with new meds which were given to replace (the presumably ineffective) old ones.

caroladybelle said:

Really, we have to go sign them out in triplicate at the blood bank, after they have found a suitable massive MI candidate that hasn't started TPA therapy.

(I'm in Florida on assignment...so there is never that big a wait....all the golf courses around Orlando help with supply, especially in the heat).

We give them slow push through tubing with a special filter....kind of like cryo......

Click to expand...

Thank you so much! I couldn't find anything about how to give it in Harrison. And they say that book is comprehensive? HA! One thing that is still unclear, do you have to T&C or T&S the donor, and which type of troponin is universal, in case of emergency?

You can't store them in the blood bank. That would be too easy. You have to do the infusion while the donor is actually infarcting.

You can give the donor IV ephedrine, or better, dobutamine to increase the quality of the direct transfusion.

Hey! Now there's an idea!

rmh149 said:

You can give the donor IV ephedrine, or better, dobutamine to increase the quality of the direct transfusion.

Click to expand...

Thank you! I've been having problems with some nurses and interns giving ASA and nitrates, can you believe that!? They also almost ruined the CKs too! Boy, good luck to them when JCHACO comes around. At least I know I'm ready thanks to all of you.

Kimberli Cox said:

Well, if that isn't a convoluted statement, I don't know what is. Confuses me just to read it! You have my permission to use it as your sig line!

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On one level it is confusing, but on another it makes absolute sense.

nurse: doctor, the patient's hungry, but he has an order for npo after midnight.
me: :glances at watch and sees that it's 930 pm: what time do you have?
nurse: it's 930 doctor.
me: well, 930's before midnight...

Kimberli Cox said:

Doesn't help the patient either. They don't understand "resume home meds" - you have to write them all out as well as anything you've added or changed while in the hospital. I've had patients still be taking their old meds, which were stopped in the hospital, along with new meds which were given to replace (the presumably ineffective) old ones.

Click to expand...

when we discharge a patient, we have to print out the medicines from the computer. we get both a list of outpatient medicines (on one form) and inpatient medicines on another- then we just reconcile them. for instance, you can mark the "continue" box on the eye drops from home, but mark "discontinue" on the home bp meds that weren't working, and mark continue on the inpatient bp meds that are working.

Well, you know, that really was a dumb question.

elwademd said:

when we discharge a patient, we have to print out the medicines from the computer. we get both a list of outpatient medicines (on one form) and inpatient medicines on another- then we just reconcile them. for instance, you can mark the "continue" box on the eye drops from home, but mark "discontinue" on the home bp meds that weren't working, and mark continue on the inpatient bp meds that are working.

Click to expand...

That is how it should work and does in teaching hospitals.

Let me explain life in nonteaching hospitals.

Prior to JCAHO raising a stink about med recs, the MD admitting the patient was to assess what meds the patient was on, and write them all out and order them.

90% never did -they wrote "Continue home meds" with no clue what meds the patient was on. This was obvious to the nurse admitting a GI Bleed for FFP and vitamin K, and noting that the patient was on coumadin, ASA and prednisone. And the writing of CHM orders was not permitted anyway, so we had to call the MD, who was pissed and let us know that he was pissed and being required to review the meds, telling us to "use our judgement" - which is not permitted as nurses cannot "prescribe".

They also rarely addressed DC meds - if they did, it was merely the new prescriptions - never addressing the old. Necessitating multiple phone calls to the MD, many of whom, side stepped it, not wanting to deal with all the patients meds from different MDs.

Thus patients bounced back due to med issues. Or worse, suffered serious issues due to this.

Jcaho recognized it had a critical issue. Thus the regs on med recs at admission and DC. Nurses put in the meds and print a form, that MDs check the box and signoff on.

And it doesn't matter when the patient is admitted, if the MD "forgets" to check and sign (which they all KNOW that they have to do), the documentation nazi comes and harasses the nurse because s/he "let" this happen.

In addition, every night we carefully print out updated MR sheets and place them on the front of the orders, so that if the patient gets transferred/DC'd, all the MD has to do is check and sign.

Easy, right?????????????

THEN HOW COME THE VAST MAJORITY OF MDS LEAVE THEM BLANK, and make me phone/fax chase them across Palm Beach County, to do the darn things? It takes one minute to check and sign but they will not do it.

At any community facility - in my humble experience, at least 50%-75% of them are not filled out - despite being right where the DC order is written.

PS, in WPB area, many forget to write "DC patient", though they conveniently tell the patient that they are DC'd. It doesn't occur to them to tell the nurse.

werewethere said:

One thing that is still unclear, do you have to T&C or T&S the donor, and which type of troponin is universal, in case of emergency?

Click to expand...

Only the ABO group has to match, though you do occasionally have to get them HLA matched if the patient becomes refractory.

caroladybelle said:

Only the ABO group has to match, though you do occasionally have to get them HLA matched if the patient becomes refractory.

Click to expand...

Actually T&S does ABO, Rh and antibody screen. If the antibody screen is negative the blood is not reserved for the patient. If the antibody screen is positive the blood is crossmatched. In T&C matched blood is specifically reserved for the patient. Use T&S if you think it is unlikely you will need blood. Use T&C if you are pretty sure you are going to give blood. In reality with computer matching they are pretty much the same even for antibody positive blood (at least thats how they do things in my neck of the woods YMMV).

David Carpenter, PA-C

core0 said:

Actually T&S does ABO, Rh and antibody screen. If the antibody screen is negative the blood is not reserved for the patient. If the antibody screen is positive the blood is crossmatched. In T&C matched blood is specifically reserved for the patient. Use T&S if you think it is unlikely you will need blood. Use T&C if you are pretty sure you are going to give blood. In reality with computer matching they are pretty much the same even for antibody positive blood (at least thats how they do things in my neck of the woods YMMV).

David Carpenter, PA-C

Click to expand...

I think, although I may be mistaken, that you completely missed the joke

jd

"I'm not sure, but I think that the patient has decreased breath sounds on the left side, but just at the base."

"You know the patient has no left lung, right?"

"Oh. right."

/fortunately not the result of a page waking me up.