Careless mistakes or common intern errors???

[nudmamer]

Started heparin 800 u/hr drip per call by resident but was not aware you had to bolus the pt first.

Ordered nuc med stress test on preop pt and a diet. Did not know you had to make nuc med stress test pts NPO, now surgery my be delayed through the weekend.

After being up all night I often confuse which pts had which resections done, its tiring and I keep trying to develope a system that works.

We have loads of autonomy on a surgical service with 15-25 pts and I feel stupid everyday. I can not convince myself I am making silly intern mistakes. I feel like I should somehow already know this stuff. I feel like I am expected to know this stuff even though its week two and I am beating myself up.

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[Smurfette]

Started heparin 800 u/hr drip per call by resident but was not aware you had to bolus the pt first.

Ordered nuc med stress test on preop pt and a diet. Did not know you had to make nuc med stress test pts NPO, now surgery my be delayed through the weekend.

After being up all night I often confuse which pts had which resections done, its tiring and I keep trying to develope a system that works.

We have loads of autonomy on a surgical service with 15-25 pts and I feel stupid everyday. I can not convince myself I am making silly intern mistakes. I feel like I should somehow already know this stuff. I feel like I am expected to know this stuff even though its week two and I am beating myself up.

Actually, in my program we rarely bolussed a patient with heparin if they were early post op. In the future, ask the resident if they want a bolus or not as well as what dose to start at. Or if therapeutic lovenox is an option (sometimes people just don't think of it).
The nuc med stress test, I can understand how you didn't realize they had to be NPO. Now you know. But someone should have told you....that is not something you should have automatically known.

It sounds like your residents need to remember it's July and be explicit about every order and the related orders it implies. Like dc foley also implies void check, and bowel prep means clear liquid diet and NPO after midnight.

In order to keep track of patients, I always wrote their procedure/diagnosis on my list copy underneath their names, if it wasn't there already. I would do this every day, copying from the previous day's list, until I knew everyone without hesitation. Important things like PE or "tylenol allergy" or EtOH withdrawal also were included with this. Not their whole PMH, but the important "bullet points". The few minutes it takes to do this is well worth it. And then I'd switch services and I'd start doing it again. This is especially helpful for days when you show up in the morning to find 5-10 (or more) new patients on your service and you need to keep them straight.

hope this helps

 

[PharmaTope]

Started heparin 800 u/hr drip per call by resident but was not aware you had to bolus the pt first.

Ordered nuc med stress test on preop pt and a diet. Did not know you had to make nuc med stress test pts NPO, now surgery my be delayed through the weekend.

After being up all night I often confuse which pts had which resections done, its tiring and I keep trying to develope a system that works.

We have loads of autonomy on a surgical service with 15-25 pts and I feel stupid everyday. I can not convince myself I am making silly intern mistakes. I feel like I should somehow already know this stuff. I feel like I am expected to know this stuff even though its week two and I am beating myself up.

why isnt your hospital providing you guys with good order sets? dont they give you an intern survival guide with all this in it?

 

[nudmamer]

It has come to my attention that our order sets have a prep information box that explains how to order these tests and other helpful information. I will be sure to click on and read these boxes for now on. I just feel there was a huge gap in our orientation process and because of it we as a new intern group have managed to piss off everyone including social work, P.T., nursing, wound care at some point.

I am chalking most of it up to being a new intern but I am hard on myself when pts have to sit in the hospital over the weekend because I goofed on ordering a test.

Thanks for the responses.

 

[dpmd]

One thing you can do is to check things. For meds, check with pharmacy if your pharmacopeia doesn't have enough info. For tests, check with the tech. That way you don't have to run to your senior to give you step by step instructions each time, and you don't end up making a mistake. Takes longer at first, but then you tuck that info away and next time its easier.

 

[wholeheartedly]

One thing you can do is to check things.

This!!! I work in a the blood bank and if you're not sure the best way to go about getting what you need I'd much rather have you call me and ask how best to go about it than play pager/phone tag while we try to work out the kinks and delay pt. care. If the new residents have a few minutes I always try to give them tips that'll make things more efficient for them down the road.

 

[Winged Scapula]

Please do not automatically use the order sets without checking with your attending or Chief resident.

Those order sets were written by committee and do not necessarily reflect what every attending wants or uses (I know mine don't).

Also be careful about taking advice about "X means Y" from SDNers...I see a couple of comments above that are not necessarily the way all surgeons practice. What you want to know is how *your* surgeons want their patients taken care of...it may differ from attending to attending (ie, especially with things like bowel preps, post op labs, dressing changes, etc.) and service to service. One of the harder things as a senior resident is to know who wants what and to convey that to the team.

At any rate, being an intern has a steep learning curve. You will make mistakes, you will do things without detailed knowledge - it is not your fault you didn't know you had to be NPO for a certain test or that your team likes boluses on Hep gtt patients. Now you know at least to ask about these things for clarification.