Ankle biter tasks

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The Knife & Gun Club

The Knife & Gun Club

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Just curious (as a current fellow) what attending life looks like in regards to the little “ankle biter” tasks from nurses/RT/pharmacy that seem to pile up and really jam up work flow in the unit. Would also be very curious if this changes with having an APP or solo coverage.

Things like…

Patient needs “mechanical soft” modification of their diet orders

Restraint orders need to be renewed at 6:55 pm

The duonebs are ordered as inhalation but we need it ordered as via ET tube

RT can’t find the artery for an ABG

Nurse needs a new nurse communication order for post-op dressings

Need to place a new dobhoff tube because patient ripped theirs out.

PT has an order for PT but need an order for therapy communication that it’s ok to be out of bed.

So on and so forth. As a fellow I get maybe 4-5 of these an hour which breaks up the workflow quite a bit. I kind of assumed it was just the nature of working at a big academic center but now doing community rotations I come to find the same is true even at sites with only an attending. I feel like it would be vastly easier to just tell PT/nurse/pharmacy/RT to adjust the computer stuff to whatever they need to do their job and I’ll co-sign it but Aparently that’s against policy at the few systems I’ve worked in.
 
Yeah, no, we don't deal with that bull****. Speech and nursing tell me their recs or what they need, I say fine, they put the modified order in, and I sign it eventually. Restraint renewals are entered automatically, and I cosign. If RT cannot find the artery, I ask them to phone a friend (and they'll try with doppler), or decide if I really need that gas. If none can find it, I'll grab the USD, place an art line, and they'll run the gas.
 
Holy **** yes, we get these sorts of things all the time. Not 4-5/hr but especially the restraints renewal is non stop.

I once had a float pool nurse tell me I needed to put in orders for each time we had increased the epi dose in a shocky patient. We had titrated a number of times in the span of 35 minutes and she wanted me to put in a specific order with the appropriate time for each change.

I wouldn't be half as pissed off about the run of the mill requests for orders (not the epi situation) if the nurses and RTs followed all the orders already placed to the letter. But instead they frequently ignore whatever is inconvenient for them while simultaneously wanting specific orders to cover them for other things (that they don't need to be covered for).
 
1. If it's something like OPO, I just tell them that I don't care what OPO wants... I'm not going to say "no" and just put it as a telephone order.

2. I find that people criminally underuse saved orders and sets. If you find yourself constantly ordering the same thing, save it. I have a "rehab" folder. It contains a PT, an OT, and a ST order. 3+ clicks and filling in the "indication" box is now 2 clicks. Same thing with one site that needed restraint orders renewed. There was a order set and it cut the clicks down.

Seriously, if you don't know how to save orders and build your own order sets, find out and it'll be time well invested.
 
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