I found out one morning that there was a patient on my ward with a troponin of >200. Was in ER yesterday, had a diagnosed NSTEMI, as well as pneumonia.  The lab did not call to inform us of this, which is odd, since they called when it was 4.43. We called the on call doctor who ordered repeat blood work and a STAT ECG. Lab tech came, drew the blood, ECG tech came and informed us of a new policy that elevated troponins were not considered stat any more, and that it should have been put in as urgent. I explained that this was critically high, and was told it didn’t matter. “There is only a few of us, and we can’t go to all these false stats” At this time, I looked at the conditions for stat and randomly picked one that applied to this patient.  I respect that I’m sure they get a lot of “false stats”, but I feel like my (and the doctor’s) clinical judgement should play some part.
So, eventually we get the repeat and it is still >200. By this time her BP is going down, she is on 80% HFFM, and slowly desatting into the high to low 80s Call the covering doctor (different than on-call person) and get an order for....Normal Saline @75. No extra blood work, no calling CCU. He needs to come up and review the chart first. An hour later she starts to fill up with fluid and her resp rate goes into the high 30s, we call again and get an order for lasix and IV morphine. 3 hours later he shows up, orders some more stuff, and then leaves. Never lays eyes on the patient, never talks to me, and doesn’t talk to the nurse.  One of his orders was to put her on 4LNP. From 80% HFFM. What?? She’s not comfort care, she’s still full medical management, but I guarantee that putting her on 4L will kill her. 

I want to reach through the phone and strangle him half the time. 

3/17/2012 01:43:20 am

I can't believe this....isn't there some way to keep them accountable? they are the ones who have to do all the school, yet you are the ones who have to do all the work and provide all the compassion. You have to catch their shitty work and slip ups. As a BC resident who has people in the hospital and has had to be in the hospital in the last year this scares the crap out of me!

I am so so so so so so so thankful for nurses who love what they do, care for their patients and understand their families! Thanks for doing what you do my friend...you are the cream of the crop!

3/27/2012 06:44:37 am

We all make mistakes, we all catch each other's errors. These things happen. The doctors I work with are incredibly hard working, caring individuals. 99% of the time.


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