Introduction
If you encounter a doctor's advice in doubt, don't execute it! These cases are lessons learned!
Case 1: Intravenously push potassium chloride to allergy patients
@Hyj**：
This happened in the emergency department. A trainee nurse is giving an intravenous bolus for a patient with drug allergies, and when she first pushed the drug, the patient complained that the pain at the puncture site was unbearable. At this time, the teacher came over and asked the trainee nurse what kind of medicine was pushed? The trainee nurse replied "potassium chloride". The teacher was almost scared to death! Hurry to pull out the needle, a doctor's advice is "10% potassium chloride 10ml + 50% glucose 20ml iv".
It turned out that the emergency doctor was busy and dizzy, and the ghost made a difference, and even opened calcium gluconate into potassium chloride. If you encounter a patient who can endure pain, or if you encounter a nurse who thinks that "pushing the medicine is already painful", the consequences can be imagined. But thankfully it was found in time... Later, doctors, teachers, and trainee nurses were all seriously dealt with.
Lesson: Instructors must be able to let go and remember to !!! In clinical work, you have to be careful every step of the way. There are special requirements for the concentration and rate of intravenous infusion of potassium chloride, and the school teachers will emphasize to the students that the trainee nurses should apply what they have learned and do not forget the pharmacological knowledge taught by the school teachers when they get to the clinic. In addition, it is necessary to pay attention to the patient's main complaint and re-evaluate when the patient tells the nurse that there is any discomfort.
Reminder: Potassium chloride should not be injected directly intravenously, and intravenous infusion should not be carried out without dilution. The general usage is to add 10-15ml of 10% potassium chloride injection to 500ml of solvent instillation, and the daily potassium supplement dose, concentration and speed are determined according to the clinical condition and blood potassium concentration, ECG potassium deficiency pattern improvement.
Case 2: Ceftriaxone is cloudy during infusion
@Lan**:
I remember that at that time in the outpatient infusion room, a doctor prescribed a doctor's order: balance solution 500ML + ceftriaxone sodium 2.0/ivgtt. At that time, the three nurses who copied the injection list, the dosing and the injection all felt that this group of doctors' instructions was strange, and they had never encountered the addition of antibiotics to the equilibrium solution, but after checking the original medical instructions, they were indeed so, and they were still executed.
Half an hour later, the family found that the infusion bottle appeared turbid, and then immediately withdrew the infusion, observed for two or three days, did various examinations, and the patient fortunately did not have an infusion reaction and other phenomena. Finally, the hospital refunded the money for the infusion, and the cost during the observation period was free, so that it could be considered calm!
Lesson: When a nurse encounters a suspicious medical order, she should first check the doctor's order again, and then she can ask the doctor in person to express doubts, or she can inquire about the compatibility of various drugs, so this error is completely avoidable. Nurses do not blindly carry out medical advice, and if they find mistakes and still carry them out, they are also responsible.
Reminder: At present, the commonly used equilibrium salt solutions in clinical practice are sodium lactate and compound sodium chloride solution. Compound sodium chloride, also known as Ringer's solution, the main components are potassium chloride and calcium chloride.
Case 3: Anthromdin opens into lumina
@lixiang**：
I'll also say one thing. An emergency night shift, our doctor was looking at an emergency patient, then came a kidney stone abdominal pain patient, the pain is unbearable, the doctor looked at it, and gave an oral doctor's order: Rumina 0.2 intramuscular injection. Or our head nurse reacted quickly and told the doctor to make a doctor's order before executing it. The doctor is still quite reasonable, let's go fight first. The head nurse adheres to principles and does not carry out the doctor's advice. The doctor was very unhappy at the time, but there was no way, and finally pulled out his hand to prescribe a medical advice, and this writing came back to himself and said that he was wrong, and originally wanted us to fight and settle down.
Lesson: Don't just carry out oral doctor's orders, unless you repeat them when rescuing the patient. Remember: it is not a matter of a few minutes to execute after the doctor's order, this is the principle and the system.
Reminder: It seems that the two medicines are not compatible, but in fact, the common names of the two drugs are similar. Lumina, also known as phenobarbital injection, is mainly used for anticonvulsants and the treatment of epilepsy. Angondine, also known as compound ammonium barbiturate injection, is an antipyretic analgesic.
Case 4: Plasma prescribed by a doctor during the opening period
@Pear***：
One year I had a nursing deficiency. I still remember that a new doctor issued a medical order: new plasma 200ML ST + QD, that QD is also very sloppy, plus our department has never had a precedent for plasma to prescribe long-term medical orders, I took it as a temporary medical order to deal with it. The nurse on duty and the nurse on the night shift did not check it out, the doctor did not find it, and after two days, somehow a nurse accidentally saw it, so everyone was surprised. Because the patient's condition was not very critical, I was later dismissed as a nursing defect. That doctor's order was the only long-term medical order for a plasma transfusion in our department so far, and the doctor never prescribed it again.
Lesson: Never act empirically, no matter what the convention is, it is possible to break the convention! Doctors should also strengthen solidarity and cooperation with nurses, when doctors prescribe doctors with unusual medical orders, please do not forget to remind nurses, small actions can help nurses avoid some problems. Mutual cooperation and complementarity are the key to healthcare cooperation.
It should be noted that the medical order check and enforcement system
As the basis and focus of nursing work, the medical advice check and implementation requires every clinical nurse to master, so let's review it together.
First, the system of checking medical orders
1. When handling long-term medical orders or temporary medical orders, the processing time should be recorded, and the executor should sign the full name, and if there is any doubt, it must be asked clearly before it can be executed. The doctor's orders of each class are checked by the 2 nurses on duty.
2. The nurse in charge and the nurse on the night shift should check the doctor's instructions on the day, check them regularly twice a week, and reorganize them as needed. After sorting out the doctor's order, it needs to be checked by another person before it can be executed.
3. The doctor's order in question must be clearly asked before it can be executed.
4. When rescuing the patient, the physician issues an oral doctor's order, and the executor must repeat it, and after verification by both parties, it can be executed. Used empty urns must be checked by 2 people before they can be discarded. Complete and sign the medical order within 6 hours after the rescue is completed.
5. After sorting out the doctor's order, treatment card, and medication card, it must be checked by 2 people.
6. The head nurse checks the doctor's order once a week.
Second, the process of medical order execution
1. After the nurse receives the doctor's order, read it carefully and check it correctly.
2. Check the doctor's order without question and confirm the doctor's order.
3. The nurse who handles the doctor's order is assigned to the nurse according to the urgent arrangement required by the doctor's order.
4. After the nurse who executes the doctor's order receives the medical order execution form, carefully checks it, strictly implements it accurately in accordance with the requirements of the content and time of the doctor's order, and must not change it without authorization.
5. After the implementation of the doctor's order, the efficacy and adverse reactions should be carefully observed, and if necessary, recorded and timely feedback with the doctor.
Thanks:
The above cases come from a medical forum site friends to share, the author sorted out, hereby thanks!
Source: "China Medical Network" public number
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