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Wednesday, September 16, 2009

Is it our duty to question stupid doctor orders?

I'm sure other RTs and even RNs have experienced the same thing, but there are a lot of times doctors order bronchodilator breathing treatments that are not indicated. I like to say that at least 80% or all bronchodilator treatments ordered are not indicated.

I don't like to pick fights. I don't like to complain. I'm not the kind of person to roll my eyes at a unit secretary when she gives me the order for yet another treatment order for a pneumonia, CHF, croupy kid, or whatever have you.

However, my coworker, Jane Sage, said to me tonight, "Have you ever thought to walk up to the doctor and say, 'Just what did you expect to happen when you ordered that 20th Xopenex treatment for croup after the first 19 did not work? Did you think to try race epi? Did you think to try nebulized Decadron?"

"Well," I said, "I think to say something like that every day. But, do you want to know the reason that I don't."

"You don't want to tick off the doctor?"

"Actually, that's not the reason."

"Well," she said.

"I don't because I know I'm not perfect, and there is a 1% chance I could be wrong."

"You could be wrong, but you're still pretty confident you are right."

"Yeah. I'm non confrontational."

"I'm like you," she said, "I don't like to cause controversy. Perhaps it's because most RTs are like us that no progress ever gets made at Shoreline Medical Center."

"True," I said.

"However," the sagacious Jane Sage said as her eyes lit up, the tel tale sign she was going to say something brilliant, "If a doctor were to order 200mg or Morphine, don't you think the nurse would say to the doctor, "Wait!"

"I see what you mean."

"Don't you think, like the nurse of that patient who was ordered to get 400mg of Morphine, that it is our duty as respectable members of society to question it when a bronchodilator is ordered and not needed?"

Anyway, that's something to think about.

1 comment:

Anonymous said...

How do you suggest that we change the culture of hospitals so that rt's and nurses can question orders they think are stupid. Wouldn't that prevent suffereing, and reduce cost?