I’m not sure how mad the doctor is in this film, but it’s Basil Rathbone!!!!
I love Basil Rathbone!
There has never been a better Sherlock Holmes on the screen.
Suave and sinister! My kinda guy!
Medication reconciliation forms.
Every time I fill one out I have every four-letter-word known to man run through my brain and then I invent some new ones.
And last night it got worse.
Pardon my language, but I am pissed off. Royally.
Let me do a quick recap of what we are required to do, as nurses, on the medication reconciliation form:
- We are required to write down precisely what the patient tells us, even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, we have to write “Ativan, 25 mg” on the reconciliation form.
- If the patient hands us a list of their medications and instead of “Furosemide”, they have written “Furobedide” we have to write it exactly as it is printed on the list!
Now, the paper that we so painstakingly fill out in our ER is then taken upstairs with the patients that are admitted and all the admitting doctor has to do is look at it and check off the box if they want it ordered in the hospital.
Did you get that? We nurses write the orders out in their entirety and all the doctors have to do is CHECK A FREAKING BOX.
Sorry, I’ll try not to shout.
What this means is that (1) the patient is actually writing their own orders based on what they tell the nurse on admission when (2) the admitting physician should be responsible for finding out exactly what the patient is taking and write their own orders!
So what’s new, you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, yadda, yadda?
I walked into work last night to find a note on the bulletin board (this is the preferred method of communication where I work) telling us that Dr. Q found a dosage error on a medication reconciliation sheet that would have “sent a patient to ICU” and that we nurses in the ER needed to be more careful.
It gets better. Attached as an afterthought was a post-it note stating Dr. Q also thought that the floor nurses should go over in detail everything that is written in the ER after the patient gets up to the floor. Oh….and he appreciates all our hard work.
<full seethe ahead>
I left a choice note on his note and I am too old and too cynical to give a damn about the repercussions.
So this week’s theme for Grand Rounds is prognostication.
I foresaw this trouble looooong before now. The way we are required to fill out the medication reconciliation sheet is a safety hazard. It has been, it is now, and it will continue to be.
It is the rare patient who knows exactly what they take, how much they take or why the hell they even take it!
But this is what their orders are being based on.
Even if they come in with two full pages of medications, single spaced and printed off a computer, when I verify the meds with them there will be 3-4 changes and at least three that have been discontinued.
So now the ER is getting criticism while doing something the doctor should be doing to begin with, but that is not the worst part.
The system is set up so that any discrepancy, any dosage error, any transcription error (we aren’t allowed to xerox the patient’s list) – any adverse reaction/incident….can be blamed on a nurse for writing it “wrong”.
Yet they require us to write it “as is”.
The system is set up to fail. Somewhere, somehow, someone is going to be hurt. And I’m not exaggerating when I say it will be the nurse whose signature is on the bottom of that form that will take the fall.
So, Dr. Q, before you come down and spread your eminent wisdom to those careless emergency department nurses, why don’t you find out why that dosage landed on your patient’s form, realize that you should be ultimately responsible for what is ordered and then thank us for doing your job.
Don’t criticize us on one hand and then patronize us with your appreciation of how hard we work.
You don’t have a clue, buddy.