Monday, July 18, 2011

The Hell

So for the last days now some jackwagon LPN has been sending his patient to the ER via EMS with some vague instructions to the medics to get us to start an IV along with an order sheet handwritten by him with some huge run on sentence on it about how the doctor ordered antibiotics to be given IV after dialysis by the dialysis nurse, but he knew that the antibiotics would require further monitoring so he was sending the patient over to the ER to have it done. WTF. This poor patient was actually oriented and stuff, too, so this shit was even more embarrassing. He was super tired of being shipped back and forth, as you would expect.
So, of course, being the way I am, I just had to talk to this, um, nurse. I mean, I had no other choice. It went about how you would expect it to.
Hood Nurse: Hi, yeah, I'm calling from Hood Hospital to speak with the nurse taking care of Mr. Jones.
Nursing Home "Nurse":Derp derp, yes, that's me.
Hood Nurse: Sooo. I gather from these here papers you sent me that you're sending your patient over here on a daily basis to receive IV antibiotics?
NH "Nurse": Yes, that's right.
Hood Nurse: You're sending him over here on an ambulance so we can give you meds for you, I've got that correct?
NH person: Yes.
Hood Nurse: Yeeahhh. So. About that. We don't do that. The emergency room is here for emergencies. So, giving your antibiotics every day is important, but it isn't an emergency, you know what I mean?
NH person:Um. Yes?
Hood Nurse: And, you know what, if you were sending him over here for line placement, let me just stop you right there. This guy has no places to start IVs left. He has a 22 in the armpit. I will not send him back with that knowing he is coming back to you and you intend on infusing antibiotics through it. If you really need access you need a PICC line and you need to get it scheduled outpatient with a real doctor's order, not whatever this business you sent us today is.
Freaking Idiot:Um. So you guys started a PICC line?
Hood nurse: NOOOO!
Seriously, moron: So, you left the IV in?
Hood Nurse: Absolutely not. He is coming back to you. Get him an order for PICC line placement if you need to give IV antibiotics. Stop sending your patient up here for this foolishness.
Nurse dumbass: Okay, we'll be expecting him.
HOLY BALLS. The worst part? Site in question they were giving antibiotics for? No signs of infection. At all. I was actually shocked to not see him rolling in last night, too.


  1. Pre-nursing student here trying to interpret. Can I assume the nurse does not know how to insert this line himself? What's wrong with the 22 - wrong method?

  2. If the Patient has Medicare and infection is dialysis related, The PPS bundled payment to the dialysis facility should pay for the antibiotics. The dialysis facility should have made the arrangements.

  3. 22 in the armpit - tiny vein in a bad spot!

  4. I smell incompetence all over the place with this situation. Someone who is paying all these costs and providing the care needs to made aware.

  5. The way the "order" was written it was pretty apparent that the doctor wanted dialysis to take care of it, but the nurse took it upon himself to change it.
    @pre-nursing student- I'm not really sure in this state if LPNs can give IV meds or not. The rules vary very strangely from institution to institution. The big thing with peripheral IV sites like that is that it's really hard to tell by just looking if it IV infiltrates, which is pretty important in a site that is in a more central part of the body. Any nurse with good judgement would probably not use an IV like this for antibiotics, too some of them cause skin necrosis and if they did infiltrate, it would be a bad scene. I wasn't convinced this dude had great judgement.