Re: The Diagnosis
From: Dean Huffman (dean@thehuffpeople.net)
Tue Mar 5 13:22:21 2002
I had an interesting experience where I used to work. They indeed has a
setup whereby orders could be directly written into the computer. I did
this frequently for laboratory work, especially complicated or infrequently
used tests where the clerk might get it wrong. For example, orders for
hemaglobin A1c often came back as hemaglobin electrophoresis. This worked
great to get things done correctly. However when the orders were for
nursing instructions, such as "remove foley", it did not work. Why? Because
the nurses rarely, if ever, looked at the computer. In fact, I would
frequently look in the computer orders that were presumably being actively
carried out and would find orders for the fetus to be monitored daily in a
patient who had a cesarean two days ago, or active orders for a foley that
had been removed the day before.
My feeling about these computer orders was that either they should be done
correctly or they should not be done at all. Unfortunatley, that attitude
was not universal.
- - - -
At 07:26 AM 3/4/2002 -0600, you wrote:
>so why not have terminals at nurses' stations for the input of orders?
>would eliminate the handwriting issue.
>
>art
>
>At Sun, 03 Mar 2002, Dean Huffman wrote:
> >
> >..
> >
> >I think that one could argue the situation both ways. The physician should
> >write the order legibly so that it can be read. If his/her writing is not
> >legible, then it should be printed. I have even seen physicians whose
> >writing and printing was so bad that they would type notes, orders, etc.
> >(The hospital had a typewriter for this purpose on every ward. Whether or
> >not the typewriters were there specifically for that physician is unknown
> >to me -- that was back in the days before word processors.)
> >
> >On the other hand, if the nurse cannot read the writing, he/she is
> >obligated to call the physician to have the orders clarified.
> >
> >You can bet that the lawyer will argue both ways. This way he can pit nurse
> >against physician and, if lucky, find liability on both sides.
> >
> >--
> >Dean Huffman
> >
> >- - - -
> >
> >At 08:08 PM 3/3/2002 -0600, you wrote:
> >>The nurse didn't necessarily "mis-read" - the PHYSICIAN wrote it
> >>illegibly and the nurse did her best to decipher. I always taught the
> >>residents and medical students that if they want the patient to get what
> >>they order - then it is his / her responsibility to write it so the
> >>order can be read! There is no excuse (in my book) for an order that can
> >>not be read.
> >>
> >>Joanne
> >>
> >>as ART says - that is my opinion...
> >>
> >> >
> >> > -----Original Message-----
> >> >From: Braun, R. Daniel [mailto:rbraun@iupui.edu]
> >> >Sent: 27 February 2002 11:47
> >> >To: Multiple recipients of list OB-GYN-L
> >> >Subject: Re: The Diagnosis
> >> >
> >> >I remember several years ago, we removed the C-L of a 6
> week pregnancy and
> >> >ordered Delalutin to replace the progesterone. The nurse misread the
> order
> >> >and gave Dilantin. The pregnancy progressed to term with a normal
> delivery.
> >> >
> >> >Dan
> >> >
> >> >R. Daniel Braun, MD
> >> >
> >> >There are strange things done in the midnight sun
> >> > By the men who moil for gold;
> >> >The Arctic trails have their secret tales
> >> > That would make your blood run cold;
> >> >The Northern Lights have seen queer sights,
> >> > But the queerest they ever did see
> >> >Was that night on the marge of Lake Lebarge
> >> > I cremated Sam McGee.
> >> > Robert W Service
> >> >
> >> > -----Original Message-----
> >> >From: Steve & Eryl Raymond [mailto:eryl@intekom.co.za]
> >> >Sent: Tuesday, February 26, 2002 11:15 PM
> >> >To: Multiple recipients of list OB-GYN-L
> >> >Subject: Re: The Diagnosis
> >> >
> >> >Is there any evidence that the human pregnancy requires extra
> progesterone
> >> >once the
> >> >placental production of HCG has started? It is my understanding that an
> >> >oophorectomy
> >> >does not affect a pregnancy after implantation.
> >> >stray
> >> >
> >> >"Marco A. Pelosi, III, MD" wrote:
> >> >
> >> >> At Mon, 25 Feb 2002, Steve & Eryl Raymond wrote:
> >> >> >
> >> >> >Why the progesterone supositories?
> >> >> >stray
> >> >> >
> >> >> >The corpus luteum was completely removed ergo progesterone deficient
> >> >> pregnancy.
> >> >>
> >> >> --
> >> >> M.A. Pelosi, III, MD
> >> >
> >> >--
> >> >
> >> >Dr.S.H. Raymond
> >> >Head of Department of O & G
> >> >Empangeni Hospital
> >> >South Africa 3880
> >> >Phone: (+27) 35-7721111
> >> >Fax: (+27) 35-7922596
> >> >
> >>
> >>--
> >>Joanne Bulley, MD
> >>Keene, NH, USA
> >>
> >>~*~ let there be peace on earth and let it begin with me ~*~
> >
>
>--
>art fougner, md
>ich bin ein New Yorker
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