A Nurse from OHIO writes:
“As a nurse I have tried to make a stand. Patients aren’t in the ICU without cause. It is horrifying to watch a patient suffer on a ventilator because the pharmacy is watching everything. I chose to do the ethical thing and medicate. I stayed within the confines of the orders however because I medicate more than all the other nurses I’m being accused of diversion. I’ve proven twice by taking their test that I was not. Now I have to worry that they will accuse me of stealing and selling the drugs because I can’t give a dirty sample. It is a witch hunt. I hate what my profession has become and it disgusts me that more of us aren’t standing up. When I first became a nurse you had to give the patient all they wanted. That created this wave of junkies. The board of pharmacy is going to be responsible for the next wave but its going to be legitimate patients they are refusing to help now. I can tell you that if you are able to make big donations and build hospital wings you can get anything you want.”
A Nurse from WI writes:
“A nurse for over 50 years, I have seen patients and friends suffer needlessly, and have experienced the denial of humane treatment myself. The current climate of over-control and witch hunts is very alarming.”
Filed under: General Problems
She is saying that it’s a sad day, when all that we can do as nurses is watch our patients suffer with avoidable, treatable pain- because the “Witchhunt” extends to professionals in the hospital setting. Where are peoples hearts?
@ Anne…I appreciate you taking the time to explain all this for the layperson. Most people reading anything even remotely related to the day-to-day kinds of things involved with the implementation health care delivery system have no idea of what they’re looking at. It’s not rocket science. One just has to know the “Captain Stupendous” super-secret code that we use. I’m a pharmacist in northern California and have worked, in terms of practice settings, retail chain and independent, Long Term Care, Hospice, Corrections, Pharmaceutical Manufacturing, and a wee bit of Hospital. I work for a health insurance company now as I cannot (for health reasons) and will not (for reasons of ethics and morals) work in a traditional dispensing setting. I really enjoy what I do now.
I feel for the nurses. Between dealing with a variety of personality types in your patients, you have to deal with the leviathan bureaucracies of the nursing board at the state level and a handful of federal agencies. Then there is the bureaucracy that is your employer. Most hospitals are run by large corporate interests that basically make for a chain operation. The standard model seems to be staffing based on the unit census and individual patient acuities are not considered at all.
The nurse ends up running (literally) from room to room and bed to bed on most shifts, delivering the minimum amount of care to less ill so as to be able to spend more time with the really sick patient who requires more consideration; that is on a good day. If one is fortunate, they work the graveyard, night or p.m. shift (nomenclature depends on a shit being 8, 10 or 12 hours). This means that some of the patients are asleep and the docs and the family members aren’t there to demand the attention of the nurse or act as a nuisance distraction. At the end of the shift, regardless of the time slot that one fills, one is again fortunate to go home on time every time. I’ve seen nurses staying an hour or two late in order to complete all the charting that has to be done. Once and again, it’s all about profit, even for the designated non-profit hospitals. Someone has to make sure that the hospital’s CEO gets their six or seven figure bonus on top of their seven figure compensation package. My hat is off to you for putting up with way more B.S. than anyone in your position has to. BTW, as I read your post, I reckoned that the repeats and typos were d/t the wonders or modern tech. My smart phone gives me the same set of fits. No worries from my little corner of space-time. {:0)>
@WI Nurse…you are correct. It is a witch hunt. Who conducted the witch hunts in this country, from a historical perspective? it was the Puritans. Their descendants are the ones conducting the current series of hunts. I refer to then simply as Neopuritans.
As to Ohio Nurse, you wrote, “When I first became a nurse you had to give the patient all they wanted. That created this wave of junkies.” That wasn’t your fault, nor is it true of the vast number of patients that you took care of in this manner. As I understand it, the per capita rate of genuine addiction in this country has always been around 4% =/- 0.5% since such metrics were compiled starting a little over 100 years ago. The majority of your patients did not leave your care as raging dope fiends in that particular period.
It does not matter what Neopuritanical policy measures have been instituted, that addiction number has not changed. The reason is because that is what happens when a disease is left untreated. It doesn’t get any better. it may get worse. The one thing that doesn’t happen, in most cases, is that it magically goes into remission. The various and sundry policies that treat addiction as some kind of discretionary moral failing have failed because the one thing addiction is not is discretionary. The other thing it is not is a moral failing. In using both of those terms, one must understand that they both have to be true in order to be used to describe addiction. If either is not true, then the premise falls apart. I can tell you that no one wakes up one morning with the thought, “Hey, I’m bored. I think I’ll go out today and become an addict so I can lie, cheat, steal, rob, batter and maybe even commit murder and ruin my life and the lives of those around me.” Yet, this is how we treat the people afflicted as such. After a century of guns, handcuffs and cages, the numbers have not changed. An honest individual with a sliver of integrity and a mite’s-worth of humility would freely admit that the current philosophy of how we deal with addiction as a public policy is an abject failure. As I’ve stated here before, if one has not taken a look yet, one should examine what Portugal has done with respect to treating addiction as a disease. They’re moving in the right direction.
My touchpad was absolutely giving me fits doing this. It started copying things over and over again and after two hours I was just entirely too frustrated to keep going. There’s also tons of typos that I couldn’t get rid of promise I’ll come back tomorrowand fix this up so that you don’t have to rewrite the same thing over and over again to get through the whole document! Ugh!
I was registered nurse in my life prior to my disability. Here’s a translation for the person who asked for some explanations and translations. On orders it is most common to have a range of doses – particularly in areas where a change in status may occur or the patient’s response to the drug is unknown. This is how to nurses can both be following the orders yet give drastically different doses of pain medication.
PRN – as needed
BID/bid – twice a day a.k.a. bis in die
TID/tid – three times per day
QID/qid – four times per day all of these don’t specify the numbers of hours in between East Coast but it is best to space them evenly. For example QID is best taken every six hours.
QOD – every other day
PO – per os aka by mouth
PR – per rectum
OS – oculus sinister left eye
OD – oculus dexter right eye
OU – both
PRN – as needed
BID/bid – twice a day a.k.a. bis in die
TID/tid – three times per day
QID/qid – four times per day all of these don’t specify the numbers of hours in between East Coast but it is best to space them evenly. For example QID is best taken every six hours.
QOD – every other day
PO – per os aka by mouth
PR – per rectum
OS – oculus sinister left eye
OD – oculus dexter right eye
OU – both eyes
PRN – as needed
BID/bid – twice a day a.k.a. bis in die
TID/tid – three times per day
QID/qid – four times per day although these don’t specify the numbers of hours in between each dose it is best to space them evenly. For example QID is best taken every six hours.
QOD – every other day
PO – per os aka by mouth
PR – per rectum
OS – oculus sinister left eye
OD – oculus dexter right eye
OU – both eyes orders.
For example, you might see an order like this on a floor patient in a teaching hospital.
MS 2 to 10 mg IV Q3h PRN hold for excessive sedation, systolic < 100, or RR < 12, or RASS <(-3).
Call H/O: systolic 15%, RR <12, PaO2 < 95%, RASS 5/10 and systolic 90-100.
Call H/O if pain score >5 15 min p MS or if pain > 5 a next dose is due.
Now all this translated into common English for the real people of the world:
First the abbreviations:
MS – morphine sulfate
IV – intravenous
Q3h or q3h – q translates to a Latin word meaning “every”, “h” stands for hour.
PRN – Latin for pro re nata means “as needed”
So…..this would read “morphine sulfate 2 to 10 mg IV every three hours as needed.”
Many orders will have something called “hold parameters”. This simply means do not carry out this order if the following circumstances exist. For this order our whole parameters are:
Abbreviations:
H/O – house officer aka resident; if not a teaching hospital it would simply say MD which would reverse the patients attending physician or the physician covering for the attending or perhaps a nurse practitioner or physician assistant.
systolic – The top number and a blood pressure reading. This is important when giving him medication that may depress blood pressure. Sometimes values will be given for the diastolic, a.k.a. lower number, as well. Low blood pressure is important safety wise as a patient may faint or become dizzy when they attempt to get up to the restroom. Low blood pressure also promotes nausea and the patient is sedated or has difficulty swallowing at greater risk for developing aspiration pneumonia if they choke on their vomit. Aspiration pneumonia takes lives of many people each year and is one of the worst types of pneumonia. As it is neither bacterial, viral, or fungal anabiotic’s are of little use unless the aspirated contents are infected.
RR – respiratory rate
PaO2 – pulse oximetry aka pulse ox, refers to oxygen content of blood; this is the little thing that they will put your finger or perhaps your ear. Normal is 100%. 95% can be normal and some smokers or chronic respiratory conditions. Our patient has neither of these so anything below 95% is where we would start to get concerned. This is not terribly low but it calls for investigation as to what is going on. In many cases the sensor simply needs to be readjusted or perhaps if the patient is postop orders been forever long. Several several good coughs may suffice and return the rating to normal. Where our patient intubated, suctioning the endotracheal tube or tracheostomy would be a first step in assessing why the pulse ox was low once it was determined the sensor was properly attached.
RASS – is one of many scales used to measure a patient’s level of wakefulness or sedation. If you look on my comment on the FFPCAN page, i’ll attach a RASS scale along with several other common sedation scales. Essentially a RASS score of (-3) means the patient is the coming difficult to awaken it is very alert even once awake. This is an indicator that the patient may be coming too sedated and maybe at risk for overdose if an additional dose of morphine is given as morphine suppresses the drive the drive to breathe. This level of sedation is likely to be more concerning on the floor that it is in the intensive care unit or PACU, aka Post Anesthesia Care Unit. In the settings, code staff are readily available to intubate if needed. The other option is giving an opioid antagonist. The major problem with this approach if she much is given is increased pain or worse yet in the opioid dependence patient precipitated withdrawal syndrome. If say this was a cardiac patient or someone with a recent CVA (cerebral vascular accident aka stroke),precipitated withdrawal would be even riskier. It’s extremely painful and involves copious amounts of vomiting and diarrhea along with elevated blood pressure for any patient. Provided it is given slowly so that the response can be judged, it can be very helpful in preventing the need to intubate the patient and transfer them to the intensive care unit. Intubation delays early postoperative ambulation which is a major risk factor for many complications including DVT (deep vein thrombosis aka blood clot) Ventilators have major risks as well such as VAP (ventilator associated pneumonia).
A few more abbreviations. Some are included in this example and some are just for your information.
All of these will appear in lower case, most often with a horizontal line above the letter:
c – with3
p – after
s – without
S/P – status post aka the patient has had a particular procedure. Ex: this is a 37-year-old female s/p lumpectomy of the right breast.
NPO – nil per os aka nothing by mouth
BKA – below the knee amputation
AKA – above the knee amputatiion
B with a circle around the B – bilateral aka both sides i.e. B mastectomy
PAP – Pap smear or peripheral arterial pressure
SOB – NOT, I REPEAT NOT Son of a bitch or the son of your beloved female dog this is one that patient see and get so incredibly upset and make many many calls to the administration when they see this without knowing what it means. More funny stories about that than I could ever want to count. This actually means short of breath or shortness of breath.
These next few relate more to psychiatry:
The Greek letter for PSI refers to psychiatry. I’m having trouble getting one but if you Google it you’ll see it. Many pain patients may see this in their chart if the doctor thinks that they are a “psych” pt.
ETOH – ethanol; alcohol as in the type that you drink NOT rubbing alcohol
SI – suicidal ideation
HI – homicidal ideation
AVH – auditory and visual hallucinations
AH – auditory hallucinations
VH – Visual hallucinations
I/J or I&J – insight and judgment insight refers to how well the patient understand what their problem is and how their behavior impacts their problem. Judgment is sort of commonsense for example a patient consider is the fact that it really wouldn’t be smart to cuss out the nastiest nurse on the unit particularly if she is in charge.
BAD – like SOB this is one that infuriates patients when they see it. Especially because it’s in capital letters they think that it means that staff really don’t like them. Though they really may not like the patient this is not what it means. BAD ACTUALLY REFERS TO BIPOLAR AFFECTIVE DISORDER
D/O – is commonly seen in sick psychiatry but it’s also use in medical and surgical contexts. IT MEANS DISORDER
S&R – seclusion and restraint
Rushing the patient or take down – The procedure use for a large group of staff will force a patient that is acting out onto a bed for restraints. This can be done in a very therapeutic way or it can be done in a way that causes severe trauma and commonly produces nightmares and PTSD. Many staff actually feel that traumatizing the patient is therapeutic.
4 point – A.K.A four point restraints; all four limbs of the patient restrained.
5/2/1 or 5/1/1 – generally means either 5 mg of Haldol 2 mg of Ativan and 1 mg of Cogentin or 5 mg of Haldol 1 mg of Ativan. Now there’s a larger variety of drugs that are used but these are the old tried-and-true ones. When there are options staff tend to use the ones that the patient dislikes the most. Many nurses were referred to this as “downing the patient” or ” HAC the patient. This refers to the initials of Haldol, Ativan, and Cogentin when you refer to the trade names of the drugs. This combination is popular and produces uncomfortable side effects. Sadly it’s a Kia tree that is preferable. The dry mouth that is producedis often very desirable among unscriptural staff. The attendant assigned to monitor the patient will often drink their drink in front of the patients when they’re awake and taunt them as beg for liquid did the dry mouth.
You’ll probably see many of these next abbreviations on scripts that your doctor or nurse practitioner, or physician assistant writes:
Lowercase i’s without the dots on top – can’t do these very well with the computer pretend that these are lowercase i’s without dots on top. Essentially he’s a Roman numerals in lowercase
Ex: II-III reads “two to three”
Most commonly these next abbreviations you’ll see in capital letters though they can also be in lowercase letters, again more Latin:
I’m getting hoarse, which dictation really hates, so I’ll probably leave out the Latin translation. P.M me for the Latin translation though if you’re just really interested :-).
PRN – as needed
BID/bid – twice a day a.k.a. bis in die
TID/tid – three times per day
QID/qid – four times per day all of these don’t specify the numbers of hours in between East Coast but it is best to space them evenly. For example QID is best taken every six hours.
QOD – every other day
PO – per os aka by mouth
PR – per rectum
OS – oculus sinister left eye
OD – oculus dexter right eye
OU – both eyes
SL – sub lingual place under the tongue to dissolve
buccal – place in cheek to dissolve
AC – before meals
PC – after a meal
cc – with food not commonly see
# or disp. – The refers to the quantity of medication prescribed for example #48 would mean 48 pills.
DAW – dispense as written means generally that the prescriber does not want the patient to have a generic if they wrote the brand-name. The opposite can also be true if they wrote the generic name as the name of the drug. I hope things drug abbreviations for scripts will help you to check your scrips for errors before you leave the doctors office to cut back on trips back to the doctor’s office. These abbreviations are really fun if you in the big lexicon of medical language. Often whatever aviation pinning one thing and one specialty is something entirely different and another specialty. Specialists focused on error prevention are working to change this though.As a registered nurse prior to my disability, translate for The person who asked for some explanation and translations. On orders it is most common of you are aware, particularly in areas like in intensive care unit, for orders to have a range of doses and frequencies of administration on the orders.
Abbreviations:
H/O – house officer aka resident; if not a teaching hospital it would simply say MD which would reverse the patients attending physician or the physician covering for the attending or perhaps a nurse practitioner or physician assistant.
systolic – The top number and a blood pressure reading. This is important when giving him medication that may depress blood pressure. Sometimes values will be given for the diastolic, a.k.a. lower number, as well. Low blood pressure is important safety wise as a patient may faint or become dizzy when they attempt to get up to the restroom. Low blood pressure also promotes nausea and the patient is sedated or has difficulty swallowing at greater risk for developing aspiration pneumonia if they choke on their vomit. Aspiration pneumonia takes lives of many people each year and is one of the worst types of pneumonia. As it is neither bacterial, viral, or fungal anabiotic’s are of little use unless the aspirated contents are infected.
RR – respiratory rate
PaO2 – pulse oximetry aka pulse ox, refers to oxygen content of blood; this is the little thing that they will put your finger or perhaps your ear. Normal is 100%. 95% can be normal and some smokers or chronic respiratory conditions. Our patient has neither of these so anything below 95% is where we would start to get concerned. This is not terribly low but it calls for investigation as to what is going on. In many cases the sensor simply needs to be readjusted or perhaps if the patient is postop orders been forever long. Several several good coughs may suffice and return the rating to normal. Where our patient intubated, suctioning the endotracheal tube or tracheostomy would be a first step in assessing why the pulse ox was low once it was determined the sensor was properly attached.
RASS – is one of many scales used to measure a patient’s level of wakefulness or sedation. If you look on my comment on the FFPCAN page, i’ll attach a RASS scale along with several other common sedation scales. Essentially a RASS score of (-3) means the patient is the coming difficult to awaken it is very alert even once awake. This is an indicator that the patient may be coming too sedated and maybe at risk for overdose if an additional dose of morphine is given as morphine suppresses the drive the drive to breathe. This level of sedation is likely to be more concerning on the floor that it is in the intensive care unit or PACU, aka Post Anesthesia Care Unit. In the settings, code staff are readily available to intubate if needed. The other option is giving an opioid antagonist. The major problem with this approach if she much is given is increased pain or worse yet in the opioid dependence patient precipitated withdrawal syndrome. If say this was a cardiac patient or someone with a recent CVA (cerebral vascular accident aka stroke),precipitated withdrawal would be even riskier. It’s extremely painful and involves copious amounts of vomiting and diarrhea along with elevated blood pressure for any patient. Provided it is given slowly so that the response can be judged, it can be very helpful in preventing the need to intubate the patient and transfer them to the intensive care unit. Intubation delays early postoperative ambulation which is a major risk factor for many complications including DVT (deep vein thrombosis aka blood clot) Ventilators have major risks as well such as VAP (ventilator associated pneumonia).
A few more abbreviations. Some are included in this example and some are just for your information.
All of these will appear in lower case, most often with a horizontal line above the letter:
c – with3
p – after
s – without
S/P – status post aka the patient has had a particular procedure. Ex: this is a 37-year-old female s/p lumpectomy of the right breast.
NPO – nil per os aka nothing by mouth
BKA – below the knee amputation
AKA – above the knee amputatiion
B with a circle around the B – bilateral aka both sides i.e. B mastectomy
PAP – Pap smear or peripheral arterial pressure
SOB – NOT, I REPEAT NOT Son of a bitch or the son of your beloved female dog this is one that patient see and get so incredibly upset and make many many calls to the administration when they see this without knowing what it means. More funny stories about that than I could ever want to count. This actually means short of breath or shortness of breath.
These next few relate more to psychiatry:
The Great letter for sign
S&R – seclusion and restraint
4 point – A.k.a. four point restraints; all four limbs of the patient restrained.
5/2/1 or 5/1/ – generally means either 5 mg of Haldol 2 mg of Ativan and 1 mg of Cogentin or 5 mg of Haldol 1 mg of Ativan. Now there’s a lot of variety of drugs that are used but these are the old tried-and-true ones. Many nurses were referred to her as “downing the patient” or ” HAC the patient. This refers to the initials of Haldol, Ativan, and Cogentin when you refer to the trade names of the drugs. This combination is popular and produces uncomfortable side effects. Sadly it’s a Kia tree that is preferable. The dry mouth that is producedis often very desirable among unscriptural staff. The attendant assigned to monitor the patient will often drink their drink in front of the patients when they’re awake and taunt them as beg for liquid did the dry mouth.
You’ll probably see many of these abbreviations on scripts that your doctor or nurse practitioner, or physician assistant writes:
Lowercase i’s without the dots on top – can’t do these very well with the computer pretend that these are lowercase i’s without dots on top. Essentially he’s a Roman numerals in lowercase
Ex: II-III reads “two to three”
Most commonly these next abbreviations you’ll see in capital letters though they can also be in lowercase letters, again more Latin:
I’m getting hoarse, which dictation really hates, so I’ll probably leave out the Latin translation. P.M me for the Latin translation though if you’re just really interested :-).
PRN – as needed
BID/bid – twice a day a.k.a. bis in die
TID/tid – three times per day
QID/qid – four times per day all of these don’t specify the numbers of hours in between East Coast but it is best to space them evenly. For example QID is best taken every six hours.
QOD – every other day
PO – per os aka by mouth
PR – per rectum
OS – oculus sinister left eye
OD – oculus dexter right eye
OU – both eyes
SL – sub lingual place under the tongue to dissolve
buccal – place in cheek to dissolve
AC – before meals
PC – after a meal
cc – with food not commonly used
Felt like I was back in school!! Great job, tons of work! Thanks for all your hard work. You’re adding this to the FILES, I imagine.
Thank you. The test will be on Tuesday.
The orders are most likely written with ‘as needed’ at the end and she is giving them per patient request within the time frame allowed (every 4 hours or 6 hours, etc) I was hospitalized with a leg abscess that had to be surgically opened, drained and packed open. IF I had a nurse that would NOT medicate me as ordered by the doctor, especially for dressing changes and in between as I requested and needed but was within the parameters and the doctor specifically stated “We want to keep your pain level as low as possible so you get up and move around so you heal” that nurse would be going through the ceiling when doing my dressing changes because I thought kidney stones were bad until I had to have wet to dry saline dressing changes on an open wound.
How far is this barbaric thinking on pain going to go……This is the 21st century not the stone age. The thing I want to point out is most hospitals are on computer…Pyxis, Omnicell for the meds, and then they bring in the dose and they scan it in the computer in the room and your armband when they give you the dose for tracking and to prevent errors.
She staid within the confines of the written orders HOWEVER because she medicated ( within the confines of the written orders) more than others she is being persecuted.
I have no idea what this nurse is trying to say. Someone translate. There is professionalism and commitment in her tone, I just don’t get how she is administrating without orders……
Prissy you must not ever have seen or felt true pain-she merely is attempting to be a nurse & not be crucified for it……
She has orders. The problem is that she’s actually following the orders that say to give pain medicine when the patient has pain, rather than withhold it. There has been a sea change in the way medicine perceives opioid medications. Once upon a time not too long ago, pain relief was felt to be good for patients. Now, because of the tiny tiny tiny uptick in outpatient suicides coupled with a fairly brisk trade in stolen/diverted pain meds to addicted people, there has been a backlash that has resulted in a clampdown on use of pain medicines even in the hospital setting. I’m so glad I’m retired!!!!!