Sunday, October 25, 2009

The case of the mysterious order

Sherlock Holmes Baffled

Elias was placed on respiratory precautions on Thursday afternoon. We are beginning day four of trying to solve this mystery. The order was randomly noticed by his Respiratory Therapist (RT) for the day as she reviewed the afternoon changes in orders. She came and asked if I had any idea what that was about, of course this was the first I was hearing of this. Another oddity is the sign on his door only reflected contact precautions for Elias colonized MRSA. and not the addition of respiratory. She set off to find Elias’ nurse who was not even aware of the change. Fearing that his viral panel that was done on Wednesday might have grown something they checked the lab results, which again no one had shared with us. Fortunately, everything showed up as negative. Still puzzled the doctor was called, but of course to our knowledge never returned an answer. We went through Friday continuing to ask, but was told it had been removed from the computer. Well apparently not! Yesterday morning his RT for today asked Katharine again about it. She shared what we knew and that was when we learned it had not been removed from the computer as we were told and on top of it all overnight the sign was finally added to our door. We also had been told that it is standard protocol to place a patient that has a viral panel pending until the results returned and the appropriate precautions would be put in place. Okay, fine but I have 2 problems with that. First the order appeared in the computer late Thursday afternoon and the viral panel had been done early Wednesday morning. Secondly, no one was taking the respiratory precautions and I can understand that the nurses and RTs being confused and knowing Elias doesn’t need this not doing it, but there is an ORDER. If they are saying that it does not need to be in place then why is there not pursuing the doctors more aggressively to remove the order. Apparently, the nurses are as incapable of following up on this as the doctors are for having knowledge of this. I have an idea call the doctor whose name appears on the order. <Shocking gasp> Oh no we can’t do that! Protocol will not allow that.

So the resident came in, and let me add that she is an annoying twit. Thankfully she is not Elias primary resident. She is the kind of doctor who will not commit to any decision and everything is preceded with “Well (drawn out) you know…” I asked her the mystery question her response was nothing short of expected. “Well, you know I was asked about this yesterday by his nurse and well, apparently he had a culture that grew MRSA and I’m trying to get clarification on this that he has to be on respiratory precautions due to that.” My response, “Okay well the problem then is if that is the protocol, Elias came into the hospital over 30 days ago for this admission with MRSA so why is the order just now showing up? We also have been in and out since August without any order as well.” The doctor’s eyes widened, “ Well you know I think it was from a culture done back in September and that is why.” I sighed, “Yes September there was a nasal culture done pre-cardiac surgery that reaffirmed his positive MRSA status. So it took 23 days into October for that order to kick in?” The doctor now looking flustered, “well you know I mean I am trying to get clarification on this.” In my nicest tone, “Yes I am too, but I am also getting quite the run around and lots of possibilities, but no concrete answers. Now I need to know because the staff is not following this precaution. I do not know if it is designed to protect Elias or the other patients, but if I do not know what is going on I can not enforce it upon the staff. If it is to protect the other patients I do not think the other parents on the unit would be too happy knowing this was happening.” She quickly tried to change the subject, “So I understand his heart rate went up last night around midnight  and how is that G-tube site looking.”  The rest of the conversation is really not relevant so I shall spare you. All I know is that it is a good thing this is not a serious thing we are chasing down, but then again I suppose it is as I always say perception because by the staff ignoring an order for Elias that is designed to protect other patients there could be cross contamination going on! As a parent knowing that is the case does not make me feel very good.

Nothing much to report on Elias. He had a pretty average day yesterday and I expect today will be much of the same. He did get his flu shot on Friday, but not the synagis. I suppose that was HER last act of Bitchism, but I will ensure to inform all her colleagues that she chose to ignore this request/order. Elias is just hanging out right now and trying to do his thing. Wish I had more for you about him, but that is the way it goes in the hospital sometimes. Hope everyone has a great weekend.

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