Two tips to make sure that the nurses follow your doctor’s orders


Don’t let orders fall through the cracks because of nursing mistakes

March 15, 2017

What happens when a doctor gives an order but it falls through the cracks or a nurse messes it up? Sometimes it can cause dangerous problems for patients.

In the hospital, doctors typically see their patients for a few minutes and then leave orders with the nursing staff. These orders tell the nurses what medications to give and other health care to provide to their patients.

But the time between the doctor giving an order and a nurse executing that order is a prime space when errors can occur. This is particularly true when a doctor gives orders shortly before three key time periods: (1) just before a nursing shift change; (2) before a patient is being transferred from the emergency room to a floor; or (3) before a patient is transferred between hospital rooms.

Nurses often work 12-hour shifts. When a doctor gives an order to a nurse just before shift-change time, the nurse may not get to the order and leave it for the new shift to take care of. Similarly, when a doctor gives an order to a nurse just before the patient is being moved to another room, quite often it is left to the new nurse to find out about the order and make sure it gets done. In these situations, there can be a communication gap, and sometimes it can be very dangerous.

 You can help avoid your doctor’s orders getting jumbled, ignored, or just flat-out wrong with these two simple techniques.

Listen up when the doctor gives orders

Listen and ask questions when the doctor is giving orders. I recommend jotting down notes. What medications are being ordered? Are they being ordered “stat” (as soon as possible) or routine? Is an x-ray, CT, or MRI being ordered? Is it stat or routine? You get the idea.

If it has been a while and the nurses have not responded to the orders, ask your for an update.

If you change rooms after the doctor has given an order, when you meet your new nurse be sure to mention the pending orders, to make sure he is aware of them—in other words, to make sure that they do not fall through the cracks.

Be aware of shift changes

Ask your nurse to do the “shift change report” or “hand-off communications” in your room, so you can listen in.

Shift change reports are done just before your nurse ends her work hours for that day. It is the time when she orients your new nurse to you, as the patient. They discuss why you are in the hospital, what medications you are receiving, what radiology imaging had been done, and plans for your care.

Hand-off communications are similar. Think of a runner passing the baton to a teammate. The conversations take place when one nurse has received a doctor’s order but is passing off responsibility to execute the order to another nurse or tech.

Recently, I was with a loved one during a brief hospital stay, and got to see first-hand how little mistakes can show up in these types of communications.

The emergency room doctor made a number orders for pain medications that were not handled before the transfer from the ER to a private room on the floor. The floor nurses did not know anything about these orders until we asked.

When it was time for shift changes during my loved one’s hospital admission, the nurses at this particular hospital automatically did the shift-change reports in the patient room. I really liked this. It showed that the hospital was making an effort to get things right by allowing the patient to listen-in on the conversation. We caught more than a few mistakes on things like radiology tests that had not been done, test results, and medications that had been given. When we spoke up, the nurses appreciated it.

When it comes to health care, knowledge is power. And when you, as a patient or loved one, are listening and speak up, it will improve safety and the outcome.

If you or someone you care for has been injured because of botched orders, called 281-580-8800 for a free consultation with Painter Law Firm’s experienced Houston medical malpractice attorneys.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.


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