Internship & Residency
Writing Orders
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Dr. Karl Newman
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For housestaff, writing orders is an
integral part of the daily routine. Properly written orders have been
shown to improve both clinical outcomes and professional satisfaction!
On the other hand, incorrectly written orders are a frequent and avoidable
cause of patient morbidity.
This month, Q Fever!’s I&R correspondent, Dr.
Karl Newman, discusses his battle-tested rules of: Writing
Orders.
Word up! It's been
a heckuva month, and all I can say is: no matter what they're payin',
do not participate in a study that involves having
radioactive seeds implanted in your prostate. Yowza!
So ya don't wanna waste any time getting
started with today's topic - I hear ya! Today we'll be reviewing the
basics of order-writing. See, they teach you a lot
of stuff in med school - dissecting frogs, stoichiometry, and the like
- but how much of it do you really wind up using as a doctor?
I can't even remember the last time I needed to do a frog dissection
on the wards. No, wait. Bad example.
But my point is, they never taught
you how to: write an order.
So you know what happens? Total chaos.
People running around without a clue as to what's going on. Security
getting paged stat. And that's just in the parking lot,
cuz' you lost your swipe card and drove through the wooden swing bar
again.
But as my grandma Bubbie always tells
me: Stick with me, young lass - I won't do you no wrong.
So here's the rules ya gotta play by:
1) Them ORDERS Gotta Have BORDERS
Think of it this way: Sure, an order
is your ultimate tool for getting things done. But that doesn't mean
you can order anything you want. You gotta show some
restraint, even when you're ordering restraints! Yeah, it takes some
time, but eventually you gotta learn what's appropriate and what's not.
Ordering yourself a ham sandwich with mustard and mayo is appropriate.
Ordering it with ketchup is not.
Other things that are are usually
inappropriate to order:
| • |
Having the nurse page you out of conference |
| • |
Having the clerk check the lights on your
SUV |
| • |
Getting escort to take you to the airport |
| • |
Having physical therapy give you a full frontal
massage |
| • |
Having physical therapy escort your SUV to
the airport for a full frontal massage |
Also, remember that most orders can
be placed online these days! You'll save big on sales tax, but watch
for those hidden shipping charges. Just another Helpful HintT from Dr.
Karl!
2) Don't Be Sloppy, Joe!
Accuracy in writing
orders is crucial. It's a clich�, but most doctors these days really
do have atrocious handwriting. You know why? Yep, you guessed
right! Most doctors these days are in fact descendants of the ancient
Egyptians, who had a culture where penmanship was taught only to priests
and select scribes. It's true! Look it up.
But that doesn't mean it's hopeless.
On the contrary, you'll make a big impression if you can neatly print
out your orders in block or cursive lettering. Better yet, do what I
do: carry around a small rubber stamp kit, with one stamp for each letter
of the alphabet. It can get a little bulky, but it'll be worth it when
you see those smiles as you approach the nurse's station!
Another way to increase accuracy is
to avoid the use of verbal orders. These can be easily
misinterpreted, and by the time discrepancies are discovered, the harm's
been done. Instead, use non-verbal orders - gesticulating
wildly with your arms and head, for example, or making thrusty-type
movements with your hips. These are much more likely to get the message
you want across to nurses and concerned bystanders.
And one important thing that's often
overlooked when it comes to good order-writing etiquette: Always make
sure your medical student spells your name correctly when he/she
forges your signature. Can't emphasize this one enough!
3) Da "i's" have it
Ever notice that a 5
looks a lot like an S? Or how a 3
looks like a backwards E? These look-a-likes are confusing,
and are a leading cause of errors.
That's why you should always use write
numbers using the "i" shorthand. For example, "two tablets by mouth
twice a day" becomes "ii tabs po bid." ... "0.05 mg once a day" becomes
"0.0iiiii mg qd" ... "100 mg four times a day" oughta be "iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii
mg qid" ... and "20,000 units subcutaneously once a week" becomes ...
well, you get the idea.
Using the "i" method will save you
time and make your life easier! For the sake of completeness, be sure
to use it to time and date your orders, too. June 4th,
2003? Try iiiiii/iiii/ii00iii. See what I mean?
Whooaaaa! Looks like
it's time to wrap up another one. Page me if you wanna chat - I'm gonna
go renew some morphine up on iiiii North. Meanwhile, 'till next issue
...
“Just
tell ‘em Dr. Karl sent ya!”
