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On a busy CCU, nurses on walking rounds discovered a patient on a D5W I.V., TKO. (This was a standing order on the unit, to maintain an open line to a patient's circulatory system.)
But the patient's Kardex called for something else: 5% dextrose in Y2 normal saline solution at 50 ml/hour. During the previous shift, the patient had become mildly dehydrated, so the doctor had written new orders. By the time the nurses discovered the new charted orders, several hours had passed.
What had gone wrong? On this unit, the unit clerk was supposed to note the doctor's orders on the Kardex and relay this information to the nurses. But the above order wasn't an emergency, and the unit clerk had forgotten to notify nurses on the previous shift about the changed order.
As a nurse, what can you do to help the unit clerk keep you informed? You could suggest that she use a flagging system that doesn't rely on memory. For example, the unit clerk could place a paper clip on a patient's Kardex as she tears off the order copy destined for pharmacy.
Even so, don't assume the unit clerk will always follow the system. If you're working on a small unit like CCU, try to make rounds with the doctor, so you know what he's writing on the patients' charts. If you're on a larger unit, and you see the doctor on the floor, check with the unit clerk automatically about any new orders.