Wednesday, March 16, 2011

new nurses, old habits

i prescribed syrup panadol to a child recovering from surgery, using the accepted acronym QID, or "quater in die", which in Latin means 4 times a day.

the 1st dose was given at 8pm, soon after returning to the ward from OT.

the next morning, i checked on the child & was surprised that the 2nd dose was given at 2am. reading thru the nite shift notes, it mentioned that the child was not in pain, was not having a fever & was sleeping at that time.

so i questioned the morning shift nurse as to why the child was woken up at 2am to be served the panadol. she replied, defending her nite shift colleague, that i had written the QID dosing, implying 4 times a day or at 6-hourly intervals.

so i questioned again, whether there was a difference between a prescription written "QID" compared to one written "6-hourly." this nurse, with her colleagues now overhearing our conversation, almost replied in unison :

NO!

i asked again : you mean, there's no difference between QID and 6-hourly dosing? and the response again, almost in one voice :

NO!

that's when i got a little hot under the collar.


ok, so i created this scenario: they went to clinic for backache at 8pm & the doctor prescribed a painkiller with a QID dosing. if they took the 1st dose at 8pm, would they wake up at 2am to take the 2nd dose IF they didn't have pain at that time? 

instead of the concerted response i had come to expect, now they gave me a blank stare. & to drive the message home, i cynically asked : if they won't wake up at nite to take their medicine, why would they want to subject a sick child recovering from surgery, who was pain-free, not having a fever & sleeping peacefully, to a rude awakening at 2am?

all i ask is a little brain common sense. life-saving medicine like powerful antibiotics are often prescribed strictly round the clock at clearly stated  intervals, eg. 6-hourly, & often given intravenously without awaking the patient from sleep. other less critical ones are prescribed to be taken during the day, eg. QID, in which case, they may be served at 8am, 12 noon, 4pm & finally 8pm.

2 things are clear now:

1) with the mushrooming of nursing colleges, don't expect the standard of teaching to improve;

2) i won't be very popular in the children's ward from now on.

24 comments:

Birthmark said...

You made a good point, doc.

Even I don't wake for my meds when I'm in my slumber. Sometimes, don't even finish my antibiotics. As I don't see a need to it.

I try not to consume drugs most of the time when I'm sick. If I can take the pain.

Birthmark said...

I think my comment never got through.

What I wanted to say is, you made a good point. Even I don't wake up for meds when I'm in my slumber.

Medie007 said...

oooo... i never look at QID that way. though i know it means 4 times a day. but it's panadol for heaven's sake. not some other things that require strict doses at a particular specific time. the child is not in pain also. but to wake him up at 2am is kinda... weird...

just being kepoci a bit, i think birthmark should erm, finish the entire course of antibiotic even when he doesnt see the need for it. though well... i never actually take mine when i have my regular bouts of tonsillitis, as long as i get my mc. hahahaha.

missyc said...

thot with children, panadol need to be given like 4-6hrs dose to prevent fever/headache?

I remembered babysitting my 5yo nephew hospitalised at TDMC for very high fever & nurses kept inserting panadol via rectum which makes him wake up & cry.. I didn't sleep for 2nites, stressed up day3 screamed at nurses :D until a paediatrician came. Thank God he recovered day 5 as his parents were overseas. What made me lost my cool was the way the nurses acted and behaved & the specialist didn't show up till I screamed..lol

Yvonne Foong said...

Waaargggghhhh!!!! U don't believe how often I was shaken awake in the middle of the night at KLGH for my blood samples to be taken old-fashioned style, for my blood pressure to be taken old-fashioned style.... and after my spine surgery, one nurse woke me up and fed me banana. Sodim, she said. It's so funny!!

My arms were blue black by the time I was conscious enough to get down from bed!

wenn said...

u r a good doctor!

reanaclaire said...

Doc, from now on, maybe u will be awakened in the night to receive calls from night shift nurses ... :)

Unicorn Girl said...

I wish to meet more doctor's like you Doc !

And on another note , the country is sure mushrooming with way too many nursing college. No wonder for the clinical error accurance.

Mei Teng said...

Some common sense things cannot be taught. It has to be caught! :)

doc said...

Birthmark,

most people stop their medication when the initial problem has gone away. however, antibiotics are different because stopping them before completing their 5-day or 7-day course encourages bacterial resistance.

doc said...

Medie,

you should know better than to stop the course of antibiotics but you'll find out soon enough that doctors make the worse patients!

& when you get into private practice, you'll work even if your tonsils give you a hoarse voice & a raging fever!

doc said...

MissyC,

adults & kids should have the panadol at regular intervals while the fever & pain persist.

the panadol suppositories (inserted into the rectum) are often given to children who can't take orally, eg. persistent vomitting.

looks like you won't be very popular at TDMC paeds ward, too!

doc said...

Yvonne,

you had major surgery, so the treatment/investigation done commensurated with the severity of the condition.

doc said...

Wenn,

(you make me blush!)

doc said...

Claire,

so far, no nite calls from them!

doc said...

UG,

ha ha, keep your fingers crossed & you will someday!

doc said...

Mei Teng,

i'm beginning to think that it's an uncommon gift.

Yvonne Foong said...

Doc, do private hospitals in Malaysia wake the patient up every hour after critical surgery to take blood samples and blood pressure too?

I don't know but at SVMC, they don't do that. Our blood pressure is monitored automatically, not mannually in the ICU. They just have to wrap our arms with the what-do-you-call-it and the machine will inflate at certain intervals to take our blood pressure automatically. We can sleep right through the day and night.

They only take our blood once prior to surgery. They don't take any more blood after surgery. And whenever they took our blood samples before surgery, they need only insert the needle once and let the blood drain into detachable test tubes so the nurse or chemist can just switch the test tubes without removing and re-inserting the needle. At KLGH, they actually had to remove and re-insert a new shringe everytime. That's why I had blue-black arms.

So the treatment i received here was not standard critical surgery procedure.

Yvonne Foong said...

At SVMC, they really don't take our blood samples anymore after surgery. I wonder why KLGH needed to take so much of my blood.

doc said...

Yvonne,

nowadays, esp in ICU, the blood pressure is measured continuously via an intra-arterial catheter which can also be used to draw blood samples for the lab.

that blood-sampling technique you described is commonly used in UK as well, but it hasn't caught on in m'sia yet.

LX said...

I always that they are od, bd, tds and qds...

Yvonne Foong said...

Hello doc,

Yes, there was an intro-arterial catheter inserted into the wrist where people can feel my pulse. :P There are so many things attached to me in the ICU that I forgot about the intro-arterial catheter.

It's amazing what these simple-looking gadgets can do.

I have a wish of seeing the NHS one day and experiencing their care one day.

doc said...

LX,

they mean the same, depending on who is prescribing, eg.

qds = quater die sumendus, which is also latin for 4 times a day.

doc said...

Yvonne,

i hope you never needed to be admitted to any hospital ever!

but in those days when i worked there, i have nothing but good things to say about the NHS.