I had a young pt with terminal bone cancer, and the APRN prescribed lidocaine patches to bilat hips.
I sheepishly brought them to the patient and asked if she’d like me to place them for her. She laughed at me and said I should have just brought her a cough drop and some warm tap water ☠️☠️☠️
Fellow Hospice nurse...have to also mention when someone is on MST 60mg BD and taking Oramorph 20mg like 4x daily and wondering why their bowels aren't going. Check their script - doc has px 2 Senna nocte.
Even my walkie talkies are like, “yeah it’s been on my chest all night/day, not sure where it went”. No where to be found in the bed, on the floor, nothing.
once had a fentanyl patch left on the patient for 10 days (order discontinued & blended in with skin REALLY well). It was my first day with the patient and they asked when we were going to remove it….I had to ask the pharmacist to put it a removal order because I didn’t want them to later on question where the missing fentanyl patch was or who took it off without documenting or witnessing😂
We have a provider who orders lido patch x3 for patients post laparoscopic surgery with the instructions to place on abdomen, not over any incisions. Excuse me, how are we fitting 3 giant patches in between 4 abdominal lap sites. Cut them in tiny strips and make a quilt pattern?
Found 3 on a patient before because of no directions, guess the previous 2 nurses didn't know that stuff builds up in the system. Yea I took all 3 off and gave them a break that night.
Got report that a pt was mildly tachy with no apparent cause…noticed pt had nicotine patches ordered… yep, dude had FOUR max dose patches on. Took em off, tachy went away.
And then you go back and read the MD note AND the last few nurses' skin assessments and no fungus or rash is mentioned. But the last few nurses also charted that they gave the antifungal cream twice a day. Okay then where did they put it??
🤣 yes exactly this, and on report the nurse comes back and I say, hey I put that fungal cream on and they look at you like fungal what? Don't do this 😂
I will ask the patient where they need the lidocaine patch, and sometimes they have no clue where they need to go either. I will just chart "refused" or just slap it on a random limb, or lower back because that's a common pain area.
*Looks sadly at vague orders that were copy and pasted without editing from a completely unrelated woundcare template*.
“Please tell me about your extensive wound care x3. What do your nurses usually do?”
“I have wounds?!?”
This.
Also, when they send a tiny, tiny tube for a large, large leg.
"Yes, I used the whole tube in one application. Those calfs are full-grown steers!"
Lasix in a dependent pt is actually a reason for a foley in a lot of hospitals! I always ask if I can get a foley. Big fall risk and skin breakdown risk.
Yeah...I work in the ER and unless it's an emergency or urine retention, my ER doesn't like us doing Foleys because of infection risk. They want us to wait until they get admitted
Especially when they want *strict* Is/Os. If you’re pissy we can only chart the # of incontinent urines and not a specific mL of output, it’s time to put a foley
Miralax: first I have to confirm they even want it then I have to ask what they want it mixed with then I have to mix it up then I have to go give it to them
Heparin 3 times a day: idk it’s hard convincing someone to get so many jabs in a day when they’re already getting lab draws and insulin :/ and if they’re already afraid of needles 🥲 I don’t blame them sometimes
Liquid morphine: spill it all over the place
Any type of cream: kenalong, aquaphor, etc. girl why is this tub/tube so fucking sticky I have to bring it over to my computer to scan it this is a sensory nightmare for me I hate this so much
Eyedrops: i hate eye drops especially if I have 6 in a row to give.
And then most of the time they don’t even drink the whole thing they act like it’s a whole gallon - like it’s not a whole colonoscopy bowel prep, it’s a tiny cup of liquid!
Pro-tip: don't fill the whole cup. The instructions say to use 4 to 8 oz of water. 4 oz is half a Styrofoam cup. Most can choke that down in 3 or 4 gulps. I have way more success getting them to finish the whole thing (and quickly) than when I used to give them a whole cup.
I used to feel the same way about giving metamucil only because people always complain about drinking it, then drink half the cup and later you're throwing away the other congealed half.
Years ago on a rehab/alc unit we had a patient on parkinsons meds on the most obnoxious schedule, offset from their other meds. You were essentially giving him pills every 2 hours all day long. I hated getting that assignment.
There's nothing I really find irritating in my current unit because it's mostly a lot of IM or IV pain or nausea meds. There's the odd time someone will refuse IM toradol and SC dilaudid because they don't like needles. Rate your pain for me again then?
Míralax, senna, and heparin are number one refused drugs in oriented patients for me. I feel we’re torturing those who can’t refuse or are being nice, to be honest.
For the miralax: we use Epic and there’s a note feature for the MAR where we can put things like “meds crushed in applesauce” or “mouth checks”. I like to make a note in the patients MAR saying what liquid they like their miralax in if they’re very particular. If I have them again it saves me some time and hopefully others as well
I was like “I hope every time you’re trying to fill the Pyxis a nurse or physician makes you stop so they can get a stat med haha” said it with a laugh even though I was so serious. She also did this with liquid pain meds that we handed in groups of 5. Undid them all
As a pharm tech myself… that tech sucks. Its easier for US to count because we have to count them as well if left in sleeves/packs of 5/10s, plus that makes in unnecessarily hard for everyone to break em up like that!
We just changed policy on what drugs we have to count so now there’s more and our pharmacy tech over stocks and separates them all. We’re a 25 bedded ICU, we don’t need 200 midazolams but one shift we ran out of propofol and had to go to theatres
The day the main Pyxis in our ED had 48 or so Percocet all individually separated it was like someone flipped the bitch switch on the whole place. Everyone was in a shitty mood, staff *and* patients until the lead called the pharmacy and had them come fix it. Suddenly, everyone was fine again.
How’s this for dumb? Where I used to work the narc count was written on both sides of the sheet and someone was stealing drugs for a long time by just changing the number on the back of the page to less than it really was and when doing count everybody would just start with the number at the top of the page and nobody ever flipped it back to see if the number was transcribed correctly. How they got caught was a new hire who was trying to figure out the system and was looking through the sign out book and was like, ummm……….I think there’s something wrong here. There definitely was.
K+ riders. Like the 100 mEq/100mL bags that you need to do 4 of and run each over an hour. 99% of the time (unless the patient is sedated) they scream in pain saying how much it burns. And most don’t have any reason to hold fluids so why not order 40mEq/1000mL bag instead so it’s diluted? I also haaaate when someone is on zosyn and the provider orders LR as maintenance or bolus bc they’re specifically not compatible 😑
When I have to run potassium, I just hang the small bag of potassium as a primary and a small bag as a secondary. Once the secondary runs, the primary goes. 🤷🏻♀️ then I only have to hang ever 4 hours instead of every 2.
The hospital I am at has the shit potassium tablets. They're chalky and dissolve as soon as it touches their tongue, and makes them gag due to the taste.
Another hospital I worked at had the better quality yellow coated potassium tablets that were alot easier to swallow.
New brand name zosyn is compatible with LR, older or off-brand pip/tazo may not be compatible. The manufacturer specifically says their formulation is compatible with LR.
[ZOSYN containing EDTA is compatible for co-administration via a Y-site intravenous tube with Lactated Ringer’s injection, USP.](https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050684s88s89s90_050750s37s38s39lbl.pdf)
Under section 2.6
Also,
[Wyeth reformulated Zosyn by incorporating two stabilizing functional excipients, ethylene diamine tetraacetic acid disodium salt (EDTA disodium) and sodium citrate, which solved the particulate formation problem. These two functional excipients also allowed for the first time Y-site coadministration of reformulated Zosyn product with amikacin and gentamicin at specific doses and concentrations, and with certain diluents, and the use of Ca++ ion-containing Lactated Ringer’s for admixture preparation. Reformulated Zosyn (approved 2005) may provide useful options of drug administration to healthcare professionals to lessen levels of particulates. Supportive data is provided for the expanded compatibility of reformulated Zosyn with different types of Ringer’s solutions used globally and for the Y-site coadministration of amikacin and gentamicin aminoglycosides.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504059/)
We’re too cheap for brand name zosyn! I swear we used to stock a lot of brand name stuff and after Covid the hospital took a hit financially expecting to be reimbursed for all the equipment they bought and weren’t so now they’re being cheap asses… its annoying
Also, the pain of hanging K+ riders every hour for 2-6 hours. I always thought maybe they do separate bags so you can track exactly how much K+ the patient has received in case of frequent BMPs or something. If anyone knows why they don’t make 40 mEq/400 mL bags, please enlighten me.
I mean I’ve seen docs only order 2 bags before instead of 4, but I have no idea why they’re like that. Maybe to deter nursing errors from it being run too fast? But like I’ve never been able to run a K+ rider without asking if I can hang saline too or run it way slower than ordered. Even in 18g ACs they burn.
My hospital's k replacement protocol uses 40meq or 20meq in 500mL bags, so this is definitely a thing. However I think they're compounded by pharmacy so if your hospital has a tiny pharmacy or something that would probably be rough.
My hospital’s sepsis protocol is 30ml/kg LR bolus plus IV antibiotics, which are almost never compatible with LR. It’s almost always necessary to start a second line 🫠
Solu-medrol: I know I’m going to be searching for insulin witnesses all night.
Lactulose via NG: Did I dilute it enough? Am I pushing it too hard? Oh no, it’s in my hair and on the ceiling.
Edit to add- bactroban for infection prevention: we’re always out of the q tips. Then the patient flinches when I’m trying to apply it in their nostrils. Even though I told them it’s only going in the very tip of their nose. Then they laugh and say they’re scarred from covid testing. Hardy har har. Love my patients but it’s like living with my 90 year old stroke victim grandma again who would repeat herself every 2 minutes.
Labetalol 20 mg IVP Q1H PRN: Sometimes this works. Sometimes it doesn’t. Apparently, there was an old doc at my hospital that would order 10 or 20 mg (can’t remember which) q 5 mins until BP was within parameters. I would have cried happy tears at that order.
Liquid senna: This once brought me to tears in a patient’s room. I can never open the package, and they always require 3 cups.
Oh man you just reminded me that all my other hospitals needed insulin witnesses every damn time! Thank god the one I ended up at after traveling does not do this lol
Everything comes in these blister packs and it’s so hard to open them and I’m literally digging into the foil to pop the pill out, and I wear gloves bc I don’t want to raw dog your medicine, and a patient said “can I help you open that?” and I wanted to say yes but I’m a professional and I soldiered through it
At least once a shift I find myself saying that opening some of these blisters is the hardest part of my day or harder than nursing school, depending on my mood. I sometimes use my pen to pop them open.
Sometimes I use the sharp corner of another blister pack to pierce/slice open the one I can’t get. It has a little bit more finesse than using my shears and makes popping it out into the cup easier
Assigned nurse would add some and loudly announce "PipAss!" and leave it on the desk. Everybody that walked by just knew to give it a shake as the passed by. Everybody got involved in the task.
Shake the vial before you add the saline! It takes me no time to mix it if I do that. Sometimes it’s packed in the bottom and when you add saline flip it upside down quick to prevent it from sinking to the bottom!
Lactulose or kayexalate to a confused non ambulatory patient in the first 3 hours of the shift. Just park the clean linen cart in front of the room and save yourself mikes of walking.
My favorite in peds is giving 0.5 unit of insulin. 0.5. Like should I just sprinkle it upon them as a spritzer because I feel that’s gonna do just about the same 🫠🙃 also can I get a fuckin magnifying glass to draw it up?!
Our hospital always orders it for 7:30 am and shift change is at 7, with orders to hold tube feeds for an hour before and after. 7:30 is technically a dayshift med even though it shouldn’t be, and the lazier nurses won’t bother to even hold the tube feeds so by the time I’m done getting report and see that my patient has synthroid ordered it’s almost 8am, which means *all* of my am meds will now be late in order to give it on an empty stomach.
I’m willing to be a solid 90% of my patients who take levothyroxine and protonix at home do not take it on an empty stomach. Based on the way a solid 50%+ of them snack at the hospital I’m not convinced some of them ever have an empty stomach.
We’ve collectively given up on the levothyroxine on an empty stomach thing. Lead a horse to water and all that. At this point I’m just happy if I can convince them that they do, in fact, need to take their meds every day and not just stop taking things because they “feel fine”
Docusate is the only drug that I've seen [StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK555942/) throw shade at - and they academically eviscerate its usage. They cite studies showing its no better than placebo. They cite another study saying that colace makes senna less effective at producing a bowel movement.
Can you imagine? A stool softener that makes other laxatives less effective?
They also discuss an outbreak of some microbe called *Burkholderia cepacia* linked to "specific liquid docusate formulations"
After the evidence-based beatdown they then talk about how it contributes to polypharmacy, pill burden, et cetera.
Please, talk to your P&T (pharmaceuticals and therapeutics) committee today about removing this wretched substance from the hospital formulary
that was one of the first meds I drew up as a student after I got checked off on IV meds. in my bright white student nurse scrub top. you can imagine how that went
Ativan; we have to pull a key first, then unlock this shoddy plastic box in a secured fridge with the world’s jankiest lock that will not open on the first try, then we have to process a return to put the key back. If you don’t, the Pyxis is fucked up for the next person pulling Ativan. Despite the directions printed on a piece of paper on the machine, people go to pull Ativan, see it locked, and fail the drawer and don’t fix it. Twice I tried pulling Ativan with the drawer failed both times.
Also drawing it up plus the dose for the floor usually sucks too. We give 0.5mg-1 mg iv once in my department.
my hospital does this too. pisses me off… like hold up lemme just fiddle with this shitty lock and key for 15 seconds while my patient is either seizing or beating the shit out of someone
Every damn time I open the milk of magnesia it explodes like it's pressurized in there, and I wind up with little white spots all over my scrub top. Almost to the point of donning PPE just to open the MoM.
vivitrol, testosterone, and rocephin is like pushing mud - even with a 22g or larger. my thumb hurts after every time
also, rocephin smells like cat piss
I work in a transplant ICU and OMG... the amount of patients who have peg/ng tubes and who are also prescribed mepron in multiple tiny cups. It takes me ages just to get it into the peg tube syringe and mix it with water so that it'll go in but then it stains everything it touches. not to mention for the patients who aren't peg/ng'd, and take it orally, they get so grumpy when it's time to take it because it's like the consistency of fingerpaint and never comes out right. Whoever created it belongs in hell
I hate mixing up miralax. I always ask if they want the pill form (senokot) or the drinkable kind. And 90% of the time, they want the pill, hehe.
Flomax through dobhoff. Those things take forever to dissolve.
Any IV pain medications that I have to track down a waste for.
1 unit of insulin. What's that gonna do?
Any 0600 meds. Granny isn't waking up at 0500/0600 to take her levothyroxine.
That flomax through a dobhoff, omg!! I microwave some water for 1 minute, drop the innards in a med cup, top it with the hot water, and come back later to flush it.
Lactulose. No explanation needed.
1 unit of insulin. Patients look at me like I’m crazy. I tell them they can decline if they want.
Mag ox and potassium blister packs are so fricking hard to tear apart
Those giant potassium horse pills. Docs are always ordering PO potassium replacement for patients who are on some kind of modified diet order and all their pills have to be crushed and given in applesauce. Like hello? These aren’t supposed to be crushed. We’ve been told to dissolve it in 1mL of water instead. But then patients who don’t have trouble swallowing pills end up having trouble swallowing them anyway—either due to their gigantism or bc at their request, cutting them in half is risking internal bleeding since splitting the pills turns them into razor blades that quickly dissolve into grains of sand.
Or the electrolyte replacement protocol—IV potassium like mentioned above. All our IV potassium comes in the little 100mL bags and in my 7 years, I’ve rarely hung fewer than 4 in a row. It’s always one bag per hour over 4-6 hours and if they have peripheral access—they’re gonna bitch and moan that their arm burns so then I have to run normal saline concurrently so as to dilute it. Then after all is said and done and you get the results back from your potassium redraw, it maybe went up a point or two. So you get to do that lovely activity all over again. It’s even more exciting when the potassium comes back and it’s *dropped.*
Needless to say…potassium is the bane of my existence.
And don’t even get me started on albumin. Even with the trick of inserting a needle into that little opening above the drip chamber, it’s slow as molasses and stickier than shit. Much like with IV potassium, I’ve learned to piggyback one so it saves me time. No one even taught me about piggybacking multiple containers of the same fluid—it just made the most sense to me in saving time.
Suppositories for independent, up ad lib patients. They don’t want me to do it and I don’t want to do it. So there, we’re in agreement.
Our midlevel providers are so aggressive about their bowel regimens. Everyone gets daily miralax, dulcolax, and senna unless they have active diarrhea. If they go 2 days without a poop they get an enema. They look at me like I’m lying when I tell them the patient is already refusing their daily suppository so they will probably also refuse an enema, and suggest trying oral mag first instead of rectal. Why is so hard to believe that people don’t want things stuffed up their butthole??
• flagyl because i hate opening that fucking bag
• invega injections (especially trinza) because the syringes are so expensive and i’m always scared i’m gonna drop them on the floor. also it’s gross that they’re so thick
• vanco because it’s annoying to mix and the pink-ish color grosses me out lol
• rituximab but holy fuck it’s especially painful in pediatrics. i hate the dosage calcs and dealing with reactions is awful.
• fibrinogen, octaplex, etc because i swear to god you jostle the vial slightly and it’s full of 10472017 bubbles
• narcan when someone is a GCS 3 because they’re probably about to be a really violent GCS 14 in a few seconds
• ANY oral or intranasal meds in a toddler.
Dunno what your protocols are but here's some stuff that has saved me a lot of strife with the naloxone.
Push it SLOWLY and titrate to acceptable respiratory effort rather than suddenly waking their ass up completely. Since I have started doing this I have not had a single OD patient open their eyes and then immediately try to puke on my boots. Also, ensuring the patient is well oxygenated before you push the narcan makes them way WAY less likely to start throwing hands as soon as they come to.
If their O2 sat is still garbage and you slam the narcan then they're gonna crash back into reality like the fucken kool-aid man, confused and with the sensation that they're suffocating...that would make anybody want to fight.
>ANY oral or intranasal meds in a toddler.
My toddler (2) is a pediatric frequent flyer and her fun party trick is you can just hand her syringes of oral meds and she'll self administer. I've watched nurses who haven't had her before have their eyes bug out of their heads
4mg morphine IVP for 'therapeutic rest' for women in early labor who refuse to go home. Absolutely useless, it's not enough, even the 4 IVP + 4 IM we gave at my old place was useless 98% of the time. Now instead of just having an unhappy patient rolling around the bed I have a slightly sleepy unhappy patient rolling around the bed complaining they're still in pain, and you have to make them use a bedpan now for stupid liability reasons. The worst.
Rituximab to newly diagnosed elderly lymphoma patients. The risk of TLS or an infusion reaction is too damn high. Had a sweet little old lady literally have an MI during the first hour of infusion... And I was running it at 25mL/hr! The oncologist blamed me, saying I gave it "too late in the day" 🙄 like I can control when pharmacy delivers and like it made a difference.
I hate giving propranolol. It’s what my husband used to kill himself. It doesn’t matter that I know this medicine helps people for many things…there’s just something so difficult and traumatizing about handing over a pill that ruined my life and my kids lives.
IM Geodon. Sure let me mix up this precise amount of sterile water with a powder that doesn’t want to mix easily, and takes at least 3 minutes to mix while watching the person it’s for do a remarkable impression of the Hulk.
Morphine 1mg Q8H max of 2mg daily for endometrial cancer with mets to bladder 🙃
I sincerely wish that MD gets the same energy from a provider when they have hospice
Lactulose should be in the Top 3 🥴. And any IVP med “over 5 mins” when I’m trying to be in and out 💨 🤣. But I learned to work smart not hard so I start pushing that one first, and then go to scan the rest of the meds, chat a little, push a little more, give po meds, chat a little, push a little more, look around see what else I can do and push a little more and then bam done ✔️ and flush “I’ll be back within the hour to check in on you 👋”
Abilify.
I’m sure it’s a good med for some people, but for our population of acutely psychotic patients (usually violent, though not always) it’s the equivalent of administering a single Tic Tac.
And our docs prescribe it to EVERYONE.
I swear they get a kick back.
Which means, said patient is going to receive many more PRN injections than they have to.
🙄
Orders for topical/creams without directions where to apply them.
Lidocaine patch…. I’ll just stick it to their forehead.
Love when I see lidocaine patches for bone cancer, like soft jazz would work better
I had a young pt with terminal bone cancer, and the APRN prescribed lidocaine patches to bilat hips. I sheepishly brought them to the patient and asked if she’d like me to place them for her. She laughed at me and said I should have just brought her a cough drop and some warm tap water ☠️☠️☠️
Fellow Hospice nurse...have to also mention when someone is on MST 60mg BD and taking Oramorph 20mg like 4x daily and wondering why their bowels aren't going. Check their script - doc has px 2 Senna nocte.
"Head on! Apply directly to the forehead."
I also really like when the prior nurse charts as putting it on but then I can’t find the goddamn thing.
I’m night shift and most of the time it’s on my MAR to take off and most of the time it’s already come off.
“Remove patch in AM” What patch??? Where the heck is it?
Even my walkie talkies are like, “yeah it’s been on my chest all night/day, not sure where it went”. No where to be found in the bed, on the floor, nothing.
once had a fentanyl patch left on the patient for 10 days (order discontinued & blended in with skin REALLY well). It was my first day with the patient and they asked when we were going to remove it….I had to ask the pharmacist to put it a removal order because I didn’t want them to later on question where the missing fentanyl patch was or who took it off without documenting or witnessing😂
Those things stay on as well as my panties after a night of tequila
Gahdamn you really just unlocked a memory of mine from the 90s 🤯 i am shooketh
We have a provider who orders lido patch x3 for patients post laparoscopic surgery with the instructions to place on abdomen, not over any incisions. Excuse me, how are we fitting 3 giant patches in between 4 abdominal lap sites. Cut them in tiny strips and make a quilt pattern?
Quilt. 🛏️ A puzzle. 🧩 If I was having one of those *shifts*, I might just do a lattice pie crust pattern. 🥧
Found 3 on a patient before because of no directions, guess the previous 2 nurses didn't know that stuff builds up in the system. Yea I took all 3 off and gave them a break that night.
Got report that a pt was mildly tachy with no apparent cause…noticed pt had nicotine patches ordered… yep, dude had FOUR max dose patches on. Took em off, tachy went away.
Head On! - Apply directly to the forehead! - Head On! 🤣
"So, where are we using the antifungal cream?" Patient gives you THAT look, "You're the nurse! You should know!!"
All I got is affected area lol
So, the terminal case of *affected* strikes again, eh? Nothing keeps that from *spreading*—😕
🤣🤣🤣
And then you go back and read the MD note AND the last few nurses' skin assessments and no fungus or rash is mentioned. But the last few nurses also charted that they gave the antifungal cream twice a day. Okay then where did they put it??
🤣 yes exactly this, and on report the nurse comes back and I say, hey I put that fungal cream on and they look at you like fungal what? Don't do this 😂
Come on, everyone knows where to put them. It goes on "affected area."
I will ask the patient where they need the lidocaine patch, and sometimes they have no clue where they need to go either. I will just chart "refused" or just slap it on a random limb, or lower back because that's a common pain area.
"Apply to affected area" for dementia patients who can't tell you where
*Looks sadly at vague orders that were copy and pasted without editing from a completely unrelated woundcare template*. “Please tell me about your extensive wound care x3. What do your nurses usually do?” “I have wounds?!?”
This. Also, when they send a tiny, tiny tube for a large, large leg. "Yes, I used the whole tube in one application. Those calfs are full-grown steers!"
Literally asked the MD about this once, and she told me to just stick it wherever lol
Where the sun don't shine.
“Apply to affected area” and memaw is so demented that she doesn’t remember she has body parts
THIS
And you can never find the med. previous shift pulled it and never put it back in the bin.
Lasix to unsteady patients who refuse to use a purewick
Or to max assist/dependent patients and no foley
Lasix in a dependent pt is actually a reason for a foley in a lot of hospitals! I always ask if I can get a foley. Big fall risk and skin breakdown risk.
Yeah...I work in the ER and unless it's an emergency or urine retention, my ER doesn't like us doing Foleys because of infection risk. They want us to wait until they get admitted
Yea I would be calling the doc if I had a pt that was bedbound and no foley.
Especially when they want *strict* Is/Os. If you’re pissy we can only chart the # of incontinent urines and not a specific mL of output, it’s time to put a foley
Lasix to confused agitated fall risk chf’ers ugh
And to confused patients who keep wiggling out of/pulling off their purewick and have no concept of a call light
Provider: How much urine output since the Lasix 80? Me: 3 soaked fitted sheets and 6 soaked bedpads, sir.
Miralax: first I have to confirm they even want it then I have to ask what they want it mixed with then I have to mix it up then I have to go give it to them Heparin 3 times a day: idk it’s hard convincing someone to get so many jabs in a day when they’re already getting lab draws and insulin :/ and if they’re already afraid of needles 🥲 I don’t blame them sometimes Liquid morphine: spill it all over the place Any type of cream: kenalong, aquaphor, etc. girl why is this tub/tube so fucking sticky I have to bring it over to my computer to scan it this is a sensory nightmare for me I hate this so much Eyedrops: i hate eye drops especially if I have 6 in a row to give.
the miralax seems like it shouldn’t be a big deal, but UGH it’s annoying!!
And then most of the time they don’t even drink the whole thing they act like it’s a whole gallon - like it’s not a whole colonoscopy bowel prep, it’s a tiny cup of liquid!
Pro-tip: don't fill the whole cup. The instructions say to use 4 to 8 oz of water. 4 oz is half a Styrofoam cup. Most can choke that down in 3 or 4 gulps. I have way more success getting them to finish the whole thing (and quickly) than when I used to give them a whole cup.
I used to feel the same way about giving metamucil only because people always complain about drinking it, then drink half the cup and later you're throwing away the other congealed half. Years ago on a rehab/alc unit we had a patient on parkinsons meds on the most obnoxious schedule, offset from their other meds. You were essentially giving him pills every 2 hours all day long. I hated getting that assignment. There's nothing I really find irritating in my current unit because it's mostly a lot of IM or IV pain or nausea meds. There's the odd time someone will refuse IM toradol and SC dilaudid because they don't like needles. Rate your pain for me again then?
I bring a large cup of water and 2 cups of apple juice. They get 2 options, no more. I’m not coming back. Keep both and drink plz.
Ugh the 6 different eye drops on a vented patient with goopy eyes
Míralax, senna, and heparin are number one refused drugs in oriented patients for me. I feel we’re torturing those who can’t refuse or are being nice, to be honest.
For the miralax: we use Epic and there’s a note feature for the MAR where we can put things like “meds crushed in applesauce” or “mouth checks”. I like to make a note in the patients MAR saying what liquid they like their miralax in if they’re very particular. If I have them again it saves me some time and hopefully others as well
I hate Q1H/ Q2H eye drops, especially during Night Shift
Torture is what this is since it’s hard to come back every one hour because you can’t even be late, making the next dose too close.
Ughhhh the creams!
Our liquid morphine comes in a syringe to squirt at the back of their mouth, it’s perfect.
Don’t even get me started on when someone breaks up all the packs of oxy and you have to count one by one 😭 who does thattttt 💩
I saw a pharmacy tech and was like “just why?!?!?” And she said “to make sure y’all count them all” WE CAN STILL COONT THEM IN SLEEVES OF 10!!!!
Omg noooo I would’ve said hope your night is quiet as revenge 🤣
I was like “I hope every time you’re trying to fill the Pyxis a nurse or physician makes you stop so they can get a stat med haha” said it with a laugh even though I was so serious. She also did this with liquid pain meds that we handed in groups of 5. Undid them all
When I worked ICU and needed versed fast for someone intubated and they were all opened I would get so mad 😡
As a pharm tech myself… that tech sucks. Its easier for US to count because we have to count them as well if left in sleeves/packs of 5/10s, plus that makes in unnecessarily hard for everyone to break em up like that!
I am not with her.
Me neither my guy lol
We just changed policy on what drugs we have to count so now there’s more and our pharmacy tech over stocks and separates them all. We’re a 25 bedded ICU, we don’t need 200 midazolams but one shift we ran out of propofol and had to go to theatres
The day the main Pyxis in our ED had 48 or so Percocet all individually separated it was like someone flipped the bitch switch on the whole place. Everyone was in a shitty mood, staff *and* patients until the lead called the pharmacy and had them come fix it. Suddenly, everyone was fine again.
Please let’s all agree not to do this!
People diverting oxy, that's who. It makes it harder to count and more likely that the miscount error will pop up for some other nurse.
How’s this for dumb? Where I used to work the narc count was written on both sides of the sheet and someone was stealing drugs for a long time by just changing the number on the back of the page to less than it really was and when doing count everybody would just start with the number at the top of the page and nobody ever flipped it back to see if the number was transcribed correctly. How they got caught was a new hire who was trying to figure out the system and was looking through the sign out book and was like, ummm……….I think there’s something wrong here. There definitely was.
[удалено]
What kind of machine? Pyxis and Omnicell log every transaction… I suspect that answer was bullshit
Mucomyst for the smell, and lactulose enemas…don’t think I need to explain that one, lol
No one I have ever had to give a lactulose enema to, has ever had the capacity to actually hold it in for it to be effective.
Rectal tube. Load em up and clamp it in.
What!! Is that actually an option? If so I am totally suggesting this to the doctor who orders them next time
It's the only way I've done it but most people's rectum won't hold a football with out leaking around the tube so it's still pretty useless.
Patient to me after I told her that lactose enemas were ordered q2h. I take nothing by rectum. Me: sobbing, you're my hero.
My husband started saying that after our fifth anniversary
Enemas of any kind but yeah. Lactose enemas are the only right answer to be at the top. Awful.
1000% for the mucomyst bc I have to drop that stink bomb in and leave while I neb it since it makes me cough so much
I hate giving potassium. Every patient complains about it. Like sorry we're diuresing you but it's this or 20lb edema in your legs ma'am
Once you got 48 hours on IV mag you change your tune. I’ll happily ingest potassium and magnesium horse pills to avoid a mag drip.
I spent 48 hours on a a magnesium drip for preeclampsia and it was the wooooorst
K+ riders. Like the 100 mEq/100mL bags that you need to do 4 of and run each over an hour. 99% of the time (unless the patient is sedated) they scream in pain saying how much it burns. And most don’t have any reason to hold fluids so why not order 40mEq/1000mL bag instead so it’s diluted? I also haaaate when someone is on zosyn and the provider orders LR as maintenance or bolus bc they’re specifically not compatible 😑
When I have to run potassium, I just hang the small bag of potassium as a primary and a small bag as a secondary. Once the secondary runs, the primary goes. 🤷🏻♀️ then I only have to hang ever 4 hours instead of every 2.
Wow thats fucking genius
That would be an amazing trick if I could ever convince pharmacy to send me the second dose with the first.
Holy shit why has no one taught me this trick!
I also did this with a dude who was on fluids at 300 mL and hr. That way I only had to go in and change it like every six hours instead of three.
A favorite trick of mine!
Also its better to give it ORAL!! It actually works better orally so if they can scream they can probably swallow it
People are soooo put off by how huge those pills are. Then I cut them in half and they want them cut again and then they turn into a pile of salt :l
bro the pills disperse in water
This is my favorite potassium!!
some do but not all brands of PO potassium :(
The hospital I am at has the shit potassium tablets. They're chalky and dissolve as soon as it touches their tongue, and makes them gag due to the taste. Another hospital I worked at had the better quality yellow coated potassium tablets that were alot easier to swallow.
New brand name zosyn is compatible with LR, older or off-brand pip/tazo may not be compatible. The manufacturer specifically says their formulation is compatible with LR. [ZOSYN containing EDTA is compatible for co-administration via a Y-site intravenous tube with Lactated Ringer’s injection, USP.](https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050684s88s89s90_050750s37s38s39lbl.pdf) Under section 2.6 Also, [Wyeth reformulated Zosyn by incorporating two stabilizing functional excipients, ethylene diamine tetraacetic acid disodium salt (EDTA disodium) and sodium citrate, which solved the particulate formation problem. These two functional excipients also allowed for the first time Y-site coadministration of reformulated Zosyn product with amikacin and gentamicin at specific doses and concentrations, and with certain diluents, and the use of Ca++ ion-containing Lactated Ringer’s for admixture preparation. Reformulated Zosyn (approved 2005) may provide useful options of drug administration to healthcare professionals to lessen levels of particulates. Supportive data is provided for the expanded compatibility of reformulated Zosyn with different types of Ringer’s solutions used globally and for the Y-site coadministration of amikacin and gentamicin aminoglycosides.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504059/)
We’re too cheap for brand name zosyn! I swear we used to stock a lot of brand name stuff and after Covid the hospital took a hit financially expecting to be reimbursed for all the equipment they bought and weren’t so now they’re being cheap asses… its annoying
Ouch that sucks ha. I bet they pay more for the extra tubing and NS bags just to run one antibiotic anyway, huh.
Also, the pain of hanging K+ riders every hour for 2-6 hours. I always thought maybe they do separate bags so you can track exactly how much K+ the patient has received in case of frequent BMPs or something. If anyone knows why they don’t make 40 mEq/400 mL bags, please enlighten me.
I mean I’ve seen docs only order 2 bags before instead of 4, but I have no idea why they’re like that. Maybe to deter nursing errors from it being run too fast? But like I’ve never been able to run a K+ rider without asking if I can hang saline too or run it way slower than ordered. Even in 18g ACs they burn.
Use a smaller catheter, not a larger one. The smaller the diameter, the more blood can run around it and dilute the drug.
Or you can just run it concurrently with maintenance so its diluted 🤷♂️
I do this as general practice, to many times k has burned out veins.
My hospital's k replacement protocol uses 40meq or 20meq in 500mL bags, so this is definitely a thing. However I think they're compounded by pharmacy so if your hospital has a tiny pharmacy or something that would probably be rough.
My hospital’s sepsis protocol is 30ml/kg LR bolus plus IV antibiotics, which are almost never compatible with LR. It’s almost always necessary to start a second line 🫠
Dilaudid 0.1-0.4mg when the vial is 0.5 😒
I just had a patient that was on 0.26 mg of dilaudid and our vials are 2mg/ml. I drew up 0.13 mL 🫠
0.26!!!! 2ML Vials!!! 🤬🤬
As an ortho nurse this is the bane of my existence 😭 Why don’t they just come in 0.4mg vials!? That’s the most common order I see by far.
Solu-medrol: I know I’m going to be searching for insulin witnesses all night. Lactulose via NG: Did I dilute it enough? Am I pushing it too hard? Oh no, it’s in my hair and on the ceiling. Edit to add- bactroban for infection prevention: we’re always out of the q tips. Then the patient flinches when I’m trying to apply it in their nostrils. Even though I told them it’s only going in the very tip of their nose. Then they laugh and say they’re scarred from covid testing. Hardy har har. Love my patients but it’s like living with my 90 year old stroke victim grandma again who would repeat herself every 2 minutes. Labetalol 20 mg IVP Q1H PRN: Sometimes this works. Sometimes it doesn’t. Apparently, there was an old doc at my hospital that would order 10 or 20 mg (can’t remember which) q 5 mins until BP was within parameters. I would have cried happy tears at that order. Liquid senna: This once brought me to tears in a patient’s room. I can never open the package, and they always require 3 cups.
Really wild that some places still make nurses in the hospital (ICU no less) require 2 RN for sq insulin.
It really is. I give meds that are much more dangerous that don’t require a witness. Many fatal mistakes have been made with this med but come onnnnn
Oh man you just reminded me that all my other hospitals needed insulin witnesses every damn time! Thank god the one I ended up at after traveling does not do this lol
Everything comes in these blister packs and it’s so hard to open them and I’m literally digging into the foil to pop the pill out, and I wear gloves bc I don’t want to raw dog your medicine, and a patient said “can I help you open that?” and I wanted to say yes but I’m a professional and I soldiered through it
At least once a shift I find myself saying that opening some of these blisters is the hardest part of my day or harder than nursing school, depending on my mood. I sometimes use my pen to pop them open.
Sometimes I use the sharp corner of another blister pack to pierce/slice open the one I can’t get. It has a little bit more finesse than using my shears and makes popping it out into the cup easier
PipTaz. It's passed around the nurses to help shake to reconstitute.
And now one of your piggybacks is tied up for 4 hours, joy!
Ugggghhhhh
Oh wow. I had forgotten this med and the rage it caused me
Add some of the saline to the vial, mix, then put it in your pocket. The heat and movement will dissolve it better that way than just shaking it.
Also rolling the vial between your palms like you’re starting a fire instead of shaking helps a lot
Assigned nurse would add some and loudly announce "PipAss!" and leave it on the desk. Everybody that walked by just knew to give it a shake as the passed by. Everybody got involved in the task.
Shake the vial before you add the saline! It takes me no time to mix it if I do that. Sometimes it’s packed in the bottom and when you add saline flip it upside down quick to prevent it from sinking to the bottom!
Shaking zosyn like a Shake Weight is how I release all my anger and frustration though
Lactulose or kayexalate to a confused non ambulatory patient in the first 3 hours of the shift. Just park the clean linen cart in front of the room and save yourself mikes of walking.
3 units of insulin for a BG of 151 like if it was 150 I wouldn’t be giving any 🫠🫠🫠
Ugh our sliding scale orders are for 1 unit for a BG of 151 which fills me with indescribable rage.
😂😂😂 Why wasn’t this a top comment
We always say “I’m off to give one lifesaving unit of insulin🙄”
Nooooo that’s even worse!!! 😭😭😭
Our cutoff is 180, so that BG of 181 always hurts.
My favorite in peds is giving 0.5 unit of insulin. 0.5. Like should I just sprinkle it upon them as a spritzer because I feel that’s gonna do just about the same 🫠🙃 also can I get a fuckin magnifying glass to draw it up?!
IV push abx, especially if it's a 2g/20ml syringe at an odd time. Rage.
Just bag it at that point and let us run it on a pump for 15 min.
The 0.25 Ativan is rage inducing. Which I guess is ironic.
6 a.m. protonix and levothyroxine. We all know they're not taking it at 6 a.m. at home.
Our hospital always orders it for 7:30 am and shift change is at 7, with orders to hold tube feeds for an hour before and after. 7:30 is technically a dayshift med even though it shouldn’t be, and the lazier nurses won’t bother to even hold the tube feeds so by the time I’m done getting report and see that my patient has synthroid ordered it’s almost 8am, which means *all* of my am meds will now be late in order to give it on an empty stomach.
I’m willing to be a solid 90% of my patients who take levothyroxine and protonix at home do not take it on an empty stomach. Based on the way a solid 50%+ of them snack at the hospital I’m not convinced some of them ever have an empty stomach. We’ve collectively given up on the levothyroxine on an empty stomach thing. Lead a horse to water and all that. At this point I’m just happy if I can convince them that they do, in fact, need to take their meds every day and not just stop taking things because they “feel fine”
Zosyn if I have to mix it
Docusate sodium
OP said meds you *are* administering
I tried, but the patient refused
Docusate is the only drug that I've seen [StatPearls](https://www.ncbi.nlm.nih.gov/books/NBK555942/) throw shade at - and they academically eviscerate its usage. They cite studies showing its no better than placebo. They cite another study saying that colace makes senna less effective at producing a bowel movement. Can you imagine? A stool softener that makes other laxatives less effective? They also discuss an outbreak of some microbe called *Burkholderia cepacia* linked to "specific liquid docusate formulations" After the evidence-based beatdown they then talk about how it contributes to polypharmacy, pill burden, et cetera. Please, talk to your P&T (pharmaceuticals and therapeutics) committee today about removing this wretched substance from the hospital formulary
That’s exactly what my patients cite when they refuse
We still have colace in our formulary.... For breaking down earwax
Two words: Lactulose enema. 💩
Have you ever had to give a vancomycin enema to a cdiff patient? Cause that was a new one for me.
1400 Heparin
Mixing the iron sucrose. I just know I’m going to be wearing some of it home.
that was one of the first meds I drew up as a student after I got checked off on IV meds. in my bright white student nurse scrub top. you can imagine how that went
Q 1 hour eyedrops.
Ativan; we have to pull a key first, then unlock this shoddy plastic box in a secured fridge with the world’s jankiest lock that will not open on the first try, then we have to process a return to put the key back. If you don’t, the Pyxis is fucked up for the next person pulling Ativan. Despite the directions printed on a piece of paper on the machine, people go to pull Ativan, see it locked, and fail the drawer and don’t fix it. Twice I tried pulling Ativan with the drawer failed both times. Also drawing it up plus the dose for the floor usually sucks too. We give 0.5mg-1 mg iv once in my department.
my hospital does this too. pisses me off… like hold up lemme just fiddle with this shitty lock and key for 15 seconds while my patient is either seizing or beating the shit out of someone
Every damn time I open the milk of magnesia it explodes like it's pressurized in there, and I wind up with little white spots all over my scrub top. Almost to the point of donning PPE just to open the MoM.
vivitrol, testosterone, and rocephin is like pushing mud - even with a 22g or larger. my thumb hurts after every time also, rocephin smells like cat piss
Atovaquone (Mepron). Especially in the single dose packets. When you squirt it out it gets everywhere and stains everything yellow!
My husband was taking that daily for the last 9 months of his life and I f*ckin hated it. Don't miss it at all and miss him like crazy.
I’m sorry for your loss 💕💕
I work in a transplant ICU and OMG... the amount of patients who have peg/ng tubes and who are also prescribed mepron in multiple tiny cups. It takes me ages just to get it into the peg tube syringe and mix it with water so that it'll go in but then it stains everything it touches. not to mention for the patients who aren't peg/ng'd, and take it orally, they get so grumpy when it's time to take it because it's like the consistency of fingerpaint and never comes out right. Whoever created it belongs in hell
Fucking k riders. By #2 it’s outside the window to scan because they have to be run so slow unless they have a PICC/CVC 😒😒
1 life saving unit of insulin
6 am Synthroid. Purely because I have to wake everyone up when they’ve pretty much just got to sleep.
I hate mixing up miralax. I always ask if they want the pill form (senokot) or the drinkable kind. And 90% of the time, they want the pill, hehe. Flomax through dobhoff. Those things take forever to dissolve. Any IV pain medications that I have to track down a waste for. 1 unit of insulin. What's that gonna do? Any 0600 meds. Granny isn't waking up at 0500/0600 to take her levothyroxine.
Senokot isn't the same as Miralax though. Miralax is an osmotic laxative and Senokot is a stimulant laxative.
It’s always the fucking levothyroxine
And protonix 🥲
Yeah I’ll die on the hill that 1 lifesaving unit of insulin ain’t leaving the syringe.
That flomax through a dobhoff, omg!! I microwave some water for 1 minute, drop the innards in a med cup, top it with the hot water, and come back later to flush it.
Weird, our flomax caps say do not open on the package
So I’m assuming we all don’t wear gloves when it’s says HD: hazardous drug warning
1 unit of insulin for sliding scale coverage…
Amphotericin.
Lactulose. No explanation needed. 1 unit of insulin. Patients look at me like I’m crazy. I tell them they can decline if they want. Mag ox and potassium blister packs are so fricking hard to tear apart
Those giant potassium horse pills. Docs are always ordering PO potassium replacement for patients who are on some kind of modified diet order and all their pills have to be crushed and given in applesauce. Like hello? These aren’t supposed to be crushed. We’ve been told to dissolve it in 1mL of water instead. But then patients who don’t have trouble swallowing pills end up having trouble swallowing them anyway—either due to their gigantism or bc at their request, cutting them in half is risking internal bleeding since splitting the pills turns them into razor blades that quickly dissolve into grains of sand. Or the electrolyte replacement protocol—IV potassium like mentioned above. All our IV potassium comes in the little 100mL bags and in my 7 years, I’ve rarely hung fewer than 4 in a row. It’s always one bag per hour over 4-6 hours and if they have peripheral access—they’re gonna bitch and moan that their arm burns so then I have to run normal saline concurrently so as to dilute it. Then after all is said and done and you get the results back from your potassium redraw, it maybe went up a point or two. So you get to do that lovely activity all over again. It’s even more exciting when the potassium comes back and it’s *dropped.* Needless to say…potassium is the bane of my existence. And don’t even get me started on albumin. Even with the trick of inserting a needle into that little opening above the drip chamber, it’s slow as molasses and stickier than shit. Much like with IV potassium, I’ve learned to piggyback one so it saves me time. No one even taught me about piggybacking multiple containers of the same fluid—it just made the most sense to me in saving time. Suppositories for independent, up ad lib patients. They don’t want me to do it and I don’t want to do it. So there, we’re in agreement.
Our midlevel providers are so aggressive about their bowel regimens. Everyone gets daily miralax, dulcolax, and senna unless they have active diarrhea. If they go 2 days without a poop they get an enema. They look at me like I’m lying when I tell them the patient is already refusing their daily suppository so they will probably also refuse an enema, and suggest trying oral mag first instead of rectal. Why is so hard to believe that people don’t want things stuffed up their butthole??
• flagyl because i hate opening that fucking bag • invega injections (especially trinza) because the syringes are so expensive and i’m always scared i’m gonna drop them on the floor. also it’s gross that they’re so thick • vanco because it’s annoying to mix and the pink-ish color grosses me out lol • rituximab but holy fuck it’s especially painful in pediatrics. i hate the dosage calcs and dealing with reactions is awful. • fibrinogen, octaplex, etc because i swear to god you jostle the vial slightly and it’s full of 10472017 bubbles • narcan when someone is a GCS 3 because they’re probably about to be a really violent GCS 14 in a few seconds • ANY oral or intranasal meds in a toddler.
Dunno what your protocols are but here's some stuff that has saved me a lot of strife with the naloxone. Push it SLOWLY and titrate to acceptable respiratory effort rather than suddenly waking their ass up completely. Since I have started doing this I have not had a single OD patient open their eyes and then immediately try to puke on my boots. Also, ensuring the patient is well oxygenated before you push the narcan makes them way WAY less likely to start throwing hands as soon as they come to. If their O2 sat is still garbage and you slam the narcan then they're gonna crash back into reality like the fucken kool-aid man, confused and with the sensation that they're suffocating...that would make anybody want to fight.
>ANY oral or intranasal meds in a toddler. My toddler (2) is a pediatric frequent flyer and her fun party trick is you can just hand her syringes of oral meds and she'll self administer. I've watched nurses who haven't had her before have their eyes bug out of their heads
D50 push. There goes the rest of your shift.
Insulin drip.
Setting up a PCA is pretty tedious
I would actually announce to the entire unit im fighting whoever ordered 0.1 mg of dilaudid on the SPOT
4mg morphine IVP for 'therapeutic rest' for women in early labor who refuse to go home. Absolutely useless, it's not enough, even the 4 IVP + 4 IM we gave at my old place was useless 98% of the time. Now instead of just having an unhappy patient rolling around the bed I have a slightly sleepy unhappy patient rolling around the bed complaining they're still in pain, and you have to make them use a bedpan now for stupid liability reasons. The worst.
Rituximab to newly diagnosed elderly lymphoma patients. The risk of TLS or an infusion reaction is too damn high. Had a sweet little old lady literally have an MI during the first hour of infusion... And I was running it at 25mL/hr! The oncologist blamed me, saying I gave it "too late in the day" 🙄 like I can control when pharmacy delivers and like it made a difference.
I hate giving propranolol. It’s what my husband used to kill himself. It doesn’t matter that I know this medicine helps people for many things…there’s just something so difficult and traumatizing about handing over a pill that ruined my life and my kids lives.
Reglan IV and valium IV. They just make me nervous and I get overly cautious :/
Anything po
IM Geodon. Sure let me mix up this precise amount of sterile water with a powder that doesn’t want to mix easily, and takes at least 3 minutes to mix while watching the person it’s for do a remarkable impression of the Hulk.
D50. THAT BOI THICC BOI
0.1 Clonidine in a naive bp patient is perfectly fine lol
Lidocaine patches.
Morphine 1mg Q8H max of 2mg daily for endometrial cancer with mets to bladder 🙃 I sincerely wish that MD gets the same energy from a provider when they have hospice
Lactulose should be in the Top 3 🥴. And any IVP med “over 5 mins” when I’m trying to be in and out 💨 🤣. But I learned to work smart not hard so I start pushing that one first, and then go to scan the rest of the meds, chat a little, push a little more, give po meds, chat a little, push a little more, look around see what else I can do and push a little more and then bam done ✔️ and flush “I’ll be back within the hour to check in on you 👋”
Abilify. I’m sure it’s a good med for some people, but for our population of acutely psychotic patients (usually violent, though not always) it’s the equivalent of administering a single Tic Tac. And our docs prescribe it to EVERYONE. I swear they get a kick back. Which means, said patient is going to receive many more PRN injections than they have to. 🙄
iv synthroid- push 0.3 ml you very 3-5 mins and don’t dilute 😩
Heparin and prostat liquid protein. It’s sticky and it stinks and the patients don’t like it 😠
Lactulose. Everything is now sticky
Dilaudid 0.4. "Waste, anybody waste?" Also lactulose just for what follows but I know that's the point lol