2.25

Thought I was going to have a nice afternoon..must have jinxed myself...

went up the ward to grab my drug charts for a medprof I was going to do for tomorrow..the only thing on my agenda..had 45 minutes to do it..which to me was very nice...it was going to be a nice afternoon..I will finish on time..over to OP by 3pm instead of being late like usual...

only to be told that Mr E was put on IV antibiotics..I looked at the dose and I thought oh no..it was a high dose..and I wasn't too familiar with the drug either..

went downstairs to try to requisition it only to find out no stock..yes there is stock but SAS stock..which means I have to find the TGA form SAS category A form...and since SAS it is expensive which means I have to find the High Cost Drug form...email the Director of Nursing to ask for permission...

to help the doctor I partly fill out the forms for him...then I had to ring our store lady to get her to order more in as 7 boxes of 10 ampoules would only last him 3 days..he was on 16 ampoules a day..and since today is already Wednesday...the weekend was creeping up..

she said to me you need to get the doctor to sign the form..get back to me early tomorrow for me to order..that way it will come in on Friday to see us through the weekend..

rang the doctor to ask him how best to get the forms to him....he said it was too late he will do it tomorrow..if I could leave the form on the ward for him..

walked all the way to the other hospital to grab my ampoules..thought I was done...the dose seemed high but maximum allowed dose 100mg/kg per day...so I passed it..

came back PS said did he have renal failure? I said don't think so ..I checked it this morning...went back to the ward to read the notes to make sure..yes of course he has renal failure...his creatinine was like 400+ ...lol... not only that when I checked the IV order the doctor wanted it infused over 6 hours...instead of the recommended 1.5 hours..cannot infuse it over a long time as it crystallizes...

went downstairs to check our internal program for his latest lab results..to work out his creatinine clearance..he had a clearance of only 10ml/min..= very very very bad renal function..but then no drug his respiratory failure would kill him first..

so back to the book..usually they would give it 3 days full dose then cut it back ..can always get the doctor to do it later date..so we passed it..
as for the IV problem..can't pass it..need to know why he wants 6 hours..rang him back...lucky I did..I told him the problem thinking all he had to do was say infuse over 1.5 hours...he's quite reasonable...

no...that didn't happen... he said forget about the IV..give him oral..as he has got a nasogastric tube now..Dr D just rang me 10 minutes ago to say he has successfully inserted one...

he then said give him equivalent dose in syrup as the tablets ordered this morning..I continued..okie...I will write a phone order..please could you sign it and write a regular order in the morning?? he replied..yes I will make it official in the morning..

I thought yippee...went to requisition the stock to find only 2 bottles left..lol...1 bottle =100ml..to convert to the equivalent dose I need 120ml per day for him...200ml was only going to last me 5 doses not even as you lose some every time you take a dose..which means he will run out mid tomorrow morning..

rang ordering person...please order..D said she will do it straight away..it will come in the morning if the wholesalers have stock..IF... asked her to go to store to see if there were actually 2 bottles sitting there on the shelf..as sometimes the computer can be wrong...

I was so relieved when she said there were 2 bottles...

next bit was to wait for the bottles to come through the chute ..label them..take them upstairs.. write in the notes showing my calculations.. write the phone order...talk to the nursing staff...

it was 430pm when I was done with him...took me 2 and a 1/4 hours to work that problem out..didn't help that I was tired..couldn't think clearly from lack of sleep..

here is hoping tomorrow will be a better day..now I know why no one wants to do my ward..it can easily turn your day upside down..