Based on long experience of seeing and experiencing newly qualified
doctors enter their profession via a position as a resident in an
Australian public hospital, I can make the following observations of
doctors prescribing practice:-
1. Doctors scripts are often illegible, requiring a team nursing
effort to decide what is written - this constitutes prescribing on the
part of the nurse.
2. Doctors often order IV fluids that can't be given due to problems
of IV access - this is compounded by the fact that junior doctors are
approximately only 10% as good as experienced doctors at gaining IV
access.
3. Doctors do prescribing roughly and very often in a hurry .
4. Doctors often prescribe nausea producing oral medications to
patients when IV would be a better choice.
5. Doctors often don't know the correct dosage of medications that
would be effective. They ask the nurse.
6. Doctors often presribe ambiguously - eg. give the drug "in 1000
mls" together with "in 100 mls" on the same script.
7. Doctors often order sliding scale IV insulin with no stated
frequencey of BSL readings - so nurses in effect are prescribing since
they must make a decision as to how often to change the rate of the
infuision.
8. Doctors order oral heparin - this is useless. Nurses just give it
sub-cutaneously because they know what is right. So once again they are
prescribing. No time to find junior and put him right.
9. Doctors make fun of the prescribing rules by ordering things like
"ted stockings" with the route of administration left blank.
Nurses only compound the problems by doing stupid things like giving
IV fluids to patients from an order written with no patient ID details at
all.
Rapid Response:
Clearly written scripts help.
Based on long experience of seeing and experiencing newly qualified
doctors enter their profession via a position as a resident in an
Australian public hospital, I can make the following observations of
doctors prescribing practice:-
1. Doctors scripts are often illegible, requiring a team nursing
effort to decide what is written - this constitutes prescribing on the
part of the nurse.
2. Doctors often order IV fluids that can't be given due to problems
of IV access - this is compounded by the fact that junior doctors are
approximately only 10% as good as experienced doctors at gaining IV
access.
3. Doctors do prescribing roughly and very often in a hurry .
4. Doctors often prescribe nausea producing oral medications to
patients when IV would be a better choice.
5. Doctors often don't know the correct dosage of medications that
would be effective. They ask the nurse.
6. Doctors often presribe ambiguously - eg. give the drug "in 1000
mls" together with "in 100 mls" on the same script.
7. Doctors often order sliding scale IV insulin with no stated
frequencey of BSL readings - so nurses in effect are prescribing since
they must make a decision as to how often to change the rate of the
infuision.
8. Doctors order oral heparin - this is useless. Nurses just give it
sub-cutaneously because they know what is right. So once again they are
prescribing. No time to find junior and put him right.
9. Doctors make fun of the prescribing rules by ordering things like
"ted stockings" with the route of administration left blank.
Nurses only compound the problems by doing stupid things like giving
IV fluids to patients from an order written with no patient ID details at
all.
Competing interests:
None declared
Competing interests: No competing interests