After 2 years of meetings and research the hospital has finally joined the rest of the country in standardizing pre-operative antibiotics. It seems the federal government feels the need to tell us what areas of health care need improvement. Congress has determined that all would be well with the world if we gave the appropriate antibiotics at the appropriate time. Other mandates include preventing hypothermia and normalizing blood sugars during surgery. That means I'll have to stop turning my patients into septic, hyperglycemic Popsicles. Which is a shame because I consider an infected patient with a blood sugar of 490 and a core temperature of 33 degrees C. to be a challenge.
The new standing order for antibiotic is:
Kefzol 1 gram IV 30 minutes pre-op. If patient weight > than 70 kg. give 2 grams of Kefzol IV 30 minutes pre-op.
Now this is pretty straightforward. That's what I thought till this Thurs. I had two patients arrive with two grams of Kefzol hanging for me to start. Then I noticed the sticky-note on the chart. It read " Do you want both grams of Kefzol? Patient 66 kg. (<70)". When I read the little yellow note, blood shot out of my right eye. Four years of college and the nurse can't figure out that 66 is less than 70. So I had to get the busy overworked nurses-aid to run extra dose back to the Out-Patient Dept. to be credited to the patient. Thirty years ago the O.R. head nurse would have walked over and fired that nurse on the spot. Don't laugh, this is some scary stuff. These are the people who are going to be taking care of you one day. It's at moments like this when I recall George C. Scott's quote from the movie The Hospital: "how am I to sustain a sense of meaningfulness in the face of this?"