Just For Fun

[tbostock]

This just in...nurses that can't translate medical terms. All of these happened this week. Our transfusion requisition has the justification choices on it so that we are doing a prospective review.

Handwritten on the form: / Choices on the form:

MDS / Myelodysplastic disorder

GI bleed / Acute blood loss

brain bleed / Intracranial hemorrhage

Each time we called to say that they needed to select the appropriate justification, they insisted that there was no choice that fit. Guess I made it too technical....oh, for the love.

[jhaig]

got used to the diagnosis of SOB (shortness of breath for those without a legend key) but a diagnosis of SOBE along with a stat request for xmatch of 6 units with a normal hemoglobin prompted a call to ER for further explanation.......SOBE = Stepped On By Elephant. Who would have guessed!!....Circus was in town, but how were we suppose to know?

As for local acronyms.....coming from a small community hospital to a urban, teritary care facility it didn't take long to learn (and sad to know there was a need for an acronym) but diagnosis of "BBB" was "beaten with baseball bat".

Some other favorites, diagnosis of Euro sepsis....

and then gangere (which is certainly never funny) but when the patient names is (I kid you not, ..) Shrek, kind of makes you step back for a minute.

And have also received the stat request from OR for fresh frozen plamsa, acknowledged request and told them to come down in 20 minutes to pick-up, OR reiterated it was stat, we reiterated acknowledgement and stated to come in 20 minutes, OR said it was stat and they were coming NOW!! When OR arrived, I handed them a frozen brick at which point they actually asked what they were suppose to do with that and how could they transfuse a frozen block of ice?.....I responsed, if they would come back in 20 minutes we would have it thawed. They left, the product was thawed and issued to the OR about 20 minutes later (but to a different transporter......... ).

I received a crossmatch order on a patient with a specific diagnosis and then had the acronym UNIVAC after it. Wondering if this was a diagnosis or a new piece of medical equipment, I called the floor and they told me it stood for "Unusually nasty infection, vultures are circling". I didn't know whether to laugh or not.

[Brenda K Hutson]

They could have asked the patient to "lick the plasma"!!

That's what I always say when pressed to "hurry" the thaw process; what do you want me to do, put it on a stick?

Brenda Hutson, CLS(ASCP)SBB

[mprandealr]

In the context of electronic issue (computer crossmatch) My anaethatist has informed me that he wants real blood not virtual blood:o

[Brenda K Hutson]

donellda - Welcome to the club!!

A few months ago (or a year or so??) we switched to physicians placing their own orders. Yikes!! The list of problems and things that need to be cancelled every day goes on and on. One of our biggest problems is that admitting physician, attending physician, consulting physicians, and residents don't look to see what has already been ordered, so they order duplicates (then they get mad when we cancelled their duplicate order instead of one of the other doc's order.) Plus, they figured out ways around the system, such as going to another floor and calling in the order (so they don't have to enter it into the computer themselves.) When we have to consult a physician about some confusing/ nonsensical order, we are often told "Well, you should know what I mean." (Yeah, right.) The docs are making our unit clerks look better & better!

However, I think the blame has to be shared with our nursing team who designed the screens, the ordering procedures/protocol, etc., and are responsible for training. I think what they designed is often not very logical and the training is weak.

A good unit clerk (or lab secretary) are worth their weight in gold!!!

Well, don't be too quick to blame the "system" instead of the Physician. My current Hospital is the first place I have worked where we have a problem with erroneous orders placed by Physicians (about 85% of the Orders we get). Either they Order a Type and Screen when they don't need to (we have a current specimen and T&S; they want blood), or they don't order it when they should (so then we are calling the Nurses, asking them to place the Order). The LIS Team here at the Hospital have done their best to dummy-proof the system for the Physicians. In the Order field (where they would order the Type and Screen and RBCs, there is a box in the center that states: Order ABO, Rh & Abdy Scrn if ABO results not displayed to the right =====>then there is a box either showing Type and Screen results, with a date; or not showing any. Why is it that they seem to do the exact opposite of what the box says?? They clearly don't even pay attention to it. This has caused an enormous amount of wasted time for us, for the Nurses, and for Phlebotomy.

My next project: dummy cards at every Nursing workstation, giving step by step instructions, with pictures. We'll see!!

Brenda Hutson, CLS(ASCP)SBB

[carduc]

I have not laughed so hard for a long time - BUT the SOBE = Stepped On By Elephant diagnosis really took it over the edge!!

[TimOz]

Sadly, As much as I am fond of Elephants, they can step on you. The first ever Australian SAS (Special Air Service) soldier to die in service was killed by an elephant in Borneo in the early 60's. True!

[richardsonj]

A frantic ER nurse shows up in the blood bank and demands 4 units of FFP RIGHT NOW! Well, it you can infuse it rock-solid frozen...

A surgeon calls from the OR and states that he is not putting his patient on the table unless we can guarantee him an "endless supply of platelets" (small community hospital about 1 hour from nearest blood center...you do the math!)

[slc7067]

I have another "I saw it on TV" story. Our NICU nurses had just recently started drawing blood from babies themselves, and we were still having lots of issues with improper tubes and insufficient volumes. I called one nurse to explain that we didn't have enough blood to perform the ordered testing on her patient. She was very irritated and informed me that she knew there was plenty of blood because she watches CSI. In fact, we should be able to "perform all the testing and more on nothing but the bandage from the baby's foot!" I explained that if she wanted to set it up with the state forensics lab, that was fine, and she would likely get her results in a couple of months!

[Brenda K Hutson]

I have another "I saw it on TV" story. Our NICU nurses had just recently started drawing blood from babies themselves, and we were still having lots of issues with improper tubes and insufficient volumes. I called one nurse to explain that we didn't have enough blood to perform the ordered testing on her patient. She was very irritated and informed me that she knew there was plenty of blood because she watches CSI. In fact, we should be able to "perform all the testing and more on nothing but the bandage from the baby's foot!" I explained that if she wanted to set it up with the state forensics lab, that was fine, and she would likely get her results in a couple of months!

I LOVE IT!!

Brenda

[jcornell]

A couple more myh perpetuating scenes from St. Elsewhere, (if any of you are old enough to remember it).

First, the Chief of Staff of a 500 bed hospital is showing a foreign counterpart a modern hospital lab including a state of the art hematology analyzer - a Coulter Z.

Second, ER doc screams for four units O neg thpe and crossed on a patient just wheeled. Nurse rushes out and returns 1 minute later with the four units.

[Brenda K Hutson]

You know, since we are all going to work everyday, this could go on forever! I just heard another one from the "sister" Hospital we recently purchased.

The Physician only ordered an Antibody Screen on a patient, so the Tech. called and said they needed to order an ABO/Rh also; that we wouldn't normally just do an Antibody Screen. The Nurse said, "NO, the doctor wants to look for antibodies because the patient has allergies!"

Brenda Hutson, MT(ASCP)SBB, CLS

[congeniality61]

I once had an oncologist visit the blood bank to argue with me over whether or not washing a unit of PRBC's would remove all the antigens from the cells...making it OK to transfuse his patient who had multiple antibodies and speeding up location of compatible units. ( SAY WHAT???)

[Barb Thompson]

I loved "St Elsewhere"....except for the scene that showed a doctor going to the lab....and no techs were there. Then he went to the blood bank, again, no one there. He opened the blood bank refrigerator and pulled out a bottle of champagne (or vodka? or some other bottle of liquor...) (I think it was New Year's Eve) and implied that the lab was drinking on the job.....I was offended.

[mcgouc]

We had a 4 year old who had been transfused multiple times. The last crossmatch and transfusion was 3 months ago. This day, she was in OR with no type and screen, started bleeding, and they needed blood STAT. When I called to let OR know there would be a delay because the patient now had an antibody, the doctor told me we couldn't have a problem because we didn't have a problem the last time we transfused her.

A second shift tech had a nurse call and ask if she could bring someone with her to bless the blood because the patient wanted it blessed before she got the unit. Since we didn't have a policy for blood blessing, he winged it and had the nurse and man she brought stand in front of some plants we had in a back corner to bless the blood - which was just mumbling a few words over it.

[janet]

Rhogain injection (should have been RhoGam)

HBD diagnosis (Has Been Drinking)

[L106]

A second shift tech had a nurse call and ask if she could bring someone with her to bless the blood because the patient wanted it blessed before she got the unit. Since we didn't have a policy for blood blessing, he winged it and had the nurse and man she brought stand in front of some plants we had in a back corner to bless the blood - which was just mumbling a few words over it.

I had to chuckle out loud!

(I usually do my praying during the crossmatching, not when it's ready to go to the floor!)

[jeanne.wall]

I had a surgeon ask for FFP stat and I explained it would take 30 min to get it ready. He said that was too long and he was sending someone up right now to pick it up, it better be ready.

When the pick up person arrived she said he wanted it regardless of how thawed it was so I sent it out about 1/4 of the way thawed, not even close to being slushy, big huge ice chunk still in the bag.

It came back up in about 10 minutes with the instructions from the surgeon to "thaw it all the way". I think he may have said please!

I had a nurse call to see "how much longer" for the FFP. When | said it was still thawing, she became upset and told me the doctor wanted FROZEN plasma - not thawed. I'm not sure what she thought she was going to do with the frozen plasma, maybe apply a compress!

[John C. Staley]

You know the best part about this stuff is it has to be true. Nobody could just make this stuff up!!!! It's also amazing how universal a lot of this really is.

We had a cardiologist named Cain and an intensivist named Able. Their battles were legendary!

[Mary**]

We have two cardiologists who are partners and their names are French and Fry! I think this was memntioned on the Letterman show too.

I am beginning to go to this tread for my daily laugh!

[KKidd]

That reminds me of the two anatomy professors at a local college - Drs. Graves and Grimm!

[clmergen]

Dentists at an Air Force base I was at, Dr Hurt and Dr Payne.

[BankerGirl]

We have a Dr. Payne, as well. He is a Urologist. I think these doctors should be required to change their names!

[Barb Thompson]

I had an RN call and demand that we re-calibrate the machine that does the cord blood DAT's. She said we were calling too many positives, and the results were wrong. I guess she could tell just by looking at the babies whether or not their DAT would be positive. I asked if the mother's and baby's blood types were different, and she replied "of course!". At that time, we were still doing DAT's manually by tube. I held off suggesting that in the future, the mothers should be more choosy about picking the fathers of their children.

[Brenda K Hutson]

I had an RN call and demand that we re-calibrate the machine that does the cord blood DAT's. She said we were calling too many positives, and the results were wrong. I guess she could tell just by looking at the babies whether or not their DAT would be positive. I asked if the mother's and baby's blood types were different, and she replied "of course!". At that time, we were still doing DAT's manually by tube. I held off suggesting that in the future, the mothers should be more choosy about picking the fathers of their children.

I am thinking she must have been referring to babies being jaundiced. Still, it is certainly not a one-to-one correlation of jaundice to positive DAT.

Brenda