Doctors, pay attention!

[crazylegs]

I am fed up to the back teeth of Doctors prescribing (in hospital) oral anti-emetics to patients who are actively vomiting. There's no point, the pills will just bounce and then there's another wait for the orders for IV/IM meds.

I understand the to preemptively deal with nausea/vomit then oral meds are appropriate, but not when you patient is trying to redecorate the inside of a CT scanner.

[Amina516]

We generally use dissolveable zofran tabs in my ED. No swallowing necessary. Then there always IV (of course, you're right...might have to wait to get it started) or rectal as well. I agree that pills you have to swallow are pointless when you're vomiting.

[EricKei]

They give oral meds to someone who someone who is tossing their cookies...

Yyyyyeahhhh.

You shouldn't even be allowed to get IN to med school if you can't explain why that might be a bad idea >_>

[AccountingDrone]

When I was pregnant, I was seriously hyperemetic - I once took my plate of breakfast into the bathroom , scraped it into the toilet and flushed it. Phenergan suppositories were my special friend!

[crazylegs]

We generally use dissolveable zofran tabs in my ED. No swallowing necessary. Then there always IV (of course, you're right...might have to wait to get it started) or rectal as well. I agree that pills you have to swallow are pointless when you're vomiting.

With this particular patient, IV access had already been gained - was the quickest absorption route available at the time (but seeing as I hadn't said that you wouldn't have known it!)

They give oral meds to someone who someone who is tossing their cookies...

Yyyyyeahhhh.

You shouldn't even be allowed to get IN to med school if you can't explain why that might be a bad idea >_>

I can only put it down to laziness - or a complete lack of thought as to the condition of the patient. Because of that I really hope it's laziness.

[Sleepwalker]

Urgh. I had to get an iv for frickin phenergan once. After it, I was fine with oral, but before then I couldn't take oral or rectal phenergan, because, yeah.

[Sapphire Silk]

I am fed up to the back teeth of Doctors prescribing (in hospital) oral anti-emetics to patients who are actively vomiting. There's no point, the pills will just bounce and then there's another wait for the orders for IV/IM meds.

I understand the to preemptively deal with nausea/vomit then oral meds are appropriate, but not when you patient is trying to redecorate the inside of a CT scanner.

Ugh. I just had this problem in clinic. We had an actively vomiting patient. We asked the doc to change her Zofran order from PO to IV. The doc did.

Pharmacy sent PO. So we call, reminding them the order is for IV. The pharmacy says IV Zofran is now limited to specific units; and ours isn't one of them. The new policy makes no sense. Zofran doesn't have the administration issues that Phenergan does IV. We had to push, but we finally got it IV>

We generally use dissolveable zofran tabs in my ED. No swallowing necessary. Then there always IV (of course, you're right...might have to wait to get it started) or rectal as well. I agree that pills you have to swallow are pointless when you're vomiting.

The problem with the sublingual Zofran is the patient still generates saliva that is swallowed, which increases the risk of vomiting and aspiration. SL is great for just nausea, but if they've been vomiting they should not get the med PO or SL.

[crazylegs]

The pharmacy says IV Zofran is now limited to specific units; and ours isn't one of them.

Why on earth are they limiting ondansetron? It's found on pretty much every ambulance here in the UK (for IM/IV administration). That doesn't make any sense at all.

[Amina516]

Why on earth are they limiting ondansetron? It's found on pretty much every ambulance here in the UK (for IM/IV administration). That doesn't make any sense at all.

Ditto. Are you having a shortage, SS? What's the rationale?

[ComputerNecromancer]

I can only put it down to laziness - or a complete lack of thought as to the condition of the patient. Because of that I really hope it's laziness.

I'm more inclined to consider it lack of thought. Too often the docs just parrot the standard responses.

As an example, I've got venous insufficiency in my left leg. Pretty obvious from the large, dark patch on my shin.

I've lost count of the times I've been told to keep it elevated while sitting.

Thing is, I've got a large pot belly (due in great part to a doctor ignoring symptoms of sleep apnea until after I'd gained more than 100 lbs).

Because of this, it's not *possible* to elevate my leg if I'm sitting in a normal chair. To get it elevated. my *back* has to be able to lean back at almost 45 degrees from the vertical. Otherwise, there's nowhere for the leg to *go*. My stomach gets in the way.

I've even *asked* a couple of them to *try* to elevate my leg. They get this baffled look if they do. Then repeat the instructions anyway.

If I could afford a recliner.... *sigh* And had room for it.

[Sapphire Silk]

Why on earth are they limiting ondansetron? It's found on pretty much every ambulance here in the UK (for IM/IV administration). That doesn't make any sense at all.

Ditto. Are you having a shortage, SS? What's the rationale?

No clue. No one seems to know.