Thursday, February 24, 2011

One step forward, two steps back

So I was on a case a while back. Patient was elderly (I mean like super elderly) and had a ton of problems which after a weeks stay in the hospital were getting better. She was coming off her broad spec antibiotics, she was eating, her pain was gone, the only thing we couldn't get her to do yet was get out of bed, which apparently won't stop you from getting the boot from a hospital anyway. Everything was good, until I came in the morning we were going to d/c her and she had spiked a white count. No fever, no tachycardia, just a 5 point jump in her WBC's overnight.

I about shit a brick. I had literally the night before written a note stating "watch out for C. diff colitis due to broad spec antibiotics and frequent watery stools," and C. diff is one infection that can hit without prompting a fever. On the contrary, Mrs. Super old also wasn't doing much and we had fluid overloaded her once during her stay, so she was having some atelectasis and effusions (google it if need be) so my attending was afraid of pneumonia (the elderly apparently don't need either a fever or white count to have an infection, thus I'm staying away from geriatrics). Chest x-ray was ordered and another round of different antibiotics was started.

Later that same afternoon, we visit the Gerry's chart to see what her x-ray showed, and my attending finds a progress note from the primary on her case that states BOLUS OF STEROIDS WAS GIVEN YESTERDAY. For those in the crowd that don't know this one I'll save you the trip to your search engine: steroids=white count elevation. Fuck me sideways Martha, I really wish I had this piece of information when I looked at the chart 15 hours after the bolus was given.

This showed two aspects of medicine that need to be addressed. One is doctors' handwriting. The whole reason this progress note wasn't on the charts is because the attending likes to dictate or type them and put them in later, making sure they're legible. But they're daily progress notes, which should be in the chart THAT DAY. Granted, it was an oversight on my team's part as we didn't flip through the couple sheets of orders to find it, but still. Can we not have something that lets us be legible AND have notes on the chart the day they're written? Trying to be legible shouldn't cost a patient mistakes in treatment and a delay in getting the hell out of a hospital bed.

1 comment:

tracy said...

So....what they say about Physican's writing IS true.....