1. Urban, Sally MSN, RN
  2. Morrison, Tiffany BSN, RN

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Drop this archaic practice

I just read the "The Curse of Cursive" (Letters, November 2014)* in which a nurse writes, "I've never understood why physicians write so poorly and leave it up to a nurse to decipher it." First, trying to decipher prescriptions isn't our job! It's not within our scope of practice to write prescriptions, so to me, this is unprofessional conduct. Instead, a review of the prescription, if handwritten, should be conducted before the prescriber leaves.

Figure. A 2 mg dose ... - Click to enlarge in new windowFigure. A 2 mg dose of Amaryl was misread as 12 mg.

Patient safety is within our scope of practice and it's our ethical obligation to advocate for our patients. Prescriptions that are unclear need to be addressed directly with the prescriber. As we transition to electronic medical records, particularly, electronic order entry, these serious patient safety issues will hopefully be resolved. Until then, we should refuse to participate in the archaic practice of deciphering prescriptions.


Each patient is a priority

A sentence from the article, "Crying Wolf or the Real Deal?" (November 2014)* really struck a chord with me: "Above all, you should always listen to your patients." I've worked for nearly 5 years in a busy ED where we see our fair share of repeat patients who visit the ED on a weekly basis for an array of vague, minor complaints. Several months ago, a patient with a long psychiatric history came in by emergency medical services (EMS) to our facility like she had many times before. However, this time she was screaming that she was going to die and begging for someone to help her. The physician prescribed her usual dose of ziprasidone and lorazepam, assuming she was having another schizophrenic episode. But the nurse who was assigned to her care felt this was inappropriate as her vital signs were unstable and she seemed genuinely fearful for her life. Within a few minutes of her arrival, the patient deteriorated and went into cardiac arrest, and resuscitation attempts were unsuccessful. It was later discovered that she had an undiagnosed heart defect that had triggered a fatal dysrhythmia.


The EMS crew, the attending physician, and many of the nurses were quick to dismiss this patient as having an acute psychiatric episode and didn't perform a full assessment of her medical complaints. Patients who frequent the ED for nonemergencies may frustrate nurses and other medical staff who want to focus on true emergencies. However, this is problematic because assuming that every complaint is insignificant has negative consequences when a critical event transpires. In the case of this patient, as well as the one from the article, tragic outcomes may be prevented if we, as nurses, are more perceptive of our patients' conditions and always make addressing their complaints our priority.




Eureka, Calif.




Fort Worth, Tex.


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