Discussion: Effective Treatment
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When Corey logs onto his email one Monday morning, he finds a request to meet with Margaret Truman, Director of Nursing. When they meet, she wastes no time in explaining what she wants to discuss.
“You’re going to have to do something about Dr. Lacey… or rather, Dr. Lasix, as the nursing staff are currently calling him”
“What’s happened?” Corey asks, somewhat nervously.
“Well, you know how we’ve been moving toward a more evidence–based approach to diagnosis and treatment in the ED” Margaret says. One of the areas where we’ve established some solid guidelines is regarding patients presenting with shortness of breath.”
Corey nods. “Yes, I remember you presented on piloting the use of the guidelines.”
“That’s just it — Dr. Lacey is completely unwilling to use them” Margaret says. We’ve come to terms with his unwillingness to use the electronic health record — that’s a battle we just weren’t going to win — but this is getting serious. He’s gotten it into his head that Lasix is the drug of choice for anyone who comes in with dyspnea. This goes against the guidelines we’ve assembled, but he won’t listen to a mere nurse — especially when he’s ordering meds for a patient.
“The thing is — Lasix can be an effective treatment in some cases, but it isn’t recommended as the first treatment option for a patient who has been brought into the ED. There are a number of situations where Lasix can actually be harmful. If the patient has pneumonia or dehydration, they shouldn’t be given Lasix at all. The guidelines we established specifically call for delaying the use of Lasix until a definitive diagnosis of heart failure can be confirmed by chest Xray and laboratory studies.”
A thought occurs to Corey. “Why are you coming to me today with this? Did something happen over the weekend?”
“That’s exactly why I’m here,” says Margaret. “We had a patient present Saturday night with confusion and difficulty breathing. Dr. Lacey ordered Lasix and chest xrays, but the nurse assisting him suspected sepsis. The patient had come in from a nursing home and her skin was not in good shape. Sure enough, the patient had a particularly nasty pressure sore.
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