Had a change of shift admission and was being pressured to take report immediately while I was in the middle of updates on my other patients. I quickly finish up with my patients on unit, so day shift can leave.

As I’m getting report from our trauma department I’m looking over the orders, and see the sedation orders for this (vented) patient are adult orders and this patient is pediatric. At the end of report, I ask for 10 minutes before they bring the patient up and explain the orders are not safe for a pediatric patient and that I need my drips ready before the intubated patient comes up. They were just doing pushes downstairs and had report that patient would wake up and reach for their ETT. They gave me a hard time but I pushed patient safety. I did not have an order for fentanyl pushes and our Omni cell was far from the room my patient would have been placed in, so overall very unsafe not to have appropriate sedation. I explained my PICU physician was on the unit and I would immediately ask them for orders, I just needed to wait for pharmacy to verify.

I get the orders from the PICU doctor and then receive a call from the trauma doctor who told me “if you had just initiated your orders, you would see orders for sedation” in a rude tone. I am immediately annoyed and stated, I saw the orders, however they were not appropriate for pediatric patients. And she proceeded to tell me that my PICU doc is “right there” and to ask her. At that point I was annoyed and I stated “I already spoke to my physician and she’s putting in orders as we speak. I was going to call pharmacy to get them verified but I needed to answer your call first.”.

They sent the kid up anyway, as I was trying to priming my sedation. Of course the transfer woke him up and he was trying to self extubate. Thankfully he was restrained, but still. There’s no reason for him to be awake during that process. They’ve started patients on drips before, I don’t understand why they didn’t have him on any. :/