DID I MUMBLE? What part of my post-op orders don't you understand?

I'm blessed with very thorough PACU nurses, but not even the most conscientious nurse can overcome my confusing post-op orders. Here are 4 examples that clearly illustrate my point.

• Can I put weight on this leg? After speaking to families and delineating post-op care, invariably I'll be in a case and receive a call to my OR from the PACU inquiring whether Mrs. Jones is "toe touch" or "non-weight bearing." Yikes! Whether someone is non-weight bearing or toe touching has no clinical relevance. The same stress is realized on the joint. It may appear important, but it is not. My bad for not making this clear. I have amended my orders now to say: "Under no circumstance can you put any weight on that leg for fear of incarceration!"
• When can I remove the dressing? There's no real hard science regarding dressing duration and its effects on infection rate. Yet, I receive scores of phone calls from nurses and patients alike about when they can remove bandages. There's no magical formula for this. Thankfully, since I perform most of my surgeries with the arthroscope, Band-Aids usually suffice. Some patients feel that if they don't change the dressing soon after surgery, flesh-eating bacteria will attack. Others take the dressings off and replace them with everything from masking tape to peat moss. Better safe than sorry: Leave the dressing on until I see you!
• When can I toss this sling? I'm a shoulder surgeon, so my patients leave the OR in a sling. The duration of wear depends on the procedure. Here is where the confusion arises. Massive cuff repairs are to leave the sling on for at least 6 weeks. A release of adhesions for a stiff shoulder should dispense with the sling ASAP. When we give the wrong instruction sheet or inadvertently administer another doctor's protocol, my gastric juice secretion escalates. Several weeks ago a patient with a massive rotator cuff tear was told to "move his arm right away." Three Hail Marys and 2 Xanax after I discovered this, I told the patient to chill and stay in the sling.

• Who changed my pain-med regimen? I try to keep it simple when it comes to post-op meds. When well-meaning residents change my post-op pain med regimen, chaos ensues. One well-intentioned resident felt that my patients were getting too much acetaminophen post-op, so she subtly altered my standard post-op pain fare only to generate at least 20 phone calls from the PACU. The dosages she prescribed had enough narcotic to halt a charging rhino. The resident also left out one detail: She prescribed the same dosages for all cases. The 90-pound, 14-year-old, hangnail excision was getting the same oxycontin dose as the 275-pound football player who had a hip scope. No wonder so many of my patients were sleepy! Thank God our dutiful nurses eventually picked this up.

In no uncertain terms
Thank God my crackerjack staff picks up most transgressions. Like a good marriage, working with the healthcare team is all about communication. I know my issues and, like everyone else, I am a true work in progress. When I get stressed out, how do I spell relief? Clear and concise communication.