Quote from jwk
Just curious - does this technically fall outside your scope of practice? (it may not, I don't know, that's why I'm asking) Maybe there are some different laws for hospice. Seems like ordering scheduled narcotics, which really is what you're doing, would be problematic, if not for you, then certainly for the pharmacy. I'm surprised they'll take the order. Don't orders/prescriptions for scheduled drugs require a physician signature, particularly Morphine which is Schedule II?
New hire nurses all were sent to an orientation, in which the legality of this practice was presented. The company told us it was legal and within our scope of practice.
I worked for this company for 4 years, and this practice was not changed.
The pharmacy required a written script within so many days. We wrote out the scrips, the doc signed them, and we sent them over to the pharm. We had a supply of MS and other drugs in stock at our facility. The pharm did not deleiver meds at night.
We had 2 different medical directors during my employment. Both docs often stated that they loved the arrangment, as they were never called at night. I worked nights.
If a pt chose to retain their primary doc, and not have our doc take over their care, the standing orders did not apply,
These docs had to be called at all hours for everything except laxatives and Tylenol. Quite a few of them were verbally abusive when called at noc.
I sometimes felt uncomfortable with the standing orders- which included nursing being able to initiate MS doses of up to 20mg per hr, IV or sc (clysis method).
I felt that if a pt ever had a bad reaction to a narc, the doc would have a legal way out, and the nurses would be liable.
Our standing orders included MS, phenobarb, Ativan, metoclophan supps, decadron, thorazine, atropine, and others.
Nursing assistants are now doing med passes, foley insertions, sterile dressing changes, and other procedures formerly done by licensed nurses only.