ACLS requires a doctor's order?

  1. 0 My facility is telling us that we must have a physician's order to start pushing ACLS drugs. They are telling us that it is a violation of the Nurse Practice Act to start ACLS without an order and that we are operating outside of our scope of practice because we are administering meds without an MD order. We have, in the past, just paged the MDs and started ACLS with high quality CPR, pushing whatever meds the patient's condition called for, following the algorithm. I work in a large teaching facility so there is always an MD somewhere close by so this problem isn't really that important specifically to me but what do smaller hospitals do when there isn't a doctor handy? Has anyone else ever heard of this? What do we need certification for if we can't do it without an order? Wouldn't any RN be able to administer these drugs with a physician present?
    Last edit by BUNightingale on Jan 13, '12
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    About BUNightingale

    BUNightingale has '8' year(s) of experience and specializes in 'Cardiac/Medicine ICU, Rapid Response'. From 'Texas'; Joined Feb '07; Posts: 6; Likes: 20.

    37 Comments so far...

  3. Visit  Rose_Queen profile page
    2
    "I'm sorry for your loss, sir. The doctor didn't call back in time for us to give your wife the life-saving drugs she needed."

    Yeah, that'll fly real well with family members.

    My understanding from the ACLS class, provided by my hospital's educators, is that anyone who has the certification can push the drugs whether a physician is present or not. However, ACLS is also incorporated into our policies and procedures. Not sure if it is also included as standing orders.
    JF808Rn and fiveofpeep like this.
  4. Visit  BUNightingale profile page
    0
    That is what assumption I have always worked under and now they are trying to tell us they will report us to the board if we do this. The people above my pay grade tell us that they have contacted "large" hospitals all over the country and they have always required an order to start ACLS.
  5. Visit  NicuGal profile page
    1
    If you have standing orders, you should be okay. It may depend on the state, I'm not sure. We always have docs there to tell us push this push that. Of course, that being said, I am taught how to intubate and put in umbilical lines in my NRP classes,but my state practice act says I can't do that on my own even though I know how.
    fiveofpeep likes this.
  6. Visit  Sun0408 profile page
    0
    Wow, that is dangerous. What's the point? We are expected to begin CPR/ACLS if the pt is a full code.
  7. Visit  Multicollinearity profile page
    2
    The facility or unit should have standing orders related to ACLS, signed by the medical director or medical officer in charge.
    elkpark and fiveofpeep like this.
  8. Visit  Multicollinearity profile page
    0
    For example EMS departments have a contracted MD who signs their standing orders, under which they give ACLS drugs according to protocol.
  9. Visit  CCRNDiva profile page
    1
    We start the code and then the resident signs the code blue record (there's your order) at the conclusion of the order. Residents respond to all of the codes and if we get there prior to their arrival, we start following ACLS protocols as long as the patient is a full code. We've never had any issues with this that I know of.
    MaMaMia1016 likes this.
  10. Visit  umcRN profile page
    0
    I work in peds so typically our codes start with bradycardia (although its a cardiac icu so all things go) but we have a PRN Epi order and EPI at the bedside for all patients which covers us until the doc shows up, which on out unit is almost always within a minute or less.
  11. Visit  traumaRUs profile page
    9
    ACLS is a certification not a license. It doesn't provide you with the ability to work outside the scope of practice.

    That said, if you have standing orders then it would be allowed.

    However, just because you have the ACLS certification, doesn't allow you to start prescribing meds without an order.
    weemsp, chansen, HazelLPN, and 6 others like this.
  12. Visit  akulahawkRN profile page
    2
    Quote from traumaRUs
    ACLS is a certification not a license. It doesn't provide you with the ability to work outside the scope of practice.

    That said, if you have standing orders then it would be allowed.

    However, just because you have the ACLS certification, doesn't allow you to start prescribing meds without an order.
    This is absolutely correct, ACLS is a certification and not a license to practice medicine. that being said, if you're in a situation where you expect to run the code, you should also expect to have either a patient specific order for ACLS or a blanket protocol covering ACLS for use on patients on your floor or in your purview. A blanket ACLS order could simply be something along the lines of: "follow ACLS algorithms, PRN." The end result would be that you could push ACLS medication or other interventions as necessary at any recommended dosage and you would still be covered under a physician's order to provide that.

    As your standing order be something along the lines of "start CPR and call the code team" if you or your floor is not typically in ACLS floor.
    MommaLynne and Multicollinearity like this.
  13. Visit  PMFB-RN profile page
    1
    Well your hospital is either lying to you or was very selective about the "large hospitals" they contacted. I have worked in several large hospitals in four states and every one had a policy and/or standing orders that not only allowed ACLS certified RN to push code drugs but REQUIRED them to do so when called for. Failing to do so leavs you open for "failure to rescue" charges.
    Your hospital administration sounds nasty and out to get you. Is this a Magnet hospital? Sounds like it.
    fiveofpeep likes this.
  14. Visit  puravidaLV profile page
    0
    I'd probably ask for the written protocol before taking someones word about this.

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