annoying little thing some of our docs are doing - page 3
That thing would be writing orders without seeing the patient. The doc looks at the CC and perhaps the triage note (although based on some orders, the latter does not seem like it always happens) and then write orders for it... Read More
- 1Mar 13, '13 by Esme12, BSN, RN Senior ModeratorQuote from kaylasmommyI agree....I have only worked in departments that allowed nurses to, at least, partially use their brains. Based on chief complaint.......These department "protocols" only initiated by the nurse who first encounters the patient....AFTER the patient is assessed by the nurse. These protocols were disease specific and assessment specific with parameters if the "patient" looks sick with a blanket ryder at the "charge nurse/triage nurses discretion". Only experienced, trained triage nurses occupied triage. We also had protocols that empowered the nurses to set off other protocols that would include "basic" meds like ASA, ibuprofen, tylenol, nebs ets......and orders for IVF if needed (no narcs).In our ER we have chief complaint driven protocols in which we can order stuff based on the CC on behalf of the doc based on pt presentation. So often things (lab work, line, X-ray, EKG) are done before the doc sees the pt. we can also give certain Meds (ie nitro and Asa to a chest painer or nebs to a sob). If a pt is on the fence (not sure if doc is going to want full work up) we let doc see pt before we do anything. Sometimes the doc beats us to the pt but other times its a huge time saver. I don't really have a problem doing these things because honestly the lab work and X-rays and EKG are data collection that gives the doc a better idea of what's going on.
Also it's a time saver because while you're getting the pt settled in and doing their vitals you are also doing things that you know are going to be ordered anyway thus saving you a second round with the pt.
The triage nurse orders x-rays etc for sprains and fractures and decided whether patients were going to the main Ed or urgent care....also protocol based and if "obvious deformity" set another group of orders with IV orders and some pain control. This was in a LARGE community department that had only 16 main rooms and 12 urgent care and served over 50,000 a year or >220 in 24 hours. This was a huge time saver for the patients, it shortened ED wait times which in turn increased satisfaction. It really streamlined the process and actually dropped our overall w/u costs/expenditures.
I would go crazy in a ED that I had to mother may I for every thing I would need to do......The docs I worked with had confidence in the nurses and they were completely on board.
- 0May 12, '13 by turnforthenurseRNWe have care sets, where we can order labs, saline lock insertion, EKG, urine, etc based on the patient's CC, but AFTER the nurse has seen them. If a patient presents with what sounds to be a UTI, the triage nurse (or us) will go ahead and order a urine and urine HCG...if a patient presents with chest pain, I will go ahead and order a continuous cardiac monitor, saline lock insertion and routine labs. The docs are totally okay with it and most of them would rather have us order too much than order nothing at all. A lot of times if a doc orders a CBC and BMP or CMP I will go ahead and draw a rainbow, that way the doc can order additional labs if necessary and they will already be done. I love this autonomy that we have in the ER, you don't really get that on the floor.
- 0May 14, '13 by TheSquireAgreed - just 'cos the doc ordered it doesn't mean you have to do it without questioning the order. If the doc ends up looking bad for whatever reason when she/he cancels orders, that's not your problem.
If it's a slower doc, I don't mind having the orders ready to go on a busy night when the doc may not even get to a new patient for over an hour - and if I think the orders are crap, I'll challenge them. Remember - attendings are like residents, you can still steer them to get the orders you want.