Telephone Admission Orders

Specialties Emergency

Published

Specializes in CEN, CPEN, RN-BC.

Hello all,

I recently (about a month ago) started a new job as an ED RN at a level II trauma center. One thing that is different from the EDs I've worked at before is taking telephone admission orders from the admitting physician. I'm so used to the ED doctor getting and writing down orders when he calls up the admitting physician. At this job the ED physician calls the admitting and goes over the pt and then will either grab the nearest RN to get orders, and sometimes the admitting doc just hangs up and won't answer the phone when we call back. Apparently, it's not uncommon to send a pt to the floor without orders at this hospital. Per protocol, the only time we absolutely need to have orders is when sending a pt to CCU/ICU/Step down. Does anyone else deal with this? Have I been spoiled by my previous work experience? Thanks all!

Specializes in Medical Surgical Orthopedic.

We get patients with no orders on our floor all the time.

We always have orders when we receive a patient to the floor from the ED. The admitting physician does however give orders over the phone to the ED RN, unless he has hospital computer access at home and can enter them directly into the system.

How can a patient go up to the floor without orders? That's crazy! They are in the hospital for a reason and need some sort of medication/tests/labs/etc. That would not fly at my hospital.

Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

its the same in my ed .i don't like it

Specializes in Medical Surgical Orthopedic.
We always have orders when we receive a patient to the floor from the ED. The admitting physician does however give orders over the phone to the ED RN, unless he has hospital computer access at home and can enter them directly into the system.

How can a patient go up to the floor without orders? That's crazy! They are in the hospital for a reason and need some sort of medication/tests/labs/etc. That would not fly at my hospital.

Well, eventually they have orders....we just have to call and wait for a call back to get them. And I do a full assessment/history on any patient I receive before calling for orders....because there have been times when I've called and the physician doesn't even know why the patient is there.

Specializes in Psych (25 years), Medical (15 years).

You do have a valid concern here, LegzRN.

It is a frustrating circumstance when the continuity of care is interupted. A seemingly simple solution is apparent to everyone except those who have the power to remedy it.

We sometimes just have to do the best we can with what we have. "With these oxen we must plow", so to speak.

Orange Tree deals with the situation through assurring knowledge of the patient's status through a full history/assessment. Good nursing practise. Then, I'm sure Orange Tree acts accordingly.

One approach in attempting to remedy a situation such as this is to inform Administrative Officials of your concern. Preferably through an objective documented process. Only then can the concern be adequately addressed.

After you've provided good nursing care with appropriate reporting, you've done all you can.

Good luck to you, LegzRN.

Dave

Specializes in Trauma/ED.

We have a very short form for "ED holding orders" that our ED docs fill out so our patients have some kind of orders. Usually has a box checked to "Notify admitting physician of patients arrival"...Works very well for us and the patients never go to a floor without some kind of orders.

Our registration can't change the patients status without our secretary marking a box in the computer that says we have admission orders.

I would have an issue with taking orders over the phone in our hospital because many of our hospitalists have strong accents or are rude and I hate dealing with them :-)

Specializes in ER.

Where I work, we take telephone admission orders all the time, especially at night. The orders might just be bridge (simple) orders. for example: the order will have what floor to admit to, for what Dx. and vitals per floor protocol, NS @ 100/hr, and some prn meds. Then in the morning the doc will come see the pt on the floor and update orders as necessary. Though the orders might be minimal, we never send pts. up without them.

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