[TriageRN_34]

I was talking to the other nurses I was working with last night about this...they all had the same responce...NO WAY! Hard enough to remind them they have to fill out the paper with circles!

Me, I found this was happenening, and I started paperclipping the sheet to the front of the chart with a sticky saying "Fill me out completely please" when I know about a possible discharge situation. That has worked well so far! We also have signs taped to the charge desk reminding Physicians to fill those out.

Nope, I will NOT justify why or why not a doc has made their choices...that is their responsibility...and I also feel that pharmacy should be more involved than us nurses and a secondary check!

[jenny031]

We've been doing it for a few months too, but I work in the ER so we just start the sheet. Well, actually we give it to the patient or family and have them write all their meds and doses down and then it goes with the chart to the floor on admission. I had no idea what they were doing with it once it got to the floor. That is crazy. I'm going to find out if it is the docs or nurses and I'll get back to you.

[jmgrn65]

We have had to do this for a couple of months, we have to write down what meds the patient is on ( this should be started in ER) and call or have the physcian choose if he wants to re order, box yes or no is checked, or already ordered. We don't have to provide rationale. I don't think that is our responsiblity to know why the doc does or does not order something.

[lsyorke]

Originally Posted by Zee_RN

On a side note, we are no longer allowed to use the words ANXIETY or AGITATION on any medication order. Period. If a person takes ativan at home and it is reordered prn, the reason is "...as per home medication." If they are attempting to rip out their endotracheal tube q15mins and you have an order for ativan, it must specifically state that in your order..."Ativan 2 mg IV prn for threats to endotracheal tube stability." *sigh*

So now you have to have a crystal ball to PREDICT a specific behavior that would need intervention....that's crazy!!!

[grammyr]

I guess you could just put "I dunno!!!!" That is a sort of rationale and very much the truth some times.

[TriageRN_34]

I wish the ER would do these, but in our facility this isn't done unless the patient goes to a floor and we have to do it ALL! I get a small list from ER if able (the old blue pill white pill you get in ER all the time), and I have to take time to call family or facilities if available and get it all straightned out...along with a skin care sheet, friction and sheer risk sheet, fall risk assessment sheet, admin hx and assessment, nursing note assessment (on top of all the other assessments I do for that one pt...oh no, need it rewritten for a different section of a dang chart ya know!), a questionaire about potential abuse and finance questions (if they feel they can't pay then that triggers certain services), a full sheet on pt teaching, another on potential service/teaching needs for the kardex, bands hand written with allergies, and lets see...oh the MD order sheets and another for potassium protocol, PCA, or CIWA scales and what not! Okay an average of 2 hours if not more just in paperwork alone, no wonder people get ticked when they can't get pain meds right away when they hit the floor! I have to get part of this done before pharm will allow any meds for anyone!!!!!!!

Frankly...I don't need the MD responsibilites on top of what I am already doing..and I certainly don't need a single other task or piece of paper! I am not a clerk, I am a bedside nurse thank you!

[PANurseRN1]

Another example of JCAHO running amok.

[sscathlab]

At our hospital, it is the nurse's responsibility to make sure the home medication list is as complete and accurate as possible. We then give it to the doctor to mark which ones they want to continue while in the hospital. If the doctor is not immediately available, we clarify them over the phone. but IT IS NOT OUR RESPONSIBILITY TO KNOW WHICH ONES THEY WANT TO CONTINUE. We print a med rec sheet after they are admitted and when they are discharged so the doctors can review them
Rachael

[RYNOBLASTER30]

You know, working in the ICU, these medications change so rapidly. I'm busy getting my patient settled and stabilized. I don't have time to find out why/why not the MD didn't continue certain meds. Let all of us nurses "Get Real!" We can't take responsiility for all of the physicians, they need to be responsible for themselves.

[deehaverrn]

The problem is we have all these administrator types and others for whom the RN is merely a footnote because they have so many other initials behind their names, and they are simply continuing to heap every change onto the bedside nurses already quite full back. And like the proverbial camel, we just plod on, never minding how our overburdened back is become swayed by the weight..heck, its good that we're camels so we don't have to stop and have a drink during our shift!
They give us more and more...computerized charting, (only takes a little longer but you have to wait in line sometimes for a computer terminal), forms (which only take 10 minutes more..but they don't consider that with 12 pts thats two hours), bar coded meds (trouble shooting the things that won't scan takes time, and even if it only takes a few minutes for each patient again ..it adds up). Finally med rec, sheets, on my floor (OB) the meds that they were going home on were never a problem. But these forms take soo much of our time and trouble. And does anyone else notice that even though all these things take more time...staffing is not adjusted to meet this added responsiblity. OH and to the person who asked why it is nursings responsiblity...I think its because our leaders, once they become administation, completely forget where they come from, and thats if they ever were bedside nurses-some just went right into management. Nursing really needs leaders who will stand up for us!