[IamRN]

Hi all,

I have had two days of orientation at my new job (SICU); I am not new to ICU, just this unit. There are a couple of issues that I am uneasy about and plan to speak to my manager about, but wanted to get some input here.

What are your transfer order routines? I am uneasy because we transfered a pt (to the floor) and although the physician didn't write to continue meds (he didn't write to dc either) my preceptor (who has less experience than I do, but has worked for three years at the said unit) insisted that it was OK to fill out pharmacy's list (pharmacy sends up a list of the meds the pt had been on in the unit and that should be signed by physician) and cosign it. Looking back I should have had her sign it until I read the policy OK'ing this.

Another thing that bother me follows...we were dc'ing a pt to home, yes from the unit. And the physician wrote him a script for darvocet prn. Well the pt needed something for pain and the things we had available were a bit strong for his situation; considering he was to go home. Again my preceptor said we were going to give him darvocet as he had a script for it; there were not orders on the physician order sheet. This must be routine, because pharmacy didn't have an issue putting it on the emar. However, just because it is routine does not mean there is a policy written on it; thinking of the nurses who gave Diprivan because everyone else did too. I kept asking if there was some such written policy, but never got a straight answer aside from this is the way we do it.

Again, I suspect my feelings are on target and I can't help beating myself over not following them! I will feel better once I speak to my manager. Thanks for your input!

[CCU NRS]

Call the doctor! Any time for anything that there need to be a doctors order for call the doctor. Probably both things you did were ok if it is unit protocol and in the bigger sense your preceptor is ultimately responsible while you are orientation but you should learn to do things the right way. I always call a doctor if I need an order I don't care if it is a simple tylenol for temp which I know he will order and when I call I just explain that right away. in your situation I would have called d/c'd pts doc and said I know you wrote the script but I need a one time order to give the guy something to hold him ovwer until he gets a chance to get it filled. On the other one I would just called and sorry to bother but you neglected to write continue same meds which I assume you want but I thought I would be sure. If a doctor gets angry that is his/her problem they became docs and they can deal with it!

[nowplayingEDRN]

Where I used to work, when the doc was transfering a pt to the floor, he had to re-write his orders, including the medications. there were no exceptions! No orders and that pt sat and occupied a critical care bed till the doc wrote them. We also did a lot of discharging to home from the unit (we had a very small critical care unit-2 beds!!) but we never dispensed anything to that pt that there was no order written for. not even when we were discharging from Same Day Surgery, if there was no order and the py had pain, the pt was instructed to use his medication that he picked up from the pharmacy (I know that it is a bit different in a MTF because they have pharmacy services for the pt's) but in a civilian hospital setting, the doctor needs to write orders and the pt should be held for at least an additional 15 minutes to make sure that there are no adverse reactions before being released to home. The bottom line is, no order, no give.....Always get that order.

[mags-rn]

The hospital I work at written physician order, or a verbal order to dc or continue meds is a must for discharge, a duration of script is also a must with indicated refills. If an RN or pharmacy has a question, physician needs to be contacted, and date and time of such communication documented. Nursing/hospital policies are only a backup tool in case of nonavailability of the physician or his designee praveen.

[suetje]

You are right to trust your gut feelings. In our unit, if this had happened, since the pt. was still in SICU, I would have used one of the pain meds from the ICU med sheet, such as a little opf morphine IV or whatever had nbeen ordered, especially so they'd be more comfortable going home. First, it was an order, and even though the pt. received a new med order, it hasn't been filled (usually.)

If the doc hadn't sign the new orders, I wouldn't administer any until I got confirmation of the order verbally (a no-no per JCAHO!)
Somethimes the Preceptor does not know either...even though they should. I have found poor practices by preceptors in the past. Never feel bad checking with a CNS or a Manager if you don't feel the answer you got was OK.