[morte]

nope, no order=no meds.....however in the big picture....this shouldnt have happened in the first place..the nurse who did the readmit should have questioned the doc and gotten those orders reinstated..all nursing home residents (excepting chronic diarhea patients, of whatever cause) should have a bowel regimen ordered.

[momnursewriter]

I agree, the admission nurse should have noticed this woman had several bowel meds ordered before going out the the hospital. Or any of the nurses in the last 5 days could have noticed she had no bowel medications ordered (especially the day shift nurses who were used to giving this woman scheduled bowel meds and she came back without them).
And just because something is what other nurses at the facility are used to doing, doesn't make it right. I guess that's my view on this. And if the other nurses want to put their butts on the line, that's one thing. But to say I was wrong for NOT doing something that is outside of my scope of practice...that is why I'm so upset.

thank you all for your feedback

[bluegeegoo2]

I would not have given her a med, either. I always figure that the Dr. has looked over her orders and decided not to continue tx for a reason, until I find out otherwise. Now, I have admin tx's without orders for skin issues, such as a skin tear, but my luck I'd give a med and something horrendous would happen. I know my karma's boundaries, and choose not to push them.

[Lexxie]

On 3-4 occasions, while waiting for new Coumadin orders, the RN has told me to go ahead and administer the current dose, since the PT/INR was virtually the same. I refused each time and luckily so as the Coumadin doses changed! My facility surely wouldn't have backed me up. They would have written me up for a med error in a heartbeat. Trust your instincts. You have to protect your license.

[Suesquatch]

Every NH I've even work in had standing order for bowel meds that could be given per protocol or nursing judgment.

What's up with none where you are?

I've never had to face giving a med without an order because those I feel qualified to use judgment to administer are generally covered by standing orders. I guess I don't understand a facility placing nurses in such a position over suppositories or colace.

[Kashia]

Yes I would consider it a nursing judgment that is dependent upon the relationship you have with the patients doctor and the situation.
But usually the charge nurse would be the one to make the call.

[Lil'mama]

In my LTC facility most of the doctor groups have a long list of standing orders so that we don't have to call them unless it's a HUGE emergency. You DO have to use your nursing judgement just be aware that there can be consequences at times.

[momnursewriter]

No we don't have standing orders like that. We have to call the MD even for a tylenol order. We do have one MD who handles most of the patients who is known by the nurses as one who you can give reasonable meds to, and the doc will cover you. (though I still don't do that as I feel comfortable). But this lady's doctor was one who will deny an order in a heartbeat unless it came from her mouth herself--even if it's given by one of her on-call doctors.
And this lady did not want colace-she wanted an enema, and had recently been in the hospital for heart problems, so if I had given it without an order and she had a vagal response and suffered injury or death, that doctor would NOT have backed me up.
And we are not put in a position where we can't reach a doctor to get a med order. If the regular doc isn't on call we page the on-call thru the hospital and he will give us an order. The issue here was it took about a half hour to get the order and in the meantime the lady fell and it was blamed on her discomfort from not having a BM. I don't think a half hour is a long time to wait to get a non-emergent med order.
thank you all for your responses.

[Lil'mama]

Oh in that case, I wouldn't have given anything since the MD is one of those evil ones that won't cover you. I love the MDs that trust my nursing judgement and will back me up.

[kat7ap]

I was taught my some seasoned nurses at my first NH job that "the Doctor is making the big bucks" to be called for orders and questions. You shouldn't have to feel bad for calling a physician if it's regarding the well being of a pt. You absolutely did the right thing, don't let anyone bully you into doing otherwise