MDs who don't sign/date/time orders

[atlkidrn]

My institution was visited by JCAHO the week of September 11, 2001 (yes, they went through with the survey despite the terrorist attacks!). We scored well, but spent months worrying, fretting, and preparing beforehand. To keep up to date for future visits, I read a newsletter called "Inside the Joint Commission." One of the topics in the December issue was concerned with how to get MDs to sign their verbal orders. This was also a huge focus of our preparation for the recent JCAHO visit.

The article - and our administration - suggests that nurses should be the ones to ensure that physicians sign, date and time their orders. Doesn't this perpetuate the idea of nurses in a "handmaiden" type role to the doctors, while excusing inappropriate behavior on the part of the MD's? We must remind, beg, plead, and cajole someone into doing their job? If I forget to sign a nursing assessment, is it reviewed by another person and flagged for my attention? No. The newsletter article makes suggestions for getting doctors to sign their orders, including the usual flagging of incomplete orders, but another suggestion is that institutions host lunches at which the charts are available to be signed while doctors eat a free meal. Doesn't this reinforce or reward negative behavior? My institution initially suggested that the secretaries or the nurses fill in the date and time if they witnessed the MD writing the order. We refused, believing that to be falsification of records since we didn't write the order, and also because it doesn't deal with the problem - the physicians!

I'm sure others have dealt with this problem. What are your thoughts?

[Nanette]

HI

You are all over this one!

NO, we should not reward poor compliance, YES everyone should be accountable for thier performance.

But, unless you have a strong admistrative team and physician leadership, you will not get the docs to comply on thier own.

Unforunately, a group that was founded by physicians [surgeons] has no clout or impact on the independent practioner!

Do your physicians care if the facility gets a good score?

The issue is how do you make them care?

We are blessed to have about 1/2 hospital employed docs, so that helps emensly, our phsysician leadership is supportive.

We still have to hound the docs, but we are able to tell a doctor if the order is not complete, we will not follow it, we will page you and get another order, write it as a valid order and you will have to sign in next time you come in.

You can't believe how many calls we make for incorrect outpatient orders! [or maybe you can!]

Yes, it is burdensome for the staff, but the doctors are getting the idea to do it right the first time.

We tell the patients the reason for thier delay is the doctor did not write the order completely and we can't honor it.

The patients put pressure on the docs too!

bottom line is we should not have to chase them around, but who gets the punishment for thier poor performance? we do, so we do what we have to in order to get it correct.

nan

[fergus51]

Start calling them at three am to ask what time they wrote the order and if it was them and I think they'll start doing it....

[deespoohbear]

At our facility we have a stamp that we are suppose to use when we take a TO or VO. It has a line for the physician to sign his name, and a line that says date and time. EXCUSE ME! These people have at a minimum of 12 years of post high school education. They are making life and death decisions and they can't remember where and when to sign their freakin' names? I absolutely refuse to use the stamp. No one is stamping my stuff for me to remind me where to sign my name! When we stop catering to the docs maybe they will grow up and finish their paperwork. Our doctors get whatever the heck they want at our facility. The nurses don't stand a chance!

[olympiad27]

I couldn't agree more! It is time we as nurses put our foot down. We have enough problems with the shortage without being made to feel responsible for physicians shortcomings. If we continue to try and cover for them, run after them to sign orders or prompt them then we are continuing to put ourselves in a position of " serving the doctors". THey need to be responsible for their own actions or inactions. It is no different than what we teach our children. You suffer consequences for your actions. If your orders are illegible then you'll get repeat phone calls for clarification and the order will be delayed. And if orders can't get carried out because they are incomplete or illegible then that reason should be documented.

Just so you don't think I am a doctor hater, I'm not. I'm happily married to one. I just think nurses need to stop feeling responsible for every problem.