We have this med order

  1. It has been on the MAR to be given BID routinely for 2 months now. The recipient's husband is not in agreement with the doctor's order and demanded that it be given in the morning only. The nurses have tried to get the doc to change the order but unsuccessfully. The only thing to indicate to us that we are to accommodate the husband's wishes is a little "sticky" on the MAR. A little piece of paper can fall off at any given time. We have to constantly circle our initials and chart on the back of the MAR the husband's request. This can get tiring and we have a lot of meds to give. Believe it or not this is not the only med that's supposed to be given routinely and ends up being given just whenever the family wants.(??????):stone
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  2. 19 Comments

  3. by   UM Review RN
    Sounds like this is a good issue to come up for discussion at the patient's Care Plan Meeting.
  4. by   Blackcat99
    If the patient is alert and oriented she should decide if she wants to take the med or not. If this is a confused and disoriented elderly lady in LTC and the husband has power of attorney then don't give it. At the LTC where I use to work the doctors would usually discontinue meds the family requested to have discontinued. I'm curious. Which medication is it?
  5. by   GLORIAmunchkin72
    We have all kinds of little "stickeys" on our MAR, and God forbid you overlook one of them....
    Quote from Angie O'Plasty, RN
    Sounds like this is a good issue to come up for discussion at the patient's Care Plan Meeting.
  6. by   alanpe
    No med order is today a big problem.
    Thanks to internet and new technologies many patients can learn about his pathology more than a doc; the doc has two responsabilites on the prescription:
    the illness people.
    the comunity.

    Many drugs are very expensive, society must administrate its resources; doc and nurses are in this way civil servants and must care not only the illness people. The comunity is important.
  7. by   GLORIAmunchkin72
    suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?
    Quote from alanpe
    No med order is today a big problem.
    Thanks to internet and new technologies many patients can learn about his pathology more than a doc; the doc has two responsabilites on the prescription:
    the illness people.
    the comunity.

    Many drugs are very expensive, society must administrate its resources; doc and nurses are in this way civil servants and must care not only the illness people. The comunity is important.
  8. by   ~Kitty~
    Quote from MUNCHKINgloria72
    A little piece of paper can fall off at any given time. We have to constantly circle our initials and chart on the back of the MAR the husband's request. This can get tiring and we have a lot of meds to give.
    Quote from MUNCHKINgloria72
    suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?
    You said you are documenting appropriately. You are right to document husband's refusal on the MAR. I don't believe "stickies" are valid documents. ;-)

    I also am curious why the doc won't change it??? What a hassle to have to document daily refusal.
  9. by   GLORIAmunchkin72
    why the doctor's sometimes refuse to change the orders. Maybe they just have so much to do that if they don't think it's a life and death situation they just let it ride. Sometimes we have veritable tag of wars between the families, the doctors and the hospice nurses. I am the little guy stuck in the middle.
    Quote from ~Kitty~
    You said you are documenting appropriately. You are right to document husband's refusal on the MAR. I don't believe "stickies" are valid documents. ;-)

    I also am curious why the doc won't change it??? What a hassle to have to document daily refusal.
  10. by   suzanne4
    A "sticky" is not a legal document in a court of law. If the order is there, and not given, it must be documented as to why it is being held on a daily basis.
    Simple as that................

    Has the husband discussed his reasons for why he only wants the drug given once a day with the physician? If not, perhaps this should be your next step..
  11. by   barefootlady
    It's time for the patients family, doctor, DON, and administrator to sit down in a meeting and iron this situation out. It is also time for the nurses(more than one) to approach the doctor. They need to make him understand that their hands are being tied by the family, then chart this in patients chart. It does need to be charted everyday that family refuses to allow med BID. We can say we are too busy, but in the end we still have to follow safe practice guideline to protect our license.
  12. by   alanpe
    Quote from MUNCHKINgloria72
    suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?
    A sticky is not a valid document to do.
    Last edit by alanpe on Mar 18, '05
  13. by   alanpe
    Quote from MUNCHKINgloria72
    suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?

    You will need the order, always the order. The sticky is not enough
  14. by   dbsn00
    The nurse manager/DON should be informed & call the doc for the reason he won't D/C the med, the social worker should call the husband & schedule a family care plan meeting ASAP. If the patient is refusing the med it's one thing. Nurses follow the MD's orders, not "sticky" orders from families, has this been explained to the son & why doesn't the son just call the MD himself & speak with the MD personally about getting the med D/C'd? Oh yes, & as above poster said, chart what husband says whenever coming to the facility.
    Last edit by dbsn00 on Mar 20, '05

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