What have you done without a Dr. order?

Nurses General Nursing Nursing Q/A

So what things have you done withOUT a doctor's order, for a patient?? I don't think I'm too bad, I'll send off a stool for c-diff if a patient has diarrhea, order a stat ABG for a pt in resp distress before calling the doc as well as an x-ray and will order a blood test or something if I think its necessary. I don't think I have ever given a med though, without an order (well, I have been known to give out a cepacol lozenge, but that's about it.) But I do know nurses that give out a maalox or robitussin without calling the doc. So I just wanna know, what kind of things do you feel comfortable doing without an order?

Specializes in ER.
You're naive if you don't think things like this can somehow be traced back. NOTHING is anonymous on the internet.

true, which is why one wouldn't want to post any incriminating information.

But really, I can't imagine there's any sleuth out there dead set on finding a nurse who posts that they put O2 on a respiratory distress patient without an order. Or similar lesser deeds that blur the line between physician order and nursing autonomy.

haaa!!!!

Specializes in ER.
Ultimately, when you come right down to it, you can always defend doing what's best for the patient. Working in ER's, for example; I'd much rather face a jury for giving a minor good medical care without parental consent, than face a jury for letting a minor suffer or deteriorate for lack of parental consent. I might lose my job, my license, the $67 I have in the bank, but I wouldn't lose 1 minute of sleep. Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

amen to that.

Specializes in ER.
I don't think anyone here has suggested that physician orders are "hallowed messages from the Gods," and I've never heard that suggested anywhere else, either. But they are legal requirements. Like driver's licenses -- I'm sure that you, and everyone else here, are just as competent as I am to drive a car safely -- but, if we do it without a valid driver's license, we're breaking the law and there will be legal consequences if we get caught. Not a chance I'm interested in taking.

dthfytr was being a bit tongue in cheek. Truth veiled with heavy sarcasm. I think how you respond to the OP depends on where you work also.

dthfytr was being a bit tongue in cheek. Truth veiled with heavy sarcasm.

I am well aware of that. However, being sarcastic and glib doesn't change the (legal) reality of the situation. I have seen many nurses get into trouble over the years because they didn't take scope of practice seriously, or believed that the "rules" weren't to be taken seriously or didn't apply to them.

when I was a new grad a resident gave me a verbal order for pain meds for a patient. He had the chart so I assumed he would write it. Well he didnt and I took the med out on override so it looked like I took out a narc with no orders to back it. I didnt see him after that morning to get the order and he wasnt a regular. I didnt even know his name. That was scary. On my most recent unit it was common practice to get stat cxr and abgs for pts in distress....ekgs for CP. And every time the docs would ask if I had done those things when I finally got around to calling them. They almost expected it and got kinda ***** if you called them with nothing to report to them, maybe because it was the middle of the night...IDK. I will admit that I am not perfect and I have done these things but some of you are not being honest. What about when a doc orders 25mg of phenergan but you thought the old lady only needed 12.5mg and thats what you gave. Or what about not giving certain meds at all and just not saying anything or calling the doc. I have seen IVFs that were turned off without a docs order and then just tell the doc on rounds why you cut it off. I think there are a lot of things we do without orders but you just dont think about it.

Not only do I think it depends on where you work facility wise, but I also think you will, in general, get different opinions from those who work in the ED vs. those on the floor.

That's all I'm gonna say... ;)

Takeaway point here: Be VERY VERY careful what you say online, in a public internet forum. Nobody is truly anonymous

On that note, here I am with my aide Igor practicing medicine without a license.

fstshot.jpg

I work in LTC and our facility has an excellent set of house orders to cover most situations. Ok to give tylenol, bowel meds, maalox etc unless contraindicated and follow up with MD if used more than 3 times. Initiate dressing orders for skin tears, Stage 1 or 2 ulcers. O2 at 2-3 LPM prn, C-Diff or UA if suspected infection. Change med from tablet to liquid or suppository at RN discretion. 3 day trial diet change to mechanical soft or puree, change from thin to thickened liquid if choking or aspiration risk at RN discretion [this one requires follow up with speech therapy]. These are just a few I remember off the top of my head. The only requirement is documentation that the standing order was initiated and follow up with the MD if the order requires.

Wow.

On admission, we check off orders for tylenol for pain or temp, our bowel protocol that includs MOM, ducolox supps and enemas and a skin tear dressing order (its not always appropriate) These are checked off so essentially they are orders that each resident has written already. Other than that...nada. All of our diabetics get an order for low blood sugars too.

I do nothing that wouldn't hold up in court.

Specializes in Oncology.
I work in LTC and our facility has an excellent set of house orders to cover most situations. Ok to give tylenol, bowel meds, maalox etc unless contraindicated and follow up with MD if used more than 3 times. Initiate dressing orders for skin tears, Stage 1 or 2 ulcers. O2 at 2-3 LPM prn, C-Diff or UA if suspected infection. Change med from tablet to liquid or suppository at RN discretion. 3 day trial diet change to mechanical soft or puree, change from thin to thickened liquid if choking or aspiration risk at RN discretion [this one requires follow up with speech therapy]. These are just a few I remember off the top of my head. The only requirement is documentation that the standing order was initiated and follow up with the MD if the order requires.

When I worked as a camp nurse we had standing orders for tons of PRN OTC meds as long as the parent gave permission. It was fabulous.

Wasn't there some hospital in FL where a lot of old time nurses got in trouble for doing stuff without orders even though it is how the docs wanted it?

I often wish there was a way to get the orders needed to care for the patient when docs don't call back.

What do you do when a doc leaves a pt NPO (was for a test to be done Friday, it didn't happen, pt is in over the weekend) and goes off for the weekend and no other doc wants to call back to give you a diet order? Do you leave the patient NPO for the weekend or change the diet and go back to NPO Sunday night for the test Monday?

It's a rock and hard place issue I hate!

Specializes in NICU,MB,Lact.Consultant, L/D.

WOW! I can't imagine a Dr. actually entering an order....

+ Add a Comment