Who signs of on orders?

  1. Who signs off on orders??

    I have long been under the (possible) misconception that a nurse was required to sign off on orders received, verbal or written, from physician/physician office.

    It has been my understanding that this is standard nursing practice and was part of the flow to ensure both accurate transmittal, responsibility and implementation of any given order.

    Is this so where you practice? If so is it in your statutes, organizational policy or is it "standard practice" and unwritten?

    would you be so kind as to indicate your state of practice in your post?? Thanks tons!

    Please add your
    Henaynei
    Last edit by henayneiCLNC on Dec 13, '07
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  2. 12 Comments

  3. by   TheCommuter
    I'm in Texas. At my place of employment, a licensed nurse (LVN or RN) must sign off on orders and ensure that they're being followed through in a timely manner.
  4. by   henayneiCLNC
    Quote from TheCommuter
    I'm in Texas. At my place of employment, a licensed nurse (LVN or RN) must sign off on orders and ensure that they're being followed through in a timely manner.
    is that a written policy of your employer or written in your state practice statutes or acknowledged (read "unwritten") "standard of practice?"
  5. by   TheCommuter
    Quote from henayneiCLNC
    is that a written policy of your employer or written in your state practice statutes or acknowledged (read "unwritten") "standard of practice?"
    It is a written policy of my employer, which happens to be a skilled nursing facility. A very small handful of the JHACO-accredited acute care hospitals in the state have policies that forbid LVNs from taking and signing off on verbal and telephone physician orders, if I am not mistaken.
  6. by   henayneiCLNC
    Thanks - I'm looking for this kind of input as I'm working for a small Personal Care Agency that just started up last year. The owner wrote up policies from his business and administrative POV. He is also uncomfortable with anything being "standard" or "necessary" if it is not written down somewhere. Since our orders are not of a strictly "medical" nature and since our state allows anyone in the doctor's office to give us our orders he does not see why I need to see all the orders and sign off on them ... I have tried to find something in our statutes but have failed. Because we are a Personal Care Agency we do not fall under JACHO or other such oversight. We do get State and Medicaid survey, but a significant portion of his business does not fall under any oversight what so ever (pvt pay companion, home maker, even private pay personal care services).

    I am uncomfortable, as the medical license, not seeing and signing all orders of any kind, but from his POV this costs my time and therefore his money and since this IS a start up the budget is *very* tight (he is not yet getting a pay check, but we are growing).

    I would be very interested in what the situation is with other folk as well
  7. by   morte
    i think you are in one BIG grey area, if you have malpractice ins, try talking to them ....
  8. by   MNlpn
    At the hospital I work at here in Minneapolis, The orders have to be cosigned by either HUC + RN, or RN + RN or RN + LPN.

    LOL.......even then stuff still gets missed! Thats why on the night shift we do 24hr chart checks.
  9. by   RNsRWe
    The nurse taking the order (verbal, phone) signs his or her name to it, then submits that chart to the charge nurse, who also signs off on every order during his or her shift. The charge is responsible to make sure that new orders are entered into the computer, tests are requested, med changes are on MAR. End of the day 24-hr check each nurse checking those charts makes sure that they ARE signed off by the last charge nurse. MDs who write their own orders leave them where the clerk and/or charge nurse can look them over and deal with them (then sign off).

    Only an RN (not LPN) can take the orders by phone or in person, btw, in our hospital.
  10. by   henayneiCLNC
    this isn't a hospital and according to the Medicaid oversight organization anyone can give an order to us and anyone can take the order ... literally... our staff coordinator or Admin can take an order (neither is licensed) and anyone at the MD office can give it, even the MD's wife who happens to pick up the phone -- I was told this to my face (by a BSN responsible to teach and communicate the rules and regs for the state vis a vis the Medicaid oversight and statute policies) at a training session for this oversight organization last spring.

    Now granted, our orders are for things like starting Personal Care Services, BSC, etc... we get an occasional order for frequency and perimeters for reporting of V/S.... but not that often. However, I did find an order to refer a client to one of the Medical Home Health Providers in our area for evaluation and it was stuck back in an obscure part of the client's file, I'd never even seen it, it was literally 5 months old AND had never been acted on. When I dropped my teeth and turned green the Admin seriously did not understand what my problem was. From this event has peaked my discomfiture...

    I can find nothing in our state standards mandating a cap signing MD orders and without something in writing he just doesn't see that "anyone would have anything to say." According to him if it is not in writing no one can hold us (read me) responsible. Efforts to explain that it is my license and livelihood, much less the welfare of our clients and the company at risk only garners the above assertions....
  11. by   txspadequeenRN
    even at the skilled nursing facilities that are jacho certified the lvn's sign the physician orders. i know about that cause ive worked at one for many years. it has to be the policy of the facility that controls who signs the physician orders...

    Quote from thecommuter
    it is a written policy of my employer, which happens to be a skilled nursing facility. a very small handful of the jhaco-accredited acute care hospitals in the state have policies that forbid lvns from taking and signing off on verbal and telephone physician orders, if i am not mistaken.
  12. by   Cardiac-RN
    Quote from txspadequeen921
    even at the skilled nursing facilities that are jacho certified the lvn's sign the physician orders. i know about that cause ive worked at one for many years. it has to be the policy of the facility that controls who signs the physician orders...
    i thought the poster was referring to acute care hospitals forbidding lvns/ lpns from signing off orders due to jcaho, not snfs.

    to the op, this does sound like a very uncomfortable situation. have you tried contacting any other personal care agencies in your area to see what their policies are on the matter and what they base them on?

    cardiac-rn, bsn, pccn
  13. by   TheCommuter
    Quote from txspadequeen921
    even at the skilled nursing facilities that are jacho certified the lvn's sign the physician orders. i know about that cause ive worked at one for many years. it has to be the policy of the facility that controls who signs the physician orders...
    my post was referring to a very small handful of jhaco-accredited acute care hospitals having the rn-only protocol. an acute care hospital is definitely not the same as a skilled nursing facility.
  14. by   caliotter3
    I agree that you should speak with the holders of your malpractice insurance. NSO has a website where you can pose your question for feedback. I think this policy of his is unreasonable for you. I work in home health and each field chart in every home is required to have a copy of the signed 485, Plan of Treatment, with the doctor's signature as well as the signature of the Director of Clinical Services, or whoever in the agency submits the info to the doctor for signature. I am provided a copy of the 485 before I even go out on a case. How else am I to know what the doctor's orders for meds and treatments are? You are essentially operating in the blind and that is not good for your license. You never know when a problem might arise, and you're in the middle of it.

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