LTC project: Who enters admission orders? MD or RN?

[KdubsRN]

hi everyone!

i work on a ltc floor in a hospital(it's orthopedic rehab but considered ltc because pts can stay for more than 2 weeks, longest someone has stayed since i started working was 2.5 months).

all the newgrads are required to work on a project concerning issues or problems on our units. i asked the nurses on my floor for ideas. the nurses enter admission orders for the physicians. it's time consuming and many times the mds will accidentally leave out meds that are important. we've had pain medicine, asthma meds, and cpap orders missing. we'd like the physicians to enter the orders instead of the nurses.

i know that nurses don't enter the orders on the acute care units, we are the only ltc unit in the hospital.

who enters admission orders in ltc? physicians or the nurses??

if it's the norm for the nurses to do it in other facilities, this will not be a viable project. if it's not the norm, then i may be able to use this as a topic.

thanks in advance for any responses! : )

[TheCommuter, BSN, RN]

I've worked in multiple LTC facilities (a.k.a. nursing homes), and usually the nurse is the one who transcribes the admission orders. The attending physician will come along and sign the orders on some later date.

Keep in mind that the typical nursing home physician does not see his/her patients daily. Sometimes they visit weekly, and other doctors only see their patients once per month.

[bratmobile]

I work subacute..we transcribe and confirm all admission orders from hospitals or other facilities...I don't mind doing it but I don't understand why our facility docs aren't faxed everything so they can read the orders themselves and fax us their changes,,rather than us READING it over the phone to them..it does seem archaic..sometimes the facility docs do not believe what I am reading to them and think I don't know what the other facility's orders are..Yes it REALLY REALLY says that I cannot control that that medication does not exist in that dose LOL..Some docs are easy to do this with and others get snippy about every little thing, (Like pronounciation of some of these drugs ..they are real tounge twisters.. I'm pretty good at how they are said but sometimes you get tripped up and sound like a 5 year old trying to read for the first time LOL)

I think the process could be streamlined but I think it's a shared process. I would not like nurses not to play a big part in admitting where I work The thing I do like about admitting a pt is that i really get to know about them since I will be taking care of them for several weeks..

[JZ_RN]

The nurse does ALL the work in LTC and subacute where I worked. And the MD writes illegible, incomplete, wrong dose, no times, no route (uh, which foot or which eye or ear, doc?) and sometimes conflicting orders, then gets mad when you have to call and clarify. The physician could save time writing and just put orders in themselves, avoid polypharmacy because the other orders are all there, avoid errors, it would always be complete, and the nurses would have more time to actually do nursing care. I think MDs should put in their own orders. Just from a safety standpoint alone it makes sense, not to mention saving time!

[CapeCodMermaid, RN]

We're moving toward EMR. At my last building, it was the expectation that the MD input all but admission orders into the computer system. The doc for the sub acute unit was in the building 3 or 4 days a week so he would enter all his orders whenever he was there and a few times he even did it from home!

[luvmy2angels]

RNs as well as LPNs enter admission orders where i work. Doc will sign them at some point when he does rounds, but we put them in.