writing telephone orders

[nurse4lyfe37]

I have a question ...ethical..in the state of Wyoming. I get to work and in report am told a resident was sent to the hospital 2 hours prior. I call the hospital an hour later to check the status and am told the resident was admitted to icu. later, the nurse manager informs me that the resident passed away at the hospital. I am told to write a physicians telephone order stating admit resident to intensive care with a diagnosis of.....(call the hospital to get the diagnosis. ) I call the hospital and am told they can't tell me the diagnosis due to hippa. so at this point I don't feel comfortable writng the order. how can I legally write a telephone order without speaking to a physician anyway. am I right in my hesitation or is it legal to do this. every time a resident is admitted, they want me to write this type of physicians telephone order without talking to a physician. please advise thank you.

[LadyFree28, BSN, LPN, RN]

It seems even if it's ok to write an order to transfer to ICU, that it's impossible because you don't know which doctor. [/quote']

The residents have primary doctors; the orders come from them; we contact the primary doctor; get the OK, then write the order.

The OP, in my last response I quoted it, states that this is happening where the sup is writing TVOs for the to be sent out to eval and tx; instead of calling the doctor FIRST, or not at all; my solution since the OP is familiar to LTC and this is a heavily regulated industry with pretty much the same protocol, is to follow protocol by calling the doctor first to clear then write the order.

[casi, ASN, RN]

I don't write a TO unless I took a TO. Add to that the whole admit to ICU with a specific dx is bizarre. The only TO pertaining to the hospital you'd get in this situation is to send to ER for evaluation. Admitting dx and what unit they go to to is then up to the ER physician.

I'd tell my NM that since I didn't send them out of and I didn't take the TO I legally can't write it. She needs to talk to the nurse that transferred the resident or write it herself.

[nurse4lyfe37]

Lady Free 28 " find out if the doctor wants the pt transferred.". I'm really not trying to be difficult, I'm just trying to understand where you are coming from. The day shift nurse called the doctor to find out if they wanted the patient transferred, and wrote the order as such, and transferred the patient, so its not a question of finding out if they want the patient transferred..That had already been done well before my shift. There already was an order to transfer to er. they wanted me to write a telephone order stating admit to ICU for..(.whatever the diagnosis)...The patient was already in icu when I came on duty. ...

[chrisrn24]

Lady Free 28 " find out if the doctor wants the pt transferred.". I'm really not trying to be difficult I'm just trying to understand where you are coming from. The day shift nurse called the doctor to find out if they wanted the patient transferred, and wrote the order as such, and transferred the patient, so its not a question of finding out if they want the patient transferred..That had already been done well before my shift. There already was an order to transfer to er. they wanted me to write a telephone order stating admit to ICU for..(.whatever the diagnosis)...The patient was already in icu when I came on duty. ...[/quote']

Then I would've said "no sorry I can't do that."

[LadyFree28, BSN, LPN, RN]

Lady Free 28 " find out if the doctor wants the pt transferred.". I'm really not trying to be difficult I'm just trying to understand where you are coming from. [/quote'] My ENTIRE response, to be clear is based on your quote at the end of your OP:

every time a resident is admitted they want me to write this type of physicians telephone order without talking to a physician. ***please advise thank you.**[/quote']

I ADVISED you on what happens...this, to me was more important in addressing due to you saying "EVERY" time=occurrence; your concern about frequency of TVOs without Dr's actual consent- and that could be interpreted as ANYTHING...that is, in my mind, moving forward, hence the question WHY don't you call the Dr. when this occurs, when they are sent out? Or is it they are asking you to specifically write "OK for pt to be admitted with ...."

Maybe I need clarification.

The day shift nurse called the doctor to find out if they wanted the patient transferred, and wrote the order as such, and transferred the patient, so its not a question of finding out if they want the patient transferred..That had already been done well before my shift. There already was an order to transfer to er. they wanted me to write a telephone order stating admit to ICU for..(.whatever the diagnosis)...The patient was already in icu when I came on duty. ...

Well now, this is it NOT acceptable and you know this.

My point was to answer what I do in my LTC; I write orders all the time as the resource desk nurse; I take orders off EVERY shift I am on (except holidays-where I take the cart on assigned holidays, and I don't work weekends). There are times where no order is written, and it was agreed upon and noted and in process; it STILL needs a TVO if there is no order on the physician order sheet. I still have to write an order to provide evidence that it was allowed; when the provider comes in monthly, they sign all the TVOs...there's not violation of CMS or anything...again, because LTC is so regulated, every order to be carried out or risk delay of care; the order, if it wasn't written (I know, you are not saying THIS) it still HAS to be written...when in doubt; I rather call the Dr. to be safe. If orders were not taken off correctly or need to be clarified and I am not the one who wrote it, I STILL have to write it for clarification and accuracy because of the strict regs.

[sapphire18]

TO = telephone order; you cannot receive a telephone order without talking on the telephone with a provider whom is giving you the order...as you know...your manager can put that on HER license if she wishes; don't let her bully you into going outside of your scope and writing orders under unsuspecting physicians' names.

[MarggoRita]

I have written a note in the chart after sending someone in to ER stating that they had been admitted and why, but it makes no sense to obtain an order as once they are sent to the ER they are no longer in your care until they return, and what happens at the hospital is documented at the hospital.

[systoly]

I'd write the order, hand it to the mgr. and tell her

"here you are, ready for you to sign, time and date"

[nurse4lyfe37]

lol...yeah sounds like a great idea. I would like to have some kind of documented evidence that it's unethical/against nurse practice act, etc etc etc, to show them next time they tell me to write these orders. this is the second time it happened. the first time, we sent the resident to hospital on my shift, but I really didn't have much to do with it because our nurse case managers went and called the doc and got the order to transfer, and transferred her, and didn't communicate a thing to me, so a few hours later, they tell me to write the order admitted to hospital for colitis. But again in this case, I never called the doctor or the hospital, or anyone because they came barging in and took over ....so it seems every time someone is in the hospital they are going to want me to write admit to ...etc. the only way an "admit to" order would be valid, is if it were a direct admit. but going through er? no.

[RN_2012, BSN, RN]

You sure they don't just want a nursing note.

[nurse4lyfe37]

yes I'm sure. the first time they sent someone out to the hospital and they were admitted, that night day nurse called me and told me she forgot to write a telephone order stating admit patient to hospital for diagnosis of...colitis. I told the dsd that I didn't feel comfortable writing it because I didn't talk to any doctor and I wasn't here when she was sent out, she was sent out 2 shifts before I got there, she told me, oh its ok just write per adon. I did it, but I regretted it and told myself I would never do it again. and I won't.