Writing Clarification Orders

Hi All,

Sorry this is kind of long.

Need some clarification. Here is the situation. I work in a Long Term Care facility. There is a nurse manager who writes a lot of "clarification orders" as the first order written (no previous order to clarify). Example:

3/23/09 Clarification Order: Cleanse skin tear to left wrist with wound cleanser, apply TAO and Band-Aid QD & PRN until healed. (Then she signs it).

There is no previous order regarding a skin tear on the left wrist. When I asked her why she wrote it as a clarification order, she stated that there was documentation about the skin tear on 3/22/09 (the incident report was done on 3/22, no other documentation). She stated, "I was taught in nursing school that if there was documentation but no order written at that time to write an order as a clarification order to cover your a$$." I have never heard of this. Our Administrator and Risk Manager have never heard of this. Our Administrator and Risk Manager are also Legal Nurse Consultants and have told her not to write "clarification orders" unless she is actually clarifying an actual written order. The nurse manager did not come to work the next day. The day after that she informed me that she had spent the previous day on the phone with "a nursing organization", which she would not clarify who, and that they told her that the way she is writing clarification orders is correct. She also said she had an email from them proving this and she was going to email it to our Risk Manager. I asked her to email it to me, but she wouldn't. She said she had to do some tweeking to it. Sounds fishy to me.

I also see clarification orders for treatment changes. Example. An order for corn cushion to corn on left middle toe written in January. In March: "Clarification Order: Corn cushion to corn on left middle toe and right pinky toe." I told them that this is NOT a clarification order. This is two separate areas and there should be a new order. I was told I was wrong (by the same nurse manager).

By the way: I'm the Care Plan Coordinator - and things like this are going into the care plans. And who do you think will get cited by surveyors - me! So I try to keep things "clarified."

My question is: When do you write clarification orders? I thought it was to clarify if the first order was written wrong, such as wrong dose (was written 25mg and should have been 0.25mg, etc.), wrong route (should be PEG instead PO), etc.