Can we recommend a medication to a doctor to prescribe?

[stallion8797]

I recently ran into a situation where I called a doctor and recommended to them a medication for an agitated patient. The patient had not had this medication in the past but had no allergies to it or its contents and no medical condition that would have made the recommendation inappropriate. The doctor wrote the order, patient received med, and no ill effects came from it. My manager is telling me it is out of the nurses scope of practice to recommend a medication to a doctor. Is this true?

[Esme12, ASN, BSN, RN]

I recently ran into a situation where I called a doctor and recommended to them a medication for an agitated patient. The patient had not had this medication in the past but had no allergies to it or its contents and no medical condition that would have made the recommendation inappropriate. The doctor wrote the order, patient received med, and no ill effects came from it. My manager is telling me it is out of the nurses scope of practice to recommend a medication to a doctor. Is this true?

That is crazy....you can suggest things that might help it is up to the MD to order....what is going on with this profession? There is a concerted effort to dumb down bedside nurses......is this to prove we need NP's at the bedside? How does you manager know you suggested it? Did the MD complain?

It is not out of scope to suggest anything to the MD.....the block comes from closed minds and insecure physicians.

We ask for meds all the time. Often, if I don't suggest it, the doc just looks at me and says, "What do you want?" If the request is reasonable, I get it. If not, I get a good reason why not and an offer of an alternative.

I don't see what you're manager's got his/her tighty whiteys in a bunch over... or the regular MD.

[SaoirseRN]

Was there a reason the primary psychiatrist did not want the patient's medication changed? Sometimes patients with chronic medical conditions do not have adequate insurance to cover the cost of different medications. If an inpatient's medication is switched to one that is not covered by their insurance, it makes it difficult for them to afford to purchase it, once they are discharged into the community.[/quote']

If that's the case then they needed to make that clear to the on-call.

[wannabecnl]

If that's the case then they needed to make that clear to the on-call.

Not to mention telling the nurse!

[sherryrodgers]

I recently ran into a situation where I called a doctor and recommended to them a medication for an agitated patient. The patient had not had this medication in the past but had no allergies to it or its contents and no medical condition that would have made the recommendation inappropriate. The doctor wrote the order, patient received med, and no ill effects came from it. My manager is telling me it is out of the nurses scope of practice to recommend a medication to a doctor. Is this true?

I reccomend medications all the time! Us Nurses are ultimately the ones who really know our patients and can pin point behaviours etc. Doc's can only go by what we see and pass on to them, they are never around long enough to see certain behaviours, ie: sun downers or aggressive behaviours, therefore we have a better understanding of what they need and what will help.

[stallion8797]

The answer I received was "Zyprexa is only used by Dr. C. We dont use that here." That started a discussion on my paet about how there is a need to not only prescribe haldol, thorazine, and the occasional risperidal to our patients. This particular hospital is far behind in termd ofbest practice treatment.

[dishes, BSN, RN]

It's easy for units to continue to do things because that's the way the doctor always orders it, sometimes it just takes one action to activate change, I hope this is the case on your unit and the discussions will continue until best practices are adopted.

"Zyprexa is only used by Dr. C. We dont use that here."

Read as, "We're trying to save money by keeping our med inventory low and staying away from on-patent meds."

If their formulary doesn't include certain meds doesn't preclude the doc from ordering them. Unless they've provided a formulary for your reference and the doc's, this lies on management, not on you.

I believe you mentioned being told that this was out of your scope. It's not.

[CaitlynRNBSN]

I don't know if it is. but I call all the time for a certain medication..."Patient X is having muscle spams, do you think we can do something like a flexaril?" It is the doctor who ordered it, i'm just asking. It isn't beyond your scope to ASK if something can be ordered. I don't think its beyond our scope to suggest either.

If someone is in pain and can't have opiods, doctors will ask nurses/pharmacist all the time "Do you have any suggestions?" Doesn't mean that the doctor doesn't know what to do, it just means there might be something better that they have not thought of. It's collaboration and discussion from different disciplines.