Is it acceptable nursing practice?

[csimes]

I have been a LPN for 13 years, but recently became a RN. I ran into something recently that has given me pause for concern. I was instructed by a supervisor to consider the directions on a prescription bottle as a valid doctor's order. I was always told never to go by a prescription bottle, but verify with a signed order. Has anyone run into this? I have been looking for the appropriate response but have been unable to find one.

[klone, MSN, RN]

I'm not sure what context this is in. Are you inpatient or outpatient? It's generally accepted that all OP orders are d/c'ed or on hold while inpatient. The inpatient attending is responsible for all orders while the patient is inpatient. And outpatient orders should be written by the care provider the patient is currently seeing. Can you give us more context?

[klone, MSN, RN]

But no, directions on a bottle are not valid orders. For one thing, you can't accept orders from just anyone.

[csimes]

The situation was I had a patient that was discharged from the hospital to an assisted living with hospice. When I went (as the hospice nurse)to the assisted living I discovered that there was not any signed physician's orders. Now we had morphine that the admission nurse ordered earlier in the day in the facility, but no signed physician's order. There were directions on the bottle but I wanted to verify the order against the bottle. So I called the doctor and obtained the orders. I was reprimanded today for not using the directions on the bottle as the physician order. I did not receive the original order from the doc and that's why I wanted to verify.

[MunoRN, RN]

I think in general there's maybe a poor understanding of the difference between administering medications and assisting with self-administration.

Typically in assisted living, residents are self-administering even though staff members might be assisting them. Unlike assisting with self-administration, administering medications is limited to staff licensed to administer and involves interpreting a provider's order, assessing for the appropriateness of the medication, checking the 5,6 or 11 rights (however many there are now), etc. If you are administering medications you need the actual order and you're potentially risking your license by administering medications for which you have not seen an order.

How did the admission nurse order morphine without an MD order or at least an order set, protocol, etc signed by a physician?

[klone, MSN, RN]

So this was a med that the patient was discharged home with from the hospital to take on his/her own? Then yes, part of the hospice nurse's role is to go through the patient's home med list, write down the home meds (which, yes, you would take from the bottle, including instructions), and then the hospice doc would write orders to include any previous home meds that the patient will be continuing to take. You would not contact the patient's previous doctor or the hospital's doctor to get orders. That's what your hospice medical director is for.

[csimes]

Thank you this clears things up for me.

[HouTx, BSN, MSN, EdD]

Interesting discussion - brings up issues most of us haven't even thought about.