Direct Admissions without doctor orders Direct Admissions without doctor orders | allnurses

Direct Admissions without doctor orders

  1. 0 Do you ever get direct admissions to your unit without any orders? Has happened to me and I feel this is a huge liability. I mean if they are on my floor in a room aren't I responsible for them? But technically can't touch them because I don't have orders (IV start for emergency)? How ridiculous is it to have to stop what i am doing to call the doctor for orders?

    Many times we get patients from Cath Lab that were classified as "outpt" so if we aren't careful and check to see that their status has been changed to "inpt or OBS" when they get to the floor we cannot get any meds out of Pyxis, put in any orders because they don't exist.

    Have spoken w/ mgmt. It doesn't occur regularly but still rears its ugly head now and then..
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  2. 16 Comments

  3. Visit  bill4745 profile page
    #1 1
    Orders should arrive before the pt or with the pt at the latest. Having a pt with no orders is potentially a huge problem.
  4. Visit  d'cm profile page
    #2 0
    To add to your worries, in regards to your cath patients, you probably should get your case manager to look at them to make sure they meet admission criteria or they will be denied for payment.
  5. Visit  General E. Speaking, RN profile page
    #3 0
    Quote from d'cm
    To add to your worries, in regards to your cath patients, you probably should get your case manager to look at them to make sure they meet admission criteria or they will be denied for payment.
    Thanks for input. The procedure is done knowing they will be admitted afterwards. Many times as charge nurse I get so busy that I forget to double check that they are actually showing up on our census. On the days that I remember, I will not let the nurses even accept report until they are moved to inpt/obs status. Funny how fast this will get done when the patient is waiting to come to the floor from Cath Lab, but slow as hell if the patient has already been moved to our unit.

    We have had this happen to post op patients that were originally scheduled for a daystay. It doesn't happen often but it is a mess when it does- mainly because it causes a delay in getting post op pain meds and meals for the patient. I know in a pinch I can override the Pyxis for emergency drugs, however, we cannot override for pain meds.

    I was just wondering if this happens at other facilities or is it just unique jacked up situation at my hospital.
  6. Visit  classicdame profile page
    #4 1
    no orders, no admit. Go thru chain of command if this is an issue - some Administrator will have to explain to MD about risk mgmt.
  7. Visit  General E. Speaking, RN profile page
    #5 0
    Quote from classicdame
    no orders, no admit. Go thru chain of command if this is an issue - some Administrator will have to explain to MD about risk mgmt.
    Everytime it happens, I do an incident report. Never hear back from Risk Mgmt. Most of the House Supervisors are good at making sure we get orders before the direct admission are accepted.

    Thanks for the responses and listening to me vent.
  8. Visit  caeRn profile page
    #6 1
    I feel you. This has happened to me multiple times even when the patient has been very ill. I had a situation where i had direct admit and took 6 hrs to get in touch with the admitting doctor. needless to say everyone was involved from supervisor to the medical director(who had to give me orders).
  9. Visit  Kooky Korky profile page
    #7 0
    OP, what is actually supposed to happen? What is the correct procedure?

    If you know that, you will be able, hopefully, to find out where the glitch is.

    Can you get a written opinion from your hospital attorneys as to where liability lies in the situation you describe?

    Can you follow up with Risk Mgmt on your own and not wait for them to respond?

    What does your Medical Director say? Can he or she light a fire somewhere and put a stop to this practice?

    Is someone just putting patients into your rooms without you knowing the patients have arrived? Or what? Not sure I understand what the issue is exactly.
  10. Visit  General E. Speaking, RN profile page
    #8 0
    The issue specifically is that the house supervisor will call me to get a room for a direct admit coming from MD office. I assign the room. The patient goes through admitting (usually). I have had occasions when they came to the room first and admitting came to the patient room. The arrive on my unit with their face sheets and arm band on but no doctor orders. I call and ask the supervisor where they are and she says "Oh yea, you are supposed to call Dr So-in-so when the patient arrives to the floor."

    Or I hear from the house supervisor that she needs a room for a Cath Lab patient. I assign the room and when the patient comes to the floor with admitting orders, they do not show up in our census/pyxis because their status wasn't changed from out pt to inpt/obs by admitting. The cath lab needs to fax a form to admitting changing their status. Part of the problem I believe is that Cath lab employees are contract workers.

    My supervisor agrees that it is a liabilty. My new coordinator basically told me not to get my panties in a wad because since I don't have admitting orders I am not responsible. I usually try and avoid these situations by asking when the bed request is made: Are there orders coming with the patient? Or have you changed the patient from out pt to inpt? However, like I said sometimes I get busy or God forbid go to lunch and they fall through the cracks.

    If it happens again I do plan to go to my supervisor and follow up with Risk mgmt personally.

    I feel if I have a patient sitting in a room on my unit that we are responsible. Even though it gets tricky because I believe if we attempt an IV (not sure about vitals) without orders that it is illegal and could be considered assault. Even though every patient admitted gets an IV, we wait for the MD to call. Worried what would happen if they coded... I mean I would code them... arrrghhhh... just frustrated that I even have to deal with this stuff.
    Last edit by General E. Speaking, RN on Mar 23, '10
  11. Visit  morte profile page
    #9 0
    could you not assign the bed without the orders?
  12. Visit  carolinapooh profile page
    #10 1
    I think the OP means there's an order to admit, but not orders for treatment. So the patient's cleared to be there, but there's nothing telling you what to do with them.
  13. Visit  General E. Speaking, RN profile page
    #11 0
    Quote from carolinapooh
    I think the OP means there's an order to admit, but not orders for treatment. So the patient's cleared to be there, but there's nothing telling you what to do with them.
    Yes, exactly!
  14. Visit  General E. Speaking, RN profile page
    #12 0
    Thanks so much for everyones input. I am really peeved about this. I am mad at the situation but also I am flabbergasted that everyone involved doesn't think of this as a HUGE liability/safety issue like I do.

    Actually, it happened again yesterday when I was off. A patient came from another hospital in a rural area via EMS. They bypass the ER and get directly admitted to a room- a direct admit. The other charge nurse told me about it today. I confronted the house sup who had arranged and accepted the patient and she became very flustered saying the this particular MD "always does this". My response was that just because a MD "always does this" and we do not have a bad outcome and we eventually get what we need doesn't make it right or safe. It should be addressed!!

    I was so busy today- 10 admits. We were full (24 bed unit) and discharged then immediately readmitted to capacity so I totally forgot to follow up and do an incident report- not that this is helping. I am making a mental note to discuss w/ Risk mgmt.

    What about the comment I had from my coordinator to not get so worried because I don't have orders yet? Meaning (I guess) that I am not responsible. She says it is just like an admitted patient waiting in the lobby for their room to be ready. They are ADMITTED to my facility and on my unit in a room as a patient. Aren't we responsible for their safety?

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