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..
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