No Insulin Order

[NightNurseRN13]

One of my patients was recently diagnosed with diabetes (should have been years ago) and when I came on for my shift the wife just verbally told me what the doctor said about when to do FSBS and how much insulin to give. I told her that I cannot give insulin without an order. I called my boss the next day to let them know about the change and that I need an order and they said they would handle it. 2 weeks later there is still no order for it. I've taught the family how to do the FSBS and verbally explained how to give the insulin and have watched them give it to make sure they are doing it correctly and they are doing it perfectly, however the family acts upset with me because I will not give it myself. I've explained a million times and all they can say is "I'm not a nurse, yet I can do it" I've been in contact with my boss, but still no changes.

I don't understand why it's such a big deal anyway, the patient ambulates, is A&O and has shown they are capable of doing it themselves... why are they so upset that I won't do it for them?

[SDALPN]

Can you get a verbal order and then send it to the agency for a signature from the Dr?

[caliotter3]

Some agencies will accept an order from the patient/parent/family member; it is written down on the order sheet showing the usual line of communication, and then sent to the doctor for signature. But in this case it looks like the people in the office are failing to follow up no matter who wrote what on the order sheet. Get a telephone order from the doctor, or better yet, if you can swing by the doctor's office have them write up the order and sign it. Then you will have your order, you place the 'suspense' copy in the home and send the already signed order to the office. Or, write it up on an order sheet yourself and mail it to the doctor's office with the agency return address on the envelope, keeping a suspense copy for the home. Voila. Everything taken care of, and you stop looking ineffectual to the clients.

[KelRN215, BSN, RN]

In my agency, it is the responsibility of the field nurse to call the ordering MD to verify the order. Why can't you call the doctor while you're in the home and get a verbal order or request that he fax an order to the agency?

[KelRN215, BSN, RN]

Also, can I ask why an adult patient who is A&O, ambulates and manages his own care has a private duty nurse?

[NightNurseRN13]

My patient only has a RN because he is on a vent at night. I work night shift so I didn't think calling the Dr. for an order at 2am was really worth it, that's why I directed it to my boss.

[SDALPN]

Some agencies will accept an order from the patient/parent/family member; it is written down on the order sheet showing the usual line of communication, and then sent to the doctor for signature. But in this case it looks like the people in the office are failing to follow up no matter who wrote what on the order sheet. Get a telephone order from the doctor, or better yet, if you can swing by the doctor's office have them write up the order and sign it. Then you will have your order, you place the 'suspense' copy in the home and send the already signed order to the office. Or, write it up on an order sheet yourself and mail it to the doctor's office with the agency return address on the envelope, keeping a suspense copy for the home. Voila. Everything taken care of, and you stop looking ineffectual to the clients.

Nobody should ever take a verbal from anyone that isn't licensed. Guess who is going down if the person relaying the order lies or misunderstands what they were told. That's basic nursing. And if I remember right, the BON says the same thing.

[NightNurseRN13]

Thank you! I'm more than comfortable with giving insulin, but I need an order and if they can do it themselves then why intervene? They should be taking care of themselves.

[caliotter3]

Nobody should ever take a verbal from anyone that isn't licensed. Guess who is going down if the person relaying the order lies or misunderstands what they were told. That's basic nursing. And if I remember right, the BON says the same thing.

Even with the agencies that go for this policy, I never follow an order until I see the written signature of the doctor. I tell the clients this, and as a matter of practice will only do a writeup conveyed by a client that appears to have the requisite three balls rolling around upstairs instead of those that act like they only have one or one and a half. Some agency policies are usually for the benefit of someone who doesn't like to do everything they should; that does not stop the nurse from using the good sense they have picked up along the way.

[NutmeggeRN, BSN]

I am a school nurse and I had a student asking to go to another building to get the siblings inhaler....student has a wicked head cold/? sinus infection. O2 Sat 100, no wheezing, crackles- anything in the lungs, There was great air exchange in all lobes. There is an old hx of asthma in the files but no current order (last one while in middle school, s/he a senior now). I called parent, not very interested in what I had to say, but was cranky because he said s/he never needed and order last year.

Yeah, s/he did, they just never notified me that s/he was carrying an inhaler (which was probably the siblings)...aye yay yay.....S/he got dismissed and was encouraged to see the MD. We shall see what happens.

[caliotter3]

I am a school nurse and I had a student asking to go to another building to get the siblings inhaler....student has a wicked head cold/? sinus infection. O2 Sat 100, no wheezing, crackles- anything in the lungs, There was great air exchange in all lobes. There is an old hx of asthma in the files but no current order (last one while in middle school, s/he a senior now). I called parent, not very interested in what I had to say, but was cranky because he said s/he never needed and order last year.

Yeah, s/he did, they just never notified me that s/he was carrying an inhaler (which was probably the siblings)...aye yay yay.....S/he got dismissed and was encouraged to see the MD. We shall see what happens.

I can not count on the fingers of both hands and the toes of both feet how many times a client has not found it necessary to inform me about a new order or new order change.

[mluvsgnc]

I would do what KelRN215 suggested (and I do it all the time)- call the MDs office and take a verbal telephone order (from an RN or higher license), read it back to them to verify, and send a copy to the agency for them to fax over for the doc's signature. I often call the clinical director at my agency and read it to her as well, so she knows/expects an order from the physician, or is at least aware that an order needing a signature is on it's way and she can follow up.

I personally never give anything without an order, and the families I work with know this. Just recently I drew up a med to be given via GT and literally handed it over to the clt.'s father and said, "here, I don't have an order for this." So he poured them in to the vent tube, and I administered the rest of the meds (that I had orders for). It seems silly at the time, but you never know when something seemingly small like that will come back and bite you in the behind- best to do diligence now Way to stick to your guns!