adding to doctors orders... legal or not?

TNRNMAN · Oct 1, 2005

Let me put this in a scenario... I work in a nursing home. We receive Junes physician order sheets (printed out from the pharmacy) on May 16th. They are checked and any changes are made. Doc makes rounds on the 29th and signs his orders. Orders are then placed on charts. On June 2, I receive a new order for Lasix. I write it on a telephone order sheet, place order on current MAR, fax order to pharmacy, make entry in nurses notes, administer the medication... am I finished? No, not according to my DON. She thinks I should also go back and put it on the orders which the doctor signed on May 29th (with my signature and the current date). I have been taught that you do not ever add to something the doctor has already signed, but she says it is ok, if I sign my name and date it. I am very uncomfortable with doing this, but have been told I will be written up if I do not put new orders on those order sheets. What is the right thing to do? If I am correct, and I am not legally supposed to write a new order on something that the doc has signed, can anyone give me reference to something legal (nurses board, etc) that I can show as proof of my case? Or am I just wrong? Help! Thanks!!
BTW, if it makes a difference, I am in GA.

I am not sure exactly what the situation is, are you writing above where a doctor has signed or under it as a new order, if you are being asked to write above a doctors signature then you need to clarify with the BON and that is okay to do they will help you, and you do not have to tell them you did it. If you are being asked to write an order under a doctors signature and you can write the order date time and write TO. DR franks / Nurse Sue , then there is nothing wrong with that. If as previously posted you are asked to squeeze in an order I would not do it under any circumstances without clarification and there alot of reasonable DONs out there to work for. Good Luck THE BON IS YOUR FRIEND> :)

Home Health Columnist / Guide · Oct 1, 2005

Why are you failing to include the PHARMACIST who reviews med orders and is part of most facilities medication review activities on this scheme?

They just might have the regs at their fingertips for your state.

Check your states Practice Act--- all states BON listed under grey toolbar top right corner website under "LINKS", If you can't locate info at state website, agree a call to BON in order. Also check under state agency that accredits your facility--varies by state.

nursepeachie · Oct 1, 2005

What is her reasoning on adding it to the monthy reorders? It will show up on next months reorders. Totally unnecessary. If the order was received after they were sighned, what she is telling you to do is add it on like it was ordered on that date? What happens if you get an order in the middle of the month, does she want you to add that also? Stupid if you ask me.

Her reasoning is that the monthly order sheet should be kept current.

She wants us to add it on and add the date we receive the new order.

Yes, even if we receive an order on the last day of the month, still wants us to put it on there.

:)

nursepeachie · Oct 1, 2005

Wow! An attorney would have a field day with this practice! Adding an order after the sheet is dated and signed by the provider is clearly improper, especially since it is being added days later.
That your DON would discipline you for refusing to participate in this improper process makes me very leery of her. Is she lazy, known for cutting corners, trying to cover up something? I would definitely take this to the BON and/or an attorney.

Thats what I am afraid of, an attorney having a field day with anything with my name on it!! Yes, she is lazy, but she she is great at brown nosing to the administrator.

nursepeachie · Oct 1, 2005

I had a state reviewer tell me to add new orders to existing MD orders (assisted living). Of course I asked if this was the right thing to do and he said yes. It still freaks me out to write on an existing order.

Supposedly, this all started with a state inspector asking why we didnt put the new orders on the existing ones. I personally think the DON misunderstood what she was saying for us to do. Are you in Ga? Just wondering if this is something our inspectors are going around telling all the facilities to do.

nursepeachie · Oct 1, 2005

I contacted the BON. They referred me to the nurse practice acts. Cant find anything relating to this in the practice acts. Any other suggestions? I dont want to do something wrong, but I also cant afford to lose my job over this. Help, someone? Thanks to all of you for your replies and suggestions!

renerian, BSN, RN · Oct 1, 2005

Funny you should bring this up. Happened to me lately and I won't do it either. STand your ground.

You could always say the date, time are different than the original order and I sure would not want anyone adding to my orders........notes etc.

renerian :rolleyes:

Jolie, BSN · Oct 1, 2005

Let me turn the tables on this one. What if you had completed, signed, and dated an admission assessment for a new resident. Then 25 days later, a CNA found a new problem such as a pressure sore and added it to the bottom of your completed assessment. Your would raise holy he**, and rightfully so. 25 days would have passed since your assessment of the resident with no mention in the chart of assessment or treatment of this pressure sore, but there it is added to your documentation.

This opens a legal can of worms that impacts the nurses, pharmacists, and physicians caring for the patient. It makes it unclear just when the problem was noted, who did what about it, how long treatment has been in effect, etc. It also implies that the original writer of the document is aware of the problem, which s/he may or may not be.

We, as nurses would not accept someone adding to or altering our documentation. Why in the world would we do that to someone else? It amounts to falsifying the initial order signed by the physician. That should get the BON's attention.

CoffeeRTC, BSN, RN · Oct 1, 2005

Her reasoning is that the monthly order sheet should be kept current.
She wants us to add it on and add the date we receive the new order.
Yes, even if we receive an order on the last day of the month, still wants us to put it on there.
:)

UMMMM that is what the MAR and TAR is for. You add new orders on to that....DUH?

This is how it works in LTC. YOu have admission orders, then off of them you generate a Mar and TAR. Any orders received are then added to that. Each month our pharmacy generates a new MAR/ TAR and monthly reorder sheet. All of the orders that were received during that month are added to the new sheets. That is the basics, that is all that is needed. If your DON wants a current list of meds, tell her to look at the MAR or TAR.....Duh?