Patient is an elderly woman who is mildly confused and depressed. She crys at the drop of a dime. The pt is a DNR and has no telemetry on. Family comes to visit and asks to take her via wheelchair out to the hospital courtyard as it was a beautiful day. The primary nurse stands firm in not allowing her to go until she gets an order from MD.
The only floor policy there is refers to patients on telemetry. Those on tele are not allowed to leave floor.
What is you alls take on this situation? Is a doctors order really necessary?
Yea most of our activity orders are "advance as tolerated" so it leaves it up to the RN to assess if the patient can be up, but my issue with this was the whole civil rights perspective.
At my hospital we have to get orders for everything, and that includes letting patients go to the dayroom by themselves, go to the other unit on the same floor, or go downstairs or outside. It's really dumb, but it's policy where I work. Yes, I have patients that cannot walk around in the hallway alone, on the DAY OF DISCHARGE. Often, I turn the other way, but technically if something happened, I'd get in trouble for it.
Yea most of our activity orders are "advance as tolerated" so it leaves it up to the RN to assess if the patient can be up, but my issue with this was the whole civil rights perspective.
Then you already have an order in place to advance as tolerated. Not sure what other kind of order one would need...
Unless the patient has been deemed incompetent to make their own medical decisions, and the family member has as well, the patient isn't required to follow any orders. If the patient's refusal to follow orders gets to the point that no medical care can be provided, then the MD can "fire" the patient and discharge them. Otherwise, it really doesn't matter than a patient needs an order to go off the floor with tele, you can't legally prevent them from doing so, the only thing you can do has have the MD discharge them. Same is true for diet orders, fluid restrictions (for therapeutic purpsoses), etc.
MendedHeart
663 Posts
Yea most of our activity orders are "advance as tolerated" so it leaves it up to the RN to assess if the patient can be up, but my issue with this was the whole civil rights perspective.