At work, can you ever give drugs with no prescription?

sunnycalifRN · Mar 13, 2011

What about oxygen? Wouldn't oxygen be the only possible exception?

Oxygen is considered a drug. It's use requires an order. We can apply it emergently because of protocols for ACS, CP, resp distress, etc. But, an order must be written later.

3dayRN · Mar 13, 2011

Yeah, that's what I said in my post. You must still get an order for it afterwards, but you do need to administer oxygen first. What if the patient's lungs collapse? What if the MD doesn't answer until after four telephone calls? Meanwhile the patient is steady struggling to breathe.
Not attacking anyone, but I was only stating that at times it is necessary to take immediate action and then notify.

Wasn't talking about your post.....was talking about the original persons post where she/he asked if meds could be given without an order then she/he posted about if O2 could also be given.....I didn't even read your post when I posted mine.....chill out.

SMARN · Mar 13, 2011

For fever, we can give tylenol and/or motrin per protocol (previously written and signed off as protocol by the Director of ED). We can also give O2 as deemed necessary. Orders for these are entered by the nurse and then signed off by the ED physician when he closes the chart.

joanna73, BSN, RN · Mar 13, 2011

In my LTC, we would never get an order for O2. The Doc trusts our judgment. We would give the O2 based on vitals and tell the Doc after. Even when I worked on a med floor, it was the same for O2. We just gave it if the pt needed it and told the Doc after.

msjellybean · Mar 13, 2011

As other people have stated, everything requires an order. In my hospital, the standard admission order set includes an order for oxgen, if needed.

For example though, if my patient c/o chest pain, while I'm waiting for the doc to call back, our protocol states I can go ahead and order a stat 12 lead & give morphine. Rapid response protocol grants us similar liberties.

And the powers that be have allowed RNs to order a few items (carmex, plain eye drops, saline nasal spray, moisture throat spray) on our own, independent of a LIP.

GreyGull · Mar 13, 2011

In my LTC, we would never get an order for O2. The Doc trusts our judgment. We would give the O2 based on vitals and tell the Doc after. Even when I worked on a med floor, it was the same for O2. We just gave it if the pt needed it and told the Doc after.

That's great depending on how long before you told the doctor and as long as there is not something seriously wrong or CMS audits your documentation and charges. The physician will trust you only until there is an adverse event. Once that happens you might be disappointed in how that trust is tossed out the window as you have to defend yourself.

If O2 is applied, something has changed in the patient's condition which might require further intervention. O2 is also sometimes uses as a quick solution to get through a shift rather than give more time consuming attention to what needs addressing. For example, it is easier to put O2 back on a post op patient than it is to spend 15 minutes coughing, deep breathing and teaching a patient how to use the incentive spirometry. However, even the problems by prolonged O2 use may eventually have to be addressed. It is also easier to put O2 on than to assess I/Os and lung sounds for a bigger problem. Nonverbal or noncommunicative patients sometimes do not get their respiratory problems addressed until they develop into something more serious and can not be fixed as easily as putting on O2 or you have to get address why you are giving tylenol for a climbing tempature. On med-surg there have been patients who have developed a need for O2 but it was never relayed to the physician who is making discharge plans that does not include O2. An order is a way of telling a physician you have done an intervention on his/her patient and you can document as such. If the patient ends up in the ICU later and it is found that the PCP didn't follow up, you did your part for the initiation of treatment, notification and documentation.

This is not to say you can not follow standing orders for initiating O2, working a code or following a Rapid Response protocol. However, you must also treat O2 as you would for any other med with thorough documentation and realize there might be more to it than just fixing an SpO2 number. It is embarrassing for a med-surg RN to be put on the spot by a bunch of MDs, RNs and RRTs from the ICU who have responded to a code or Rapid Response and have absolutely no clue why or when the patient was put on oxygen and what follow up was done when the SpO2 dropped initially.

joanna73, BSN, RN · Mar 13, 2011

Well as I said in my post, the doctor IS notified, and we aren't just putting people on oxygen for no reason. No one is going to wait until the patient crashes. Also, in some LTC's, you do have a little more autonomy. And my last med surg floor was extremely busy. Of course, the nurses would notify the MD with a rationale and document everything. However, in the places I have worked, very rarely have I actually seen a written order from the doctor for O2, even though, yes, it is a drug, and should be treated as such.