Blanket Orders

O. K. My very small, teeny-tiny ruraly hospital doesn't have a cath lab. But like other hospitals, we have same day surgery, fresh post-ops, etc.

Simply put, the physician is supposed to re-write the orders following the procedure. Does it happen all the time?? No. Does the nurse end up taking a "verbal order" and re-write all meds, diet, etc?? Sometimes, but they're not supposed to. Does it happen anyway?? Yep.

Clear as mud?

One thing that the "powers that be" (in our really, really small, teeny-tiny hospital) do not like to see is:

Continuous Previous Order

Anyone else???

On our standard post op orders it states to continue previous orders. We do not rewrite the previous orders as written before we just continue what was already written. Pharmacy continues all meds ordered before procedure, continuous labs remain ongoing. The previous diet is changed back from NPO status. We have also started doing this with transfers to different floors. If they are moving from a non-monitored bed we just get an order to continue previous orders and meds. We do not transcribe all the medications, activity, diets etc over. The only time we get orders rewritten is from transfer from Unit to floor but thats obvious. So far it seems to work out well. I have noticed where meds were not written exactly the same when transcribed for the second time, easily to correct if caught in time.

We are no longer allowed to use the line "continue previous meds". JCAHO? I am not sure, the solution is for all patients who have invasive procedures a re-order med sheet is printed for MD review and signature. (only exception is invasive radiology ie pic line, angio,graft declot etc). Saves lots of time and errors basically this sheet is a slimed down copy of the computer generated MAR.

We don't re-write orders, either. If it says continue previous orders, we just go on as before. The orders are already written, why re-write them? Our Post cath orders override the previous orders, though. It's a pre-printed order sheet. Sometimes they will write to continue previous meds, or they will write them out. We do, occasionally have a problem with "continue home meds" written on admission. That is a no-no.